-
Der Gynakologe Aug 1994
Review
Topics: Birth Injuries; Dystocia; Expert Testimony; Extraction, Obstetrical; Female; Germany; Humans; Infant, Newborn; Liability, Legal; Malpractice; Pregnancy; Risk Factors
PubMed: 7959308
DOI: No ID Found -
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 -
Asian Journal of Surgery Jun 2021
Topics: Dystocia; Female; Hand; Humans; Pregnancy; Shoulder Dystocia
PubMed: 34045130
DOI: 10.1016/j.asjsur.2021.04.009 -
American Journal of Obstetrics and... Nov 2022Shoulder dystocia is one of the most threatening complications during delivery, and although it is difficult to predict, individual risk should be considered when...
BACKGROUND
Shoulder dystocia is one of the most threatening complications during delivery, and although it is difficult to predict, individual risk should be considered when counseling for mode of delivery.
OBJECTIVE
This study aimed to develop and validate a risk score for shoulder dystocia based on fetal ultrasound and maternal data from 15,000 deliveries.
STUDY DESIGN
Data were retrospectively obtained of deliveries in 3 tertiary centers between 2014 and 2017 for the derivation cohort and between 2018 and 2020 for the validation cohort. Inclusion criteria were singleton pregnancy, vaginal delivery in cephalic presentation at ≥37+0 weeks' gestation, and fetal biometry data available within 2 weeks of delivery. Independent predictors were determined by multivariate regression analysis in the derivation cohort, and a score was developed on the basis of the effect of the predictors.
RESULTS
The derivation cohort consisted of 7396 deliveries with a 0.91% rate of shoulder dystocia, and the validation cohort of 7965 deliveries with a 1.0% rate of shoulder dystocia. Among all women, 13.8% had diabetes mellitus, and 12.1% were obese (body mass index ≥30 kg/m). Independent risk factors in the derivation cohort were: estimated fetal weight ≥4250 g (odds ratio, 4.27; P=.002), abdominal-head-circumference ≥2.5 cm (odds ratio, 3.96; P<.001), and diabetes mellitus (odds ratio, 2.18; P=.009). On the basis of the strength of effect, a risk score was developed: estimated fetal weight ≥4250 g=2, abdominal-head-circumference ≥2.5 cm=2, and diabetes mellitus=1. The risk score predicted shoulder dystocia with moderate discriminatory ability (area under the receiver-operating characteristic curve, 0.69; P<.001; area under the receiver-operating characteristic curve, 0.71; P<.001) and good calibration (Hosmer-Lemeshow goodness-of-fit; P=.466; P=.167) for the derivation and validation cohorts, respectively. With 1 score point, 16 shoulder dystocia cases occurred in 1764 deliveries, with 0.6% shoulder dystocia incidence and a number needed to treat with cesarean delivery to avoid 1 case of shoulder dystocia of 172 (2 points: 38/1809, 2.1%, 48; 3 points: 18/336, 5.4%, 19; 4 points: 10/96, 10.5%, 10; and 5 points: 5/20, 25%, 4); 40.8% of the shoulder dystocia cases occurred without risk factors.
CONCLUSION
The presented risk score for shoulder dystocia may act as a supplemental tool for the clinical decision-making regarding mode of delivery. According to our score model, in pregnancies with a score ≤2, meaning having solely estimated fetal weight ≥4250 g, or abdominal-head-circumference ≥2.5, or diabetes mellitus, cesarean delivery for prevention of shoulder dystocia should not be recommended because of the high number needed to treat to avoid 1 case of shoulder dystocia. Conversely, in patients with a score of ≥4 with or without diabetes mellitus, cesarean delivery may be considered. However, in 40% of the shoulder dystocia cases, no risk factors had been present.
Topics: Pregnancy; Female; Humans; Shoulder Dystocia; Dystocia; Retrospective Studies; Fetal Weight; Risk Factors; Diabetes Mellitus; Shoulder
PubMed: 35697095
DOI: 10.1016/j.ajog.2022.06.008 -
The Veterinary Record May 1977Herpetology is a rapidly growing interest in this country, reptiles being kept both for research purposes and as pets. However, there is a lack of literature on...
Herpetology is a rapidly growing interest in this country, reptiles being kept both for research purposes and as pets. However, there is a lack of literature on reptilian medicine and surgery; the authors know of only one available text (Frye 1973). Furthermore, there are only two published case histories of dystocia in the snake (Huff 1976, Hime 1976) and thus this case was considered to be of particular interest.
Topics: Anesthesia; Animals; Dystocia; Female; Ketamine; Pregnancy; Snakes
PubMed: 878245
DOI: 10.1136/vr.100.20.423 -
Journal of Gynecology Obstetrics and... Sep 2021
Topics: Adult; Cesarean Section; Dystocia; Female; Humans; Live Birth; Magnetic Resonance Imaging; Obstetric Labor Complications; Pregnancy; Pregnancy, Twin
PubMed: 33453447
DOI: 10.1016/j.jogoh.2021.102065 -
The Veterinary Record Mar 2019Canine dystocia is a relatively common veterinary presentation. First opinion emergency care clinical data from 50 Vets Now clinics across the UK were used to explore...
Canine dystocia is a relatively common veterinary presentation. First opinion emergency care clinical data from 50 Vets Now clinics across the UK were used to explore dystocia management and outcomes in bitches. Caesarean section (CS) was performed on 341/701 (48.6 per cent (95 per cent CI 44.9 to 52.4)) of dystocia cases. The bulldog (OR 7.60, 95 per cent CI 1.51 to 38.26, P=0.014), Border terrier (OR 4.89, 95 per cent CI 0.92 to 25.97, P=0.063) and golden retriever (OR 4.07, 95 per cent CI 0.97 to 17.07, P=0.055) had the highest odds of CS among dystocic bitches compared with crossbreds. Brachycephalic dystocic bitches had 1.54 (95 per cent CI 1.05 to 2.28, P=0.028) times the odds of CS compared with non-brachycephalics. Oxytocin was administered to 380/701 (54.2 per cent) and calcium gluconate was administered to 82/701 (11.7 per cent) of dystocic bitches. 12 of 701 dystocia cases (1.7 per cent) died during emergency care. These results can help veterinary surgeons to provide better evidence on the risks to owners who may be contemplating breeding from their bitches. In addition, the results on the management and clinical trajectory of dystocia can facilitate clinical benchmarking and encourage clinical audit within primary care veterinary practice.
Topics: Animals; Breeding; Cesarean Section; Dog Diseases; Dogs; Dystocia; Emergency Medical Services; Female; Pregnancy; Treatment Outcome; United Kingdom; Veterinary Medicine
PubMed: 30718270
DOI: 10.1136/vr.104944 -
Polish Journal of Veterinary Sciences Dec 2023The Black-and-White (BW) breed, which until recently had dominated in Europe, was replaced by the Holstein-Friesian (HF) breed. As a result, the incidence of dystocia...
The Black-and-White (BW) breed, which until recently had dominated in Europe, was replaced by the Holstein-Friesian (HF) breed. As a result, the incidence of dystocia has increased. Dystocia occurs most frequently in heifers, and it is associated with high calf weight and/or too narrow pelvic openings in heifers. The aim of this study was to evaluate retrospectively the effects of pelvic dimensions and rump angle on calving ease in two cattle breeds. The research was carried out in four barns where BW and HF cattle were used. The course of parturition was evaluated in 317 heifers (BW, n=169; HF, n=148) based on direct observations. Calves were weighed, external and internal pelvic measurements were performed (using the Rice pelvimeter), and rump angle was determined in heifers. Based on the course of parturition, heifers of both breeds were divided into easy calving (EC) and difficult calving (DC) groups. The frequency of DC was 24.3% in HF heifers and 13.1% in BW heifers. In comparison with DC heifers, EC heifers had a larger pelvic area, in particular the internal dimensions of the bony pelvis, and a higher rump angle. In comparison with BW heifers, HF heifers had a smaller rump angle, a narrower pelvis and a lower ratio of pelvic area to calf weight. High dystocia rates in HF heifers could result from a relatively large fetus size and a less preferable pelvic size and rump angle. High variation in the internal pelvic dimensions in HF heifers indicates that the incidence of dystocia can be reduced through selection for a larger pelvic size and the optimal rump angle.
Topics: Cattle; Pregnancy; Animals; Female; Birth Weight; Retrospective Studies; Pelvis; Dystocia; Parturition; Cattle Diseases
PubMed: 38088415
DOI: 10.24425/pjvs.2023.148288 -
Equine Veterinary Journal Jan 2003Dystocia in the mare is an emergency in which duration has a profound effect on survival of the foal. Specific examination of the effects of dystocia duration on foal...
REASONS FOR PERFORMING STUDY
Dystocia in the mare is an emergency in which duration has a profound effect on survival of the foal. Specific examination of the effects of dystocia duration on foal survival provides information to enable horse care personnel and veterinarians to manage these cases more effectively and maximise the chances of obtaining a live foal.
HYPOTHESIS
Dystocia duration would have a negative impact on foal survival while method of dystocia resolution would not have an effect on foal survival. Additionally, we were interested in determining the effects of dystocia on subsequent fertility.
METHODS AND RESULTS
In the years 1986-1999, 247 dystocias were admitted. Of these, 91 % resulted in survival and discharge of the mare, 42% in delivery of a live foal, and 29% of foals survived to discharge. Period from hospital arrival to delivery for foals alive at discharge (23.0 +/- 14.1 mins) was not significantly different than for foals not surviving (24.8 +/- 10.6 mins) (P > 0.05); and from chorioallantoic rupture to delivery for foals alive at discharge (71.7 +/- 343 mins) was significantly less than for foals not surviving (853 +/- 37.4 mins) (P < 0.05). Average predystocia live foaling rates for all mares with available records was 84%. Overall post dystocia live foaling rates over the entire period of this study were 67%. Of mares bred in the year of the dystocia, 59% had a live foal in the year following.
CONCLUSIONS
Based on these results, dystocia duration has a significant effect on foal survival and resolution methods should be chosen to minimise this time, as the difference between mean dystocia duration for foals that lived and those that did not in this study was 13.6 mins. Post dystocia foaling rates reported here are higher than previously reported for both same-season and overall breedings, indicating same-season breeding may be rewarding for select dystocia cases.
POTENTIAL RELEVANCE
Dystocia resolution methods that minimise delivery time may maximise foal survival. Post dystoicia breeding may be rewarding in select cases.
Topics: Animals; Animals, Newborn; Delivery, Obstetric; Dystocia; Female; Fertility; Horse Diseases; Horses; Hospitals, Animal; Pregnancy; Pregnancy Outcome; Retrospective Studies; Survival Analysis; Time Factors
PubMed: 12553468
DOI: 10.2746/042516403775467405 -
Archives of Gynecology and Obstetrics Nov 2016To examine the course and outcome of deliveries occurring in women who previously experienced shoulder dystocia. In addition, recurrent shoulder dystocia risk factors...
OBJECTIVE
To examine the course and outcome of deliveries occurring in women who previously experienced shoulder dystocia. In addition, recurrent shoulder dystocia risk factors were assessed.
METHODS
A retrospective cohