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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 The review demonstrates that current understandings of dystocia rest on outdated definitions of active first stage of labour, its progress and on treatments with an equivocal evidence base.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 -
Zentralblatt Fur Gynakologie Jul 2001Shoulder dystocia is defined as a standstill of delivery after the birth of the head and is attributed to an insufficient rotation of the shoulder. Risk factors include... (Review)
Review
UNLABELLED
Shoulder dystocia is defined as a standstill of delivery after the birth of the head and is attributed to an insufficient rotation of the shoulder. Risk factors include a history of prior macrosomia or shoulder dystocia, maternal obesity or excessive weight gain during pregnancy, maternal diabetes or postdate pregnancy and prolonged descent or midpelvic operative delivery. Neonatal morbidities associated with traumatic birth include fetal hypoxia with acidosis and permanent brachial plexus injury.
THERAPY
After the recognition of a shoulder dystocia a series of steps should be undertaken beginning with cutting or extending the episiotomy, McRobert's Manoeuvre, Wood's Manoeuvre and delivery of posterior arm. A tocolytic administered as a bolus or general anesthesia also may be needed. Documentation should include the exact time the dystocia was recognized by the midwife and/or obstetrician, the time at which intervention was started and a detailed operative report.
Topics: Dystocia; Female; Fetal Macrosomia; Humans; Infant, Newborn; Infant, Newborn, Diseases; Morbidity; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Risk Factors; Shoulder; Weight Gain
PubMed: 11534296
DOI: 10.1055/s-2001-16859 -
Acta Medica Portuguesa 2011Shoulder dystocia is one of the most feared obstetric emergencies due to related maternal and neonatal complications and therefore, the growing of medico-legal... (Review)
Review
Shoulder dystocia is one of the most feared obstetric emergencies due to related maternal and neonatal complications and therefore, the growing of medico-legal litigation that it entails. Although associated with risk factors such as fetal macrossomia, gestacional diabetes and instrumented delivery, the majority of cases are unpredictable. The lack of a consensus on shoulder dystocia diagnosis causes variations on its incidence and hampers a more comprehensive analysis. Management guidelines described for its resolution include several manoeuvres but the ideal sequence of procedures is not clearly defined in more severe cases. Hands-on and team training, through simulation-based techniques applied to medicine, seems to be a promising method to learn how to deal with shoulder dystocia having in mind a reduction in related maternal or neonatal morbidity and mortality. The main goal of this paper is to provide a comprehensive revision of shoulder dystocia highlighting its relevance as an obstetric emergency. A reflection on the management is presented emphasising the importance of simulation-based training.
Topics: Delivery, Obstetric; Dystocia; Emergency Treatment; Female; Humans; Labor Presentation; Pregnancy; Shoulder
PubMed: 22521019
DOI: No ID Found -
Reproduction in Domestic Animals =... Jun 2009The paper reviews the various factors affecting dystocia in cattle. It is based mainly on the recent studies found in the literature of the subject but refers... (Review)
Review
The paper reviews the various factors affecting dystocia in cattle. It is based mainly on the recent studies found in the literature of the subject but refers occasionally to some older papers as well. The factors are grouped into four main categories: direct factors, phenotypic factors related to calf and cow, non-genetic and genetic factors. The first group includes malpresentations and uterine torsion. The second one includes: calf birth weight, multiple calvings, perinatal mortality, cow pelvic area, cow body weight and body condition at calving, gestation length. The non-genetic factors are: cow age and parity, year and season of calving, place of calving, maintenance practises, disorders, calf sex and nutrition. Other non-genetic factors are the level of hormones in the periparturient period, in vitro production of embryos and embryo cloning. Finally, the genotypes of cow, bull and calf, inbreeding, muscular hypertrophy, selection and quantitative trait loci form the fourth group of genetic factors.
Topics: Animals; Birth Weight; Body Composition; Body Weight; Cattle; Cattle Diseases; Dystocia; Female; Gestational Age; Labor Presentation; Male; Parity; Perinatal Mortality; Phenotype; Pregnancy; Reproductive Techniques; Torsion Abnormality; Uterine Diseases
PubMed: 19055561
DOI: 10.1111/j.1439-0531.2008.01123.x -
Obstetrics and Gynecology Oct 2022The Yaari Extractor is intended to wrap around and guide the fetal shoulder to facilitate vaginal delivery in cases of shoulder dystocia.
