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Obstetrics and Gynecology Clinics of... Sep 2022Most of our knowledge pertaining to this obstetric emergency has emanated from case reports and retrospective studies that have subsequently resulted in empirical... (Review)
Review
Most of our knowledge pertaining to this obstetric emergency has emanated from case reports and retrospective studies that have subsequently resulted in empirical management protocols. This article has identified the existence of large gaps in our clinical knowledge base regarding the prevention and resolution of shoulder dystocia, as well as its long-term sequelae. We have attempted to challenge current recommendations regarding whether prophylactic cesarean delivery should be performed based on estimated fetal weight alone or a prior history of shoulder dystocia, shoulder dystocia management techniques, what defines "excessive" traction, and the role of simulation training for all clinicians.
Topics: Delivery, Obstetric; Dystocia; Female; Humans; Pregnancy; Retrospective Studies; Shoulder; Shoulder Dystocia
PubMed: 36122981
DOI: 10.1016/j.ogc.2022.02.005 -
The Veterinary Clinics of North... Sep 2023Veterinary care of breeding dogs begins before a breeding takes place, during prebreeding consultations, through matings, gestation, and delivery of newborns. (Review)
Review
Veterinary care of breeding dogs begins before a breeding takes place, during prebreeding consultations, through matings, gestation, and delivery of newborns.
Topics: Pregnancy; Female; Animals; Dogs; Dystocia; Reproduction; Dog Diseases
PubMed: 37414692
DOI: 10.1016/j.cvsm.2023.05.004 -
Journal of Perinatal Medicine May 2022
Topics: Decapitation; Delivery, Obstetric; Dystocia; Female; Humans; Pregnancy; Shoulder; Shoulder Dystocia; Vacuum Extraction, Obstetrical
PubMed: 34904426
DOI: 10.1515/jpm-2021-0638 -
MCN. the American Journal of Maternal... 2020
Topics: Adult; Dystocia; Female; Humans; Oxytocics; Oxytocin; Pregnancy
PubMed: 33074919
DOI: 10.1097/NMC.0000000000000659 -
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 -
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 -
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 -
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 -
South Dakota Medicine : the Journal of... Apr 2023Postpartum hemorrhage (PPH) continues to be one of the leading causes of maternal morbidity and mortality worldwide. The four main causes of PPH are uterine atony,... (Review)
Review
Postpartum hemorrhage (PPH) continues to be one of the leading causes of maternal morbidity and mortality worldwide. The four main causes of PPH are uterine atony, lacerations, retained placenta, and bleeding diathesis. In the patient with PPH, immediate evaluation is needed to diagnose and treat the underlying cause of hemorrhage. Uterotonic agents such as oxytocin remain first line for prevention and treatment of uterine atony. Studies have evaluated the antifibrinolytic tranexamic acid (TXA) as an adjunctive therapy in the prevention and treatment of PPH. TXA has been shown to reduce blood loss, bleeding-associated mortality, and transfusion rates in a variety of clinical settings and thus may serve a role in treating PPH. Current studies have demonstrated that TXA is an effective treatment option with limited risk of adverse events in appropriately selected patients; however, additional studies are needed to further clarify the role of TXA in the prevention of PPH.
Topics: Pregnancy; Female; Humans; Postpartum Hemorrhage; Tranexamic Acid; Uterine Inertia; Oxytocin; Antifibrinolytic Agents
PubMed: 37566674
DOI: No ID Found -
Obstetrics and Gynecology Oct 2020To analyze the origins and consequences of cases of brachial plexus injuries and their relationship to shoulder dystocia.
OBJECTIVE
To analyze the origins and consequences of cases of brachial plexus injuries and their relationship to shoulder dystocia.
METHODS
We conducted a retrospective cohort study and identified all neonates with brachial plexus injury delivered at our institution between March 2012 and July 2019. A review was performed of the maternal and neonatal records of each neonate to identify obstetric antecedents, including the occurrence of shoulder dystocia and persistence of the injury. Experience of the delivering clinician was also examined. Statistical analysis was performed with the Fisher exact test, χ test for trends, and two-tailed t tests.
RESULTS
Thirty-three cases of brachial plexus injury were identified in 41,525 deliveries (0.08%). Fourteen (42%) of these cases were not associated with shoulder dystocia; three (9%) followed cesarean delivery. Brachial plexus injury without shoulder dystocia was related to the absence of maternal diabetes, lower birth weights, and a longer second stage of labor. Persistent brachial plexus injury at the time of discharge was seen with equal frequency among neonates with (17/19, 89%, 95% CI 0.52-100%) and without shoulder dystocia (10/14, 71%, 95% CI 34-100%), P=.36). Whether brachial plexus injury was transient or persistent after shoulder dystocia was unrelated to the years of experience of the delivering clinician. Despite ongoing training and simulation, the already low incidence of brachial plexus injury did not decrease over time at our institution.
CONCLUSION
Brachial plexus injury and shoulder dystocia represent two complications of uterine forces driving a fetus through the maternal pelvis in the presence of disproportion between the passage and the shoulder girdle of the passenger. Either or both of these complications may occur, but often are not causally related.
Topics: Adult; Causality; Cesarean Section; Delivery, Obstetric; Electronic Health Records; Female; Humans; Infant, Newborn; Male; Neonatal Brachial Plexus Palsy; Pregnancy; Pregnancy Outcome; Retrospective Studies; Risk Assessment; Risk Factors; Shoulder Dystocia; Texas
PubMed: 32925630
DOI: 10.1097/AOG.0000000000004013