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American Family Physician Apr 2004Shoulder dystocia can be one of the most frightening emergencies in the delivery room. Although many factors have been associated with shoulder dystocia, most cases...
Shoulder dystocia can be one of the most frightening emergencies in the delivery room. Although many factors have been associated with shoulder dystocia, most cases occur with no warning. Calm and effective management of this emergency is possible with recognition of the impaction and institution of specified maneuvers, such as the McRoberts maneuver, suprapubic pressure, internal rotation, or removal of the posterior arm, to relieve the impacted shoulder and allow for spontaneous delivery of the infant. The "HELPERR" mnemonic from the Advanced Life Support in Obstetrics course can be a useful tool for addressing this emergency. Although no ideal manipulation or treatment exists, all maneuvers in the HELPERR mnemonic aid physicians in completing one of three actions: enlarging the maternal pelvis through cephalad rotation of the symphysis and flattening of the sacrum; collapsing the fetal shoulder width; or altering the orientation of the longitudinal axis of the fetus to the plane of the obstruction. In rare cases in which these interventions are unsuccessful, additional management options, such as intentional clavicle fracture, symphysiotomy, and the Zavanelli maneuver, are described.
Topics: Birth Weight; Dystocia; Female; Humans; Infant, Newborn; Life Support Care; Pregnancy; Risk Factors; Shoulder Injuries
PubMed: 15086043
DOI: No ID Found -
European Journal of Obstetrics,... Nov 2021The Zavanelli manoeuvre is often the final resort of the clinician facing undeliverable shoulder dystocia and we present retrospective pooled data comprising 110... (Review)
Review
The Zavanelli manoeuvre is often the final resort of the clinician facing undeliverable shoulder dystocia and we present retrospective pooled data comprising 110 shoulder dystocia cases, 11 impacted breech and 11 locked twin deliveries assessed from ten case series and 38 individual case reports. Although recommended when other external and internal manipulations have failed, we suspect that many clinicians have not had formal training on how to conduct the manoeuvre and may be unfamiliar with the steps involved, leading to a reluctance and delay in initiating this. We describe original descriptions of the manoeuvre, examine its use in intractable shoulder dystocia and illustrate stepwise the cephalic replacement technique. For this review, we have concentrated mainly on the outcomes of the Zavanelli manoeuvre in shoulder dystocia but have also touched on its role in impacted breech and locked twin deliveries. Lastly, we discuss the cognitive load an obstetrician faces when having to make time critical decisions in severe shoulder dystocia and share how other disciplines train and prepare their personnel to manage similar rare and unexpected scenarios.
Topics: Delivery, Obstetric; Dystocia; Female; Humans; Pregnancy; Pregnancy, Twin; Retrospective Studies; Shoulder; Shoulder Dystocia
PubMed: 34592651
DOI: 10.1016/j.ejogrb.2021.09.011 -
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 -
Clinical Obstetrics and Gynecology Jun 1980Avoidance of shoulder dystocia is the best form of management. The potential for such a situation should be considered in the presence of a large fetus when the second... (Review)
Review
Avoidance of shoulder dystocia is the best form of management. The potential for such a situation should be considered in the presence of a large fetus when the second stage of labor is prolonged and the fetal head fails to descend to the pelvic outlet. Awareness of a past history of delivery of a large infant is also helpful. Liberal use of cesarean section in such cases will prevent serious neurologic sequelae. If shoulder dystocia occurs, the obstetrician should have a well-conceived approach directed toward disimpaction of the anterior shoulder. The most effective maneuver includes suprapubic pressure and delivery of the posterior arm.
