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Ugeskrift For Laeger Jun 2024Shoulder dystocia is a serious obstetric complication, where one or both shoulders of a child are trapped after the head is born during vaginal delivery. The situation...
Shoulder dystocia is a serious obstetric complication, where one or both shoulders of a child are trapped after the head is born during vaginal delivery. The situation is life-threatening for the child and requires quick management with obstetric manoeuveres for delivering the shoulders. Rarely, the abdominal approach called Zavanelli manoeuvre is used to achieve delivery after a replacement of the head back in the birth canal, prior to acute caesarean section. This is a case report of a 26-year-old woman with severe shoulder dystocia, failed Zavanelli manoeuvre and vaginal delivery of a lifeless child.
Topics: Humans; Female; Pregnancy; Adult; Stillbirth; Delivery, Obstetric; Shoulder Dystocia; Infant, Newborn
PubMed: 38904285
DOI: 10.61409/V02240095 -
Obstetrics and Gynecology Clinics of... Jun 2017Shoulder dystocia and postpartum hemorrhage represent two of the most common emergencies faced in obstetric clinical practice, both requiring prompt recognition and... (Review)
Review
Shoulder dystocia and postpartum hemorrhage represent two of the most common emergencies faced in obstetric clinical practice, both requiring prompt recognition and management to avoid significant morbidity or mortality. Shoulder dystocia is an uncommon, unpredictable, and unpreventable obstetric emergency and can be managed with appropriate intervention. Postpartum hemorrhage occurs more commonly and carries significant risk of maternal morbidity. Institutional protocols and algorithms for the prevention and management of shoulder dystocia and postpartum hemorrhage have become mainstays for clinicians. The goal of this review is to summarize the diagnosis, incidence, risk factors, and management of shoulder dystocia and postpartum hemorrhage.
Topics: Birth Injuries; Delivery, Obstetric; Dystocia; Emergencies; Female; Humans; Postpartum Hemorrhage; Pregnancy; Risk Factors; Shoulder
PubMed: 28499533
DOI: 10.1016/j.ogc.2017.02.003 -
Theriogenology Oct 2020In captive rhinoceros stillbirth and perinatal death are recorded at a rate of 6-17% in the various species. At the same time there is a substantial lack of knowledge on...
In captive rhinoceros stillbirth and perinatal death are recorded at a rate of 6-17% in the various species. At the same time there is a substantial lack of knowledge on rhinoceros parturition. Yet, predicting parameters for birth and progress of parturition are fundamental for the recognition of dystocia and perinatal problems. Therefore, we here intended to pay close attention to the Achilles heel of the 1.5-2.5 year reproduction cycle in rhinoceros, the parturition. For the prediction of parturition we recorded timelines for pre-birth udder development, genital swelling, milk production, behavioral unrest, and decrease of serum progesterone concentration and the gestational length in 19 white rhinoceros. First, second and third labour stage, foetal presentation and events in perinatal period were recorded to describe normal parturition and establish a guideline for better birth management in rhinoceros. Udder development and genital swelling were observed 3 and 2 weeks prior birth, respectively. Milk production was observed to start up to 3 weeks prior birth and increased significantly in the last week with most significant increase one day before parturition to 50.6 ± 45.4 mL (p < 0.006). Serum progesterone concentration started to decrease 7 days prior parturition and more significantly 48 h before parturition. While behavioral unrest and first stage labour was not observed reliably in all females the break of foetal waters and thus the start of second stage labour was unmistakably observed. Second stage labour, when foetal membranes had ruptured until the foetus was born, took 1:50 ± 0:20 h:min. Eighty-four percent of fetuses were born in anterior presentation (n = 16/19) and the final expulsion took <25 min suggesting that this is the normal presentation in white rhinoceros. In the less frequent posterior presentation final expulsion took up to 47 min. Overall, 95% of calves were born alive. Calves were standing and nursing in 0:55 ± 0:12 min and 3:32 ± 0:53 h:min, respectively. In 10.5% of births (n = 2/19) in anterior presentation perinatal complications occurred. Stillbirth occurred once (5.3% n = 1/19) when the foetus was born in posterior presentation. The recorded gestational length was 506 ± 2d. Delivering live offspring is of key importance to establish a new generation and secure long-term survival of a species. Various pre-birth changes, significant decrease of serum progesterone 48 h prior birth, different labour stages, foetal presentation and perinatal events described here add substantial knowledge on the understanding of normal rhinoceros parturition and may help diagnose dystocia and perinatal complications.
