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American Journal of Obstetrics and... Mar 2024This tutorial of the intrapartum management of shoulder dystocia uses drawings and videos of simulated and actual deliveries to illustrate the biomechanical principles... (Review)
Review
This tutorial of the intrapartum management of shoulder dystocia uses drawings and videos of simulated and actual deliveries to illustrate the biomechanical principles of specialized delivery maneuvers and examine missteps associated with brachial plexus injury. It is intended to complement haptic, mannequin-based simulation training. Demonstrative explication of each maneuver is accompanied by specific examples of what not to do. Positive (prescriptive) instruction prioritizes early use of direct fetal manipulation and stresses the importance of determining the alignment of the fetal shoulders by direct palpation, and that the biacromial width should be manually adjusted to an oblique orientation within the pelvis-before application of traction to the fetal head, the biacromial width is manually adjusted to an oblique orientation within the pelvis. Negative (proscriptive) instructions includes the following: to avoid more than usual and/or laterally directed traction, to use episiotomy only as a means to gain access to the posterior shoulder and arm, and to use a 2-step procedure in which a 60-second hands-off period ("do not do anything") is inserted between the emergence of the head and any initial attempts at downward traction to allow for spontaneous rotation of the fetal shoulders. The tutorial presents a stepwise approach focused on the delivering clinician's tasks while including the role of assistive techniques, including McRoberts, Gaskin, and Sims positioning, suprapubic pressure, and episiotomy. Video footage of actual deliveries involving shoulder dystocia and permanent brachial plexus injury demonstrates ambiguities in making the diagnosis of shoulder dystocia, risks of improper traction and torsion of the head, and overreliance on repeating maneuvers that prove initially unsuccessful.
Topics: Pregnancy; Female; Humans; Dystocia; Shoulder Dystocia; Shoulder; Episiotomy; Prenatal Care; Delivery, Obstetric
PubMed: 38462247
DOI: 10.1016/j.ajog.2022.03.016 -
Tierarztliche Praxis. Ausgabe G,... Oct 2019
Topics: Animals; Dystocia; Female; Pregnancy
PubMed: 31634944
DOI: 10.1055/a-1004-9774 -
Journal of Midwifery & Women's Health May 2020Labor dystocia is the most common cause of cesarean birth in the United States, yet how dystocia develops during labor remains elusive. Uterine activity monitoring has... (Review)
Review
INTRODUCTION
Labor dystocia is the most common cause of cesarean birth in the United States, yet how dystocia develops during labor remains elusive. Uterine activity monitoring has significant potential for advancing our understanding of labor dystocia. While evaluating contraction frequency and amplitude is a common component of labor dystocia management, the literature describing the relationship between measures of uterine activity and labor dystocia is heterogeneous and has not been synthesized to identify the best methods for use in clinical investigation.
METHODS
We conducted a literature search for original research exploring the relationship between uterine activity and labor dystocia published between 2000 and 2019. Included articles were critically reviewed and synthesized.
RESULTS
Across 11 identified studies, investigators employed 3 different techniques for monitoring uterine activity and 9 different measures were employed. Uterine activity measures, including Montevideo units, uterine electromyography power density spectrum and sample entropy, and the fall-to-rise ratio of contraction shape, detected patterns associated with labor dystocia or cesarean birth.
DISCUSSION
The use of multiple regression with clinical covariates and a uterine activity measure increased the accuracy of predicting cesarean delivery. Uterine electromyography may be especially useful to evaluate labor dystocia phenotypes to differentiate uterine muscle fatigue from understimulation and lead to algorithms for increased precision in the diagnosis of labor dystocia and innovative approaches to treatment.
Topics: Adult; Cesarean Section; Dystocia; Electromyography; Female; Humans; Labor, Obstetric; Obstetric Labor Complications; Pregnancy; Uterus
PubMed: 32478978
DOI: 10.1111/jmwh.13119 -
Obstetrical & Gynecological Survey May 2015Shoulder dystocia is an obstetric emergency with potential catastrophic outcomes. (Review)
Review
IMPORTANCE
Shoulder dystocia is an obstetric emergency with potential catastrophic outcomes.
OBJECTIVE
To perform a systematic literature review examining the effectiveness of episiotomy in the prevention and management of shoulder dystocia during vaginal birth.
