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Clinical Obstetrics and Gynecology Jun 2002
Review
Topics: Dystocia; Emergency Treatment; Evidence-Based Medicine; Female; Humans; Infant, Newborn; Labor Presentation; Obstetrics; Pregnancy; Risk Factors; Shoulder Injuries
PubMed: 12048394
DOI: 10.1097/00003081-200206000-00006 -
Akusherstvo I Ginekologiia May 1991
Review
Topics: Dystocia; Female; Humans; Labor Presentation; Obstetrical Forceps; Pregnancy; Shoulder; Version, Fetal
PubMed: 1897663
DOI: No ID Found -
Modern Midwife Aug 1997
Review
Topics: Adult; Diabetes Complications; Dystocia; Female; Humans; Infant, Newborn; Predictive Value of Tests; Pregnancy; Pregnancy Complications; Risk Factors; Shoulder
PubMed: 9348859
DOI: No ID Found -
Journal of Midwifery & Women's Health 2007The primary indication for cesarean section in nulliparous women continues to be clinical diagnoses that fall under the rubric of dystocia. These diagnoses account for... (Review)
Review
The primary indication for cesarean section in nulliparous women continues to be clinical diagnoses that fall under the rubric of dystocia. These diagnoses account for approximately two-thirds of all cesareans experienced by otherwise healthy nulliparous women. Contemporary research evidence suggests that this clinical phenomenon is complex and multifactorial. This review explores factors associated with the phenomenon of dystocia in the context of a conceptual model that considers women's physical and psychological characteristics, fetal factors, intrapartum care and interventions, assessments and clinical decision-making of health care providers, the sociopolitical environment, and the social and physical environment of childbirth. Clinical recommendations include emphasis on the maintenance of normal weight and weight gain during pregnancy, delaying the admission of nulliparous women to the hospital until active labor is established, avoiding elective induction for nulliparous women, keeping women well-hydrated and well-fed during labor, providing high-quality supportive care during labor, staying the course with effective treatment when dystocia is encountered, and a renewed emphasis on the psychobehavioral preparation of nulliparous women for the realities of labor.
Topics: Body Size; Cesarean Section; Dystocia; Female; Fluid Therapy; Humans; Labor, Obstetric; Maternal Age; Parity; Pregnancy; Risk Factors
PubMed: 17467588
DOI: 10.1016/j.jmwh.2007.03.003 -
International Journal of Gynaecology... Apr 2024To study risk factors for shoulder dystocia (ShD) among women delivering <3500 g newborn.
OBJECTIVES
To study risk factors for shoulder dystocia (ShD) among women delivering <3500 g newborn.
METHODS
A retrospective case-control study of all term live-singleton deliveries during 2011-2019. Women with neonatal birthweight <3500 g were included. We compared cases of ShD to other deliveries by univariate and multivariable regression.
RESULTS
There were 79/41 092 (0.19%) cases of ShD among neonates <3500 g. In multivariable regression analysis, the following factors were independently associated with ShD; operative vaginal delivery (odds ratio [OR] 2.78; 95% confidence interval [CI]: 1.28-6.02, P = 0.009), vaginal birth after cesarean (VBAC, OR 2.74; 1.22-6.13, P = 0.010), sonographic abdominal circumference to biparietal diameter ratio (3.73 among ShD vs. 3.62, OR 1.35; 95% CI: 1.12-1.63, P = 0.001) and sonographic abdominal circumference to head circumference ratio (1.036 among ShD vs. 1.011, OR 3.04; 95% CI: 1.006-9.23, P = 0.049).
CONCLUSIONS
There is an association between operative vaginal delivery and ShD also in deliveries <3500 g. Importantly, the proportions between the fetal head and abdominal circumference are a better predictor of ShD than the newborn fetal weight and VBAC is associated with ShD.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Dystocia; Shoulder Dystocia; Retrospective Studies; Case-Control Studies; Birth Injuries; Shoulder
PubMed: 37864450
DOI: 10.1002/ijgo.15204 -
Obstetrical & Gynecological Survey Apr 2024Macrosomia represents the most significant risk factor of shoulder dystocia (SD), which is a severe and emergent complication of vaginal delivery. They are both... (Review)
Review
IMPORTANCE
Macrosomia represents the most significant risk factor of shoulder dystocia (SD), which is a severe and emergent complication of vaginal delivery. They are both associated with adverse pregnancy outcomes.
OBJECTIVE
The aim of this study was to review and compare the most recently published influential guidelines on the diagnosis and management of fetal macrosomia and SD.