Topics: Animals; Dystocia; Female; Labor, Obstetric; Parturition; Perissodactyla; Pregnancy; Stillbirth
PubMed: 32755717
DOI: 10.1016/j.theriogenology.2020.06.035 -
Journal of Midwifery & Women's Health 2015Labor dystocia (slow or difficult labor or birth) is the most commonly diagnosed aberration of labor and the most frequently documented indication for primary cesarean... (Review)
Review
INTRODUCTION
Labor dystocia (slow or difficult labor or birth) is the most commonly diagnosed aberration of labor and the most frequently documented indication for primary cesarean birth. Yet, dystocia remains a poorly specified diagnostic category, with determinations often varying widely among clinicians. The primary aims of this review are to 1) summarize definitions of active labor and dystocia, as put forth by leading professional obstetric and midwifery organizations in world regions wherein English is the majority language and 2) describe the use of dystocia and related terms in contemporary research studies.
METHODS
Major national midwifery and obstetric organizations from qualifying United Nations-member sovereign nations and international organizations were searched to identify guidelines providing definitions of active labor and dystocia or related terms. Research studies (2000-2013) were systematically identified via PubMed, MEDLINE, and CINAHL searches to describe the use of dystocia and related terms in contemporary scientific publications.
RESULTS
Only 6 organizational guidelines defined dystocia or related terms. Few research teams (n = 25 publications) defined dystocia-related terms with nonambiguous clinical parameters that can be applied prospectively. There is heterogeneity in the nomenclature used to describe dystocia, and when a similar term is shared between guidelines or research publications, the underlying definition of that term is sometimes inconsistent between documents.
DISCUSSION
Failure to define dystocia in evidence-based, well-described, clinically meaningful terms that are widely acceptable to and reproducible among clinicians and researchers is concerning at both national and global levels. This failure is particularly problematic in light of the major contribution of this diagnosis to primary cesarean birth rates.
Topics: Cesarean Section; Delivery, Obstetric; Dystocia; Female; Humans; Labor, Obstetric; Midwifery; Obstetrics; Practice Guidelines as Topic; Pregnancy; Terminology as Topic; Trial of Labor
PubMed: 26461188
DOI: 10.1111/jmwh.12355 -
American Journal of Obstetrics and... May 2023The active phase of labor begins at various degrees of dilatation when the rate of dilatation transitions from the relatively flat slope of the latent phase to a more... (Review)
Review
The active phase of labor begins at various degrees of dilatation when the rate of dilatation transitions from the relatively flat slope of the latent phase to a more rapid slope. No diagnostic manifestations demarcate its onset, other than accelerating dilatation. It ends with apparent slowing of dilatation, a deceleration phase, which is usually short in duration and frequently undetected. Several aberrant labor patterns can be detected during the active phase, including protracted dilatation, arrest of dilatation, prolonged deceleration phase and failure of descent. Underlying factors may include cephalopelvic disproportion, excessive neuraxial block, poor uterine contractility, fetal malpositions, malpresentations, uterine infection, maternal obesity, advanced maternal age and previous cesarean delivery. When an active-phase disorder is identified, cesarean delivery is justifiable if there is compelling clinical evidence of disproportion. A prolonged deceleration disorder is strongly associated with disproportion and second stage abnormalities. Shoulder dystocia may occur if vaginal delivery eventuates. This review discusses several issues raised by the introduction of new clinical practice guidelines for labor management.
Topics: Pregnancy; Female; Humans; Cesarean Section; Delivery, Obstetric; Cephalopelvic Disproportion; Labor Presentation; Dystocia
PubMed: 36997397
DOI: 10.1016/j.ajog.2021.12.269 -
Clinical Obstetrics and Gynecology Dec 2016Shoulder dystocia complicates ∼1% of vaginal births. Although fetal macrosomia and maternal diabetes are risk factors for shoulder dystocia, for the most part its... (Review)
Review
Shoulder dystocia complicates ∼1% of vaginal births. Although fetal macrosomia and maternal diabetes are risk factors for shoulder dystocia, for the most part its occurrence remains largely unpredictable and unpreventable.
Topics: Birth Injuries; Birth Weight; Delivery, Obstetric; Dystocia; Female; Humans; Incidence; Infant, Newborn; Pregnancy; Recurrence; Risk Factors; Shoulder
PubMed: 27662540
DOI: 10.1097/GRF.0000000000000227 -
Topics in Companion Animal Medicine Dec 2016The objective of the study was to assess clinical alterations, electrocardiographic, hematological, biochemical, hemogasometric, electrolytic, and hormone plasma... (Review)
Review
The objective of the study was to assess clinical alterations, electrocardiographic, hematological, biochemical, hemogasometric, electrolytic, and hormone plasma concentrations in bitches with eutocia and dystocia. Overall, 28 bitches (dystocia, n = 22 and eutocia, n = 6) were assessed. The evaluations were performed at 2 time points, M1 (1 hour prepartum-eutocia group and cesarean or clinical intervention-dystocia group) and M2 (postpartum-eutocia or dystocia group and anesthetic recovery-dystocia group). The main clinical finding was the hypothermia (mean: 36.9°C dystocia vs. 36.8°C eutocia). Sinus arrhythmia and tachycardia were the electrocardiographic parameters predominant in eutocia and sinus rhythm in dystocia group. The P wave amplitude, heart rate, creatinine concentration, hematocrit, and hemoglobin were increased in M1 (P < .05), whereas the concentration of TCO was higher in M2. There was an increase in P concentration in dystocia and total T concentrations were increased in M1 in both groups. Total T was higher in dystocia during M1 and in dystocia during M2 in eutocia than in dystocia. We concluded that at 1 hour prepartum or pre-cesarean, there is an increase in heart rate in bitches with eutocia or dystocia, and this finding was correlated to thyroid hormone concentration. P concentrations remained high during dystocia, and hematological and biochemical changes returned to normal after parturition. The evaluation of these parameters in pregnancy can be used as tool to prevent dystocia and consequent fetal death.