EVIDENCE ACQUISITION
Search was conducted by a research librarian in MEDLINE, Web of Science, Cochrane Library, and SCOPUS databases using the terms "episiotomy" and "shoulder dystocia," with no language or time restrictions. Two investigators independently selected original researches examining the effects of episiotomy on shoulder dystocia and its neonatal andmaternal outcomes. Relevant articles were accessed in full text, including manual search of the references. We contacted authors of studies with insufficient or unclear data. Because of clinical and methodological diversity of the studies, meta-analysis was not performed.
RESULTS
Fourteen articles met the inclusion criteria, encompassing a total of 9769 shoulder dystocia cases. Only 1 study effectively evaluated the role of episiotomy in shoulder dystocia prevention, yielding a nonsignificant result. Three articles assessed neonatal consequences of shoulder dystocia, one of them linking episiotomy to higher risk of neonatal injury. Two of the 3 studies evaluating maternal outcomes showed that episiotomy is related to increased risk of advanced perineal tears. Overall quality of evidence was rated as very low.
CONCLUSIONS AND RELEVANCE
Our systematic review found no evidence supporting the use of episiotomy in the prevention and management of shoulder dystocia. This observation carries major clinical and legal implications for the obstetricians. Higher-quality studies are needed to evaluate this important issue.
Topics: Dystocia; Episiotomy; Female; Humans; Infant, Newborn; Pregnancy; Shoulder
PubMed: 25974732
DOI: 10.1097/OGX.0000000000000179 -
Ginekologia Polska 2022The aim of the study was to compare the perinatal outcome between the normal weight, overweight and obese pregnant women who delivered in the third-level center of...
OBJECTIVES
The aim of the study was to compare the perinatal outcome between the normal weight, overweight and obese pregnant women who delivered in the third-level center of reference. Moreover, the objective was to analyze the usefulness of predelivery body mass index (BMI) in prediction of preterm delivery, prolonged second stage of labor, instrumental vaginal delivery, cesarean section, fetal macrosomia, dystocia and newborn acidosis.
MATERIAL AND METHODS
The retrospective study included 2104 patients, divided into three groups, with BMI between 18.5 and 24.9; 25.0 and 29.9; higher than or equal 30.0 kg/m2, respectively. The data were assessed from the medical history.
RESULTS
The predelivery obesity increases the risk of cesarean section (aOR 1.63), macrosomia (aOR 8.89) and dystocia (aOR 3.40) in comparison to normal weight women. Moreover, the obese females had three times greater risk of having a macrosomic child (aOR 3.57) and 1.5 times greater risk of cesarean section (aOR 1.52) than overweight group. The role of predelivery BMI in the prediction of cesarean delivery (AUC 0.550; sensitivity 0.39; specificity 0.71, p < 0.001, cut-off value 28.7 kg/m2), macrosomia (AUC 0.714; sensitivity 0.66; specificity 0.70; p < 0.001, cut-off value 29.0 kg/m2) and dystocia (AUC 0.658; sensitivity 0.77; specificity 0.53, p < 0.001, cut-off value 27.0 kg/m2) was significant.
CONCLUSIONS
The predelivery obesity increases the risk of cesarean section, macrosomia and shoulder dystocia and is a useful parameter in the prediction of perinatal outcomes. The establishing cut-off value for predelivery BMI was the lowest in prediction of shoulder dystocia.
Topics: Infant, Newborn; Child; Pregnancy; Female; Humans; Fetal Macrosomia; Cesarean Section; Body Mass Index; Overweight; Retrospective Studies; Shoulder Dystocia; Obesity; Weight Gain; Dystocia; Labor, Obstetric
PubMed: 35325456
DOI: 10.5603/GP.a2022.0005 -
Clinical Obstetrics and Gynecology Dec 2016Shoulder dystocia is an obstetrical emergency that may result in significant neonatal complications. It requires rapid recognition and a coordinated response.... (Review)
Review
Shoulder dystocia is an obstetrical emergency that may result in significant neonatal complications. It requires rapid recognition and a coordinated response. Standardization of care, teamwork and communication, and clinical simulation are the key components of patient safety programs in obstetrics. Simulation-based team training and institutional protocols for the management of shoulder dystocia are emerging as integral components of many labor and delivery safety initiatives because of their impact on technical skills and team performance.