Topics: Dystocia; Female; Humans; Pregnancy; Shoulder
PubMed: 6994971
DOI: 10.1097/00003081-198006000-00024 -
American Journal of Obstetrics and... Dec 2011The objective of this study was to assess outcomes that are associated with the implementation of a shoulder dystocia protocol that is focused on team response. We... (Review)
Review
The objective of this study was to assess outcomes that are associated with the implementation of a shoulder dystocia protocol that is focused on team response. We identified women who had a shoulder dystocia during 3 time periods: 6 months before (period A), 6 months during (period B), and 6 months after (period C) the institution of a shoulder dystocia protocol. Documentation and health outcomes were compared among the time periods. During the study period, 254 women (77, 100, and 77 in periods A, B, and C, respectively) had a shoulder dystocia. There were no differences among study periods in patient characteristics. However, complete and consistent documentation increased (14% to 50% to 92%; P < .001), and brachial plexus palsy that was diagnosed at delivery (10.1% to 4.0% to 2.6%; P = .03) and at neonatal discharge (7.6% to 3.0% to 1.3%; P = .04) declined.
Topics: Birth Injuries; Dystocia; Extraction, Obstetrical; Female; Humans; Infant, Newborn; Paralysis, Obstetric; Pregnancy; Pregnancy Outcome; Shoulder
PubMed: 21703592
DOI: 10.1016/j.ajog.2011.05.002 -
Veterinary Journal (London, England :... Apr 2008This review focuses on the case definition of dystocia, its current prevalence and recent temporal trends, the different types of dystocia and their associated risk... (Review)
Review
This review focuses on the case definition of dystocia, its current prevalence and recent temporal trends, the different types of dystocia and their associated risk factors in dairy cattle. The reported dystocia rates in dairy cattle internationally are generally <5%, apart from those in the United States, where they are higher. Given the skewed distribution of herd dystocia rates, average figures mask high prevalence herds. Phenotypic dystocia trends are generally increasing internationally and this trend has been partially attributed to the introduction of Holstein genes. The principal types of dystocia differ between primiparae and pluriparae, with feto-pelvic disproportion (FPD) predominating in the former and fetal malposition in the latter. In order of importance, the two major determinants of FPD are calf birthweight and maternal pelvic size. Abnormal fetal position is most influenced by the number of fetuses, parity and calf sire breed. Adequate weighting of dystocia in selection indices, achievement of heifer rearing targets prior to both service and calving, and appropriate periparturient management decisions are prerequisites for controlling dystocia in dairy cattle.
Topics: Animals; Birth Weight; Breeding; Cattle; Cattle Diseases; Dystocia; Female; Fetal Death; Genetic Predisposition to Disease; Parity; Pregnancy; Prevalence; Risk Factors
PubMed: 18328750
DOI: 10.1016/j.tvjl.2007.12.032 -
Preventive Veterinary Medicine Jan 2023Dystocia or difficult calving in cattle is detrimental to the health of the afflicted cows and has a negative economic impact on the dairy industry. The goal of this...
Dystocia or difficult calving in cattle is detrimental to the health of the afflicted cows and has a negative economic impact on the dairy industry. The goal of this study was to create a data-driven tool for predicting the calving difficulty of non-heifer cows using input variables that are known prior to the moment of insemination. Compared to past studies, we excluded input variables that can only be known during or after insemination, such as birth weight and gestation length. This makes the model suitable for informing mating decisions that could reduce the incidence of difficult calvings or mitigate their consequences. We used a dataset consisting of 131,527 calving records of Holstein cattle, from which we derived a total of 274 phenotypic features and estimated breeding values. The distribution of classes in the dataset was 96.7 % normal calvings, and 3.3 % difficult calvings. We used a gradient boosted trees (XGBoost) as the learning model and a bagging ensemble approach to deal with the extreme class imbalance. The model achieved an average area under the ROC curve of 0.73 on unseen test data. Using feature importance analysis, we identified a number of features that have a high discriminatory value for calving difficulty, including maternal and paternal breeding values, and past phenotypic measurements of the cow.