EVIDENCE ACQUISITION
A comparative review of guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynaecologists, the National Institute for Health and Care Excellence, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), and the Department for Health and Wellbeing of the Government of South Australia on macrosomia and SD was conducted.
RESULTS
The ACOG and RANZCOG agree that macrosomia should be defined as birthweight above 4000-4500 g regardless of the gestational age, whereas the National Institute for Health and Care Excellence defines macrosomia as an estimated fetal weight above the 95th percentile. According to ACOG and RANZCOG, ultrasound scans and clinical estimates can be used to rule out fetal macrosomia, although lacking accuracy. Routine induction of labor before 39 weeks of gestation with the sole indication of suspected fetal macrosomia is unanimously not recommended, but an individualized counseling should be provided. Exercise, appropriate diet, and prepregnancy bariatric surgery are mentioned as preventive measures. There is also consensus among the reviewed guidelines regarding the definition and the diagnosis of SD, with the "turtle sign" being the most common sign for its recognition as well as the poor predictability of the reported risk factors. Moreover, there is an overall agreement on the algorithm of SD management with McRoberts technique suggested as first-line maneuver. In addition, appropriate staff training, thorough documentation, and time keeping are crucial aspects of SD management according to all medical societies. Elective delivery for the prevention of SD is discouraged by all the reviewed guidelines.
CONCLUSIONS
Macrosomia is associated not only with SD but also with maternal and neonatal complications. Similarly, SD can lead to permanent neurologic sequalae, as well as perinatal death if managed in a suboptimal way. Therefore, it is crucial to develop consistent international practice protocols for their prompt diagnosis and effective management in order to safely guide clinical practice and improve pregnancy outcomes.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Fetal Macrosomia; Dystocia; Shoulder Dystocia; Australia; Delivery, Obstetric
PubMed: 38640129
DOI: 10.1097/OGX.0000000000001253 -
Obstetrics and Gynecology Clinics of... Jun 1995It is clear that in the vast majority of cases, shoulder dystocia cannot be predicted by the physician. Although macrosomia is strongly associated with shoulder dystocia... (Review)
Review
It is clear that in the vast majority of cases, shoulder dystocia cannot be predicted by the physician. Although macrosomia is strongly associated with shoulder dystocia in retrospective analyses, there are no clinical or sonographic parameters that can reliably and prospectively identify the individual macrosomic fetus. Furthermore, more than 98% of patients with macrosomic fetuses who deliver vaginally do not have shoulder dystocia. Some investigators have advocated the use of cesarean delivery for suspected macrosomic fetuses to avoid potential birth trauma during vaginal delivery; however, this strategy has not been shown to be beneficial in the majority of cases. Boyd and colleagues report that an increase in the cesarean delivery rate for suspected macrosomia from 8% in the 1960s to 21% in 1980 did not improve overall perinatal outcome among macrosomic infants. Since 50% to 90% of cases of shoulder dystocia occur in normally grown fetuses, cesarean delivery for all suspected macrosomic fetuses would not be expected to prevent the vast majority of cases of shoulder dystocia and would expose many mothers to a substantially increased risk for morbidity and mortality. Management of this complex problem requires clinical judgment by the well-trained physician and individualized care for each patient. Because shoulder dystocia remains unpredictable in almost all cases, when it does occur it must be managed expeditiously but carefully with one or more of the maneuvers described. The sequence of manipulations reported herein represents one way of managing shoulder dystocia (Fig. 11). As noted before, however, there are no data to support improved efficacy of one particular sequence over another. The sequence of maneuvers chosen by the clinician should be based on the algorithm with which he or she is most familiar and which has proven successful in their hands. Permanent injury to the fetus fortunately is rare but does occur even in the well-managed case.
Topics: Delivery, Obstetric; Dystocia; Emergencies; Female; Humans; Pregnancy; Shoulder
PubMed: 7651669
DOI: No ID Found -
New Zealand Veterinary Journal Mar 2022
Topics: Animals; Animals, Newborn; Cattle; Cattle Diseases; Dystocia; Female; Mesothelioma; Pregnancy
PubMed: 34547984
DOI: 10.1080/00480169.2021.1984336 -
The Veterinary Record Jun 1977
Topics: Animals; Dystocia; Female; Pregnancy; Snakes
PubMed: 878276
DOI: 10.1136/vr.100.25.536-b -
International Journal of Gynaecology... Jun 2004
Topics: Analgesia, Epidural; Caregivers; Cesarean Section; Dystocia; Female; Fetal Monitoring; Humans; Oxytocin; Pregnancy; Pregnancy, Multiple; Risk Factors; Walking
PubMed: 15216860
DOI: 10.1016/s0020-7292(04)00096-7