Topics: Animals; Blood Gas Analysis; Body Temperature Regulation; Dog Diseases; Dogs; Dystocia; Electrocardiography; Female; Heart Rate; Hormones; Pregnancy; Uterine Inertia
PubMed: 28317612
DOI: 10.1053/j.tcam.2016.10.003 -
Topics in Companion Animal Medicine Mar 2018Dystocia can be defined broadly as "difficult birth" or more specifically as difficulty in the bitch expelling the pups through the cervix, vagina, and vestibule. It is... (Review)
Review
Dystocia can be defined broadly as "difficult birth" or more specifically as difficulty in the bitch expelling the pups through the cervix, vagina, and vestibule. It is a fairly common emergency presented to the small animal practitioner with an incidence rate of approximately 5%. The incidence of dystocia is highest in toy and brachycephalic breeds, and occurs frequently in small litters (<3 pups) due to fetal oversize and delayed onset of labor. As duration of labor progresses, the mortality of the pups and even the bitch increases, with the highest number of stillborn pups occurring after 6 hours from the time of active parturition. Practitioners should understand the mechanism of normal parturition so that abnormalities can be readily identified and medical or surgical intervention performed in a safe and timely manner.
Topics: Animals; Cesarean Section; Dog Diseases; Dogs; Dystocia; Female; Pregnancy
PubMed: 29793723
DOI: 10.1053/j.tcam.2018.03.003 -
Reproduction (Cambridge, England) Jan 2021Intermittent myometrial hypoxia is a normal feature of labour, as the powerful contractions compress blood vessels. In this review, we focus on the relation between... (Review)
Review
Intermittent myometrial hypoxia is a normal feature of labour, as the powerful contractions compress blood vessels. In this review, we focus on the relation between hypoxia, myometrial metabolism, and contractility. We dissect how hypoxia can feedback and limit an ongoing contraction and help prevent foetal distress. The mechanisms involve acidification from lactate, decreased excitability, and a fall of intracellular calcium concentration. As this cycle of contraction and relaxation repeats in labour, the hypoxia also engenders mechanisms that increase force; hypoxia-induced force increase, HIFI. We also discuss the role of the myometrial blood vessels in dysfunctional labour, which is associated with lactic acidosis. In synthesising these studies, we have attempted to unify findings by considering the importance of experimental protocols and finding direct mechanistic evidence from human myometrium or in vivo studies. We have made suggestions for future studies to fill the holes in our understanding and speed up the translation of our knowledge to improve births for mothers and babies everywhere.
Topics: Dystocia; Female; Humans; Hypoxia; Labor, Obstetric; Myometrium; Pregnancy; Reproductive Health; Uterine Contraction; Uterus
PubMed: 33112773
DOI: 10.1530/REP-20-0327 -
European Journal of Obstetrics,... Nov 2014The objective of the review is to critically review the diagnosis and management of dystocia in the first stage of labour. We conducted a narrative review of research... (Review)
Review
The objective of the review is to critically review the diagnosis and management of dystocia in the first stage of labour. We conducted a narrative review of research since 1998. Eight studies were identified, four about the onset and duration of active phase of the first stage of labour, one on the diagnosis of dystocia, and three focused on the treatment of dystocia. The review demonstrates that current understandings of dystocia rest on outdated definitions of active first stage of labour, its progress and on treatments with an equivocal evidence base. These include the cervical dilatation threshold for active first stage, uncertainty over whether a reduced rate of dilatation and reduced strength of uterine contractions always represent pathology and the effectiveness of amniotomy/oxytocin for treating dystocia. Prospective studies should evaluate the impact of defining the active phase of the first stage of labour as commencing at 6 cm dilated and should test this definition in combination with Zhang's revised partogram.
Topics: Dystocia; Female; Humans; Labor Stage, First; Pregnancy
PubMed: 25268780
DOI: 10.1016/j.ejogrb.2014.09.011