Topics: Animals; Cattle; Female; Pregnancy; Birth Weight; Cattle Diseases; Dairying; Dystocia; Insemination; Reproduction; Risk Factors
PubMed: 36521412
DOI: 10.1016/j.prevetmed.2022.105812 -
The Journal of Emergency Medicine Mar 2014Precipitous obstetric deliveries can occur outside of the labor and delivery suite, often in the emergency department (ED). Shoulder dystocia is an obstetric emergency... (Review)
Review
BACKGROUND
Precipitous obstetric deliveries can occur outside of the labor and delivery suite, often in the emergency department (ED). Shoulder dystocia is an obstetric emergency with significant risk of adverse outcome.
OBJECTIVE
To review multiple techniques for managing a shoulder dystocia in the ED.
DISCUSSION
We review various techniques and approaches for achieving delivery in the setting of shoulder dystocia. These include common maneuvers, controversial interventions, and interventions of last resort.
CONCLUSIONS
Emergency physicians should be familiar with multiple techniques for managing a shoulder dystocia to reduce the chances of fetal and maternal morbidity and mortality.
Topics: Delivery, Obstetric; Dystocia; Emergency Service, Hospital; Female; Humans; Patient Positioning; Posture; Pregnancy; Shoulder
PubMed: 24360351
DOI: 10.1016/j.jemermed.2013.08.110 -
Orvosi Hetilap May 2012Shoulder dystocia is one of the most tragic, fatal and unexpected obstetrical events, which is mostly unpredictable and unpreventable. This clinical picture is defined... (Review)
Review
Shoulder dystocia is one of the most tragic, fatal and unexpected obstetrical events, which is mostly unpredictable and unpreventable. This clinical picture is defined as a delivery that requires additional obstetric maneuvers to release the shoulders after gentle downward traction has failed. Shoulder dystocia occurs when the fetal shoulder impacts on the maternal symphysis or sacral promontory. The incidence of shoulder dystocia is 0.2-0.6%. High perinatal mortality and morbidity is associated with the condition, even when it is managed appropriately. Obstetricians should be aware of the existing risk factors, but should always be alert to the possibility of shoulder dystocia in all labors. Maternal morbidity is also increased, particularly postpartum hemorrhage, rupture of the uterus, injury of the bladder, urethra and the bowels and fourth-degree perineal tears. Complications of the newborn include asphyxia, perinatal mortality, fracture of the clavicula and the humerus. Brachial plexus injuries are one of the most important fetal complications of shoulder dystocia, complicating 4-16% of such deliveries. The purpose of this article is to review the current evidence regarding the possible prediction, prevention and management of shoulder dystocia.
Topics: Birth Injuries; Clavicle; Delivery, Obstetric; Dystocia; Evidence-Based Medicine; Female; Fractures, Bone; Humans; Humeral Fractures; Humerus; Infant Mortality; Infant, Newborn; Morbidity; Mothers; Predictive Value of Tests; Pregnancy; Shoulder
PubMed: 22580502
DOI: 10.1556/OH.2012.29339 -
Current Opinion in Obstetrics &... Dec 1992This review covers the recent literature relevant to breech presentation and shoulder dystocia. Further evidence in favor of external cephalic version at term has... (Review)
Review
This review covers the recent literature relevant to breech presentation and shoulder dystocia. Further evidence in favor of external cephalic version at term has emerged, and the possibility of its use in women with previous cesarean section has been suggested. Attention has been given to trial of labor in selected cases of term breech presentation. The evidence to guide the method of delivery for preterm breech presentations remains inadequate. No perinatal differences have been demonstrated among the outcome of breech second-born twins delivered by external cephalic version, breech extraction, or cesarean section. The evidence in favor of elective cesarean for suspected macrosomia to prevent shoulder dystocia is unconvincing for nondiabetics and is doubtful for pregnant diabetics. The McRoberts maneuver for shoulder dystocia has not received the prominence that it deserves.
Topics: Breech Presentation; Cesarean Section; Delivery, Obstetric; Dystocia; Female; Humans; Incidence; Pregnancy; Prognosis; Risk Factors; Shoulder
PubMed: 1450343
DOI: No ID Found