Topics: Delivery, Obstetric; Dystocia; Emergencies; Female; Humans; Infant, Newborn; Inservice Training; Obstetrics; Patient Care Team; Patient Safety; Pregnancy; Shoulder; Simulation Training
PubMed: 27741211
DOI: 10.1097/GRF.0000000000000231 -
Revista Brasileira de Ginecologia E... Jul 2022
Topics: Delivery, Obstetric; Dystocia; Female; Humans; Pregnancy; Shoulder Dystocia
PubMed: 35940174
DOI: 10.1055/s-0042-1755446 -
NeoReviews Sep 2022
Topics: Birth Injuries; Delivery, Obstetric; Dystocia; Female; Humans; Infant, Newborn; Pregnancy; Shoulder Dystocia
PubMed: 36047758
DOI: 10.1542/neo.23-9-e645 -
Turkish Journal of Medical Sciences Aug 2021This study aimed to evaluate the relationship between second- and third-trimester clavicle lengths and birth weight and shoulder dystocia. (Observational Study)
Observational Study
BACKGROUND/AIM
This study aimed to evaluate the relationship between second- and third-trimester clavicle lengths and birth weight and shoulder dystocia.
MATERIALS AND METHODS
This prospective observational study included 181 patients who presented to the Private Etlik Lokman Hekim Hospital for routine pregnancy visits between March 2019 and March 2020. In addition to routine pregnancy examinations, the patients also underwent ultrasonography twice at weeks 20–23 and 33–36 to determine the length of the fetal clavicle. The patients were evaluated for shoulder dystocia in the second stage of labor. The birth weight of the neonates was recorded. The primary objective of this study was to establish the relationship between third-trimester clavicle length and shoulder dystocia.
RESULTS
Fetal clavicle length increases in the second trimester with the advancing gestational week but does not significantly change in the third trimester. We did not observe any significant difference for second trimester clavicle length between the type of delivery, birth weight, or shoulder dystocia. Moreover, we did not observe any significant difference for third trimester clavicle length between types of delivery. However, we found a significant relationship between third trimester clavicle length and birth weight and shoulder dystocia. The median third-trimester clavicle length was 39.5 mm (range: 30.7–43.9) in neonates who did not develop shoulder dystocia and 42.5 mm (range: 41.4–43.1) in the 3 neonates who developed shoulder dystocia. The third-trimester clavicle length cut-off for shoulder dystocia was calculated as 41.35 mm (sensitivity: 100.00%, specificity: 83.82%, accuracy: 84.5%). The third-trimester clavicle length cut-off for macrosomia (defined as birth weight of ≥4100 g) was 40.75 mm (sensitivity: 87.50%, specificity: 77.56%, accuracy: 78.05%).
CONCLUSION
Third-trimester fetal clavicle length, an important component of biacromial diameter, as measured by ultrasonography, is a practical and significant method for predicting macrosomia and shoulder dystocia.
Topics: Adult; Birth Weight; Clavicle; Dystocia; Female; Fetal Macrosomia; Humans; Infant, Newborn; Male; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Risk Factors; Shoulder Dystocia
PubMed: 33843172
DOI: 10.3906/sag-2011-145 -
Best Practice & Research. Clinical... Apr 2019Forceps are a commonly used instrument for assisting vaginal birth. Accepted indications include prolonged labour, suspected foetal distress and maternal medical... (Review)
Review
Forceps are a commonly used instrument for assisting vaginal birth. Accepted indications include prolonged labour, suspected foetal distress and maternal medical conditions that benefit from a shortened second stage of labour. Maternal and offspring outcomes of forceps-assisted birth have been extensively reported in observational studies, but randomised trial evidence is limited. Forceps-assisted delivery has a lower failure rate than vacuum-assisted delivery but is associated with a higher incidence of maternal pelvic floor trauma. Second-stage caesarean section is associated with less foetal-neonatal trauma than forceps-assisted delivery but markedly reduces the chance of a subsequent vaginal birth. This review outlines the existing evidence on prevention, indications and contraindications for forceps-assisted birth (non-rotational and rotational), short- and long-term complications for mother and baby, alternatives to use of forceps and how to manage an abandoned forceps-assisted birth. The essential components of informed consent are also discussed.
Topics: Contraindications, Procedure; Dystocia; Episiotomy; Extraction, Obstetrical; Female; Humans; Infant, Newborn; Labor Stage, Second; Obstetrical Forceps; Perineum; Postpartum Hemorrhage; Pregnancy; Urinary Incontinence; Version, Fetal; Wounds and Injuries
PubMed: 30827815
DOI: 10.1016/j.bpobgyn.2019.02.002