BACKGROUND
The Yaari Extractor is intended to wrap around and guide the fetal shoulder to facilitate vaginal delivery in cases of shoulder dystocia.
INSTRUMENT
The Yaari Extractor is a single-use device for fetal shoulder extraction. The device consists of two curved, rigid plastic-coated metal arms with handles and an elastic engagement element that includes two hollow sleeves that cover the portion of the device that enters the vagina and contacts the fetus.
EXPERIENCE
The device has been used in three cases of shoulder dystocia. In all three cases, the shoulder dystocia was resolved without the need for ancillary obstetric maneuvers, and there was no reported maternal or fetal injury.
CONCLUSION
The Yaari Extractor is a novel technology that can be used to successfully resolve shoulder dystocia.
Topics: Pregnancy; Female; Humans; Shoulder Dystocia; Dystocia; Delivery, Obstetric; Shoulder; Prenatal Care
PubMed: 36356249
DOI: 10.1097/AOG.0000000000004935 -
Journal of Obstetrics and Gynaecology :... May 2008
Topics: Birth Injuries; Brachial Plexus; Delivery, Obstetric; Dystocia; Female; Humans; Pregnancy; Shoulder
PubMed: 18604665
DOI: 10.1080/01443610802141068 -
The Journal of Small Animal Practice Feb 1974
Review
Topics: Anesthesia, Epidural; Anesthesia, Inhalation; Animals; Animals, Newborn; Cesarean Section; Delivery, Obstetric; Dog Diseases; Dogs; Dystocia; Episiotomy; Extraembryonic Membranes; Female; Hysterectomy; Labor Presentation; Labor, Obstetric; Oxytocin; Pregnancy; Uterine Inertia; Uterine Rupture
PubMed: 4615208
DOI: 10.1111/j.1748-5827.1974.tb05667.x -
Seminars in Perinatology Jun 2007Among risk factors for shoulder dystocia, a prior history of delivery complicated by shoulder dystocia is the single greatest risk factor for shoulder dystocia... (Review)
Review
Among risk factors for shoulder dystocia, a prior history of delivery complicated by shoulder dystocia is the single greatest risk factor for shoulder dystocia occurrence, with odds ratios 7 to 10 times that of the general population. Recurrence rates have been reported to be as high as 16%. Whereas prevention of shoulder dystocia in the general population is neither feasible nor cost-effective, intervention efforts directed at the particular subgroup of women with a prior history of shoulder dystocia can concentrate on potentially modifiable risk factors and individualized management strategies that can minimize recurrence and the associated significant morbidities and mortality.
Topics: Delivery, Obstetric; Dystocia; Female; Humans; Pregnancy; Prenatal Care; Recurrence; Risk Factors; Shoulder Injuries
PubMed: 17531900
DOI: 10.1053/j.semperi.2007.03.009 -
The Veterinary Record Jan 2021
Topics: Animals; Cattle; Cattle Diseases; Dystocia; Female; Pregnancy
PubMed: 34651846
DOI: 10.1002/vetr.101 -
Obstetrics and Gynecology Jan 2024The purpose of this document is to define labor and labor arrest and provide recommendations for the management of dystocia in the first and second stage of labor and...
PURPOSE
The purpose of this document is to define labor and labor arrest and provide recommendations for the management of dystocia in the first and second stage of labor and labor arrest.
TARGET POPULATION
Pregnant individuals in the first or second stage of labor.
METHODS
This guideline was developed using an a priori protocol in conjunction with a writing team consisting of one maternal-fetal medicine subspecialist appointed by the ACOG Committee on Clinical Practice Guidelines-Obstetrics and two external subject matter experts. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements.
RECOMMENDATIONS
This Clinical Practice Guideline includes definitions of labor and labor arrest, along with recommendations for the management of dystocia in the first and second stages of labor and labor arrest. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.
Topics: Female; Humans; Pregnancy; Dystocia; Labor Stage, Second; Obstetrics; Perinatology
PubMed: 38096556
DOI: 10.1097/AOG.0000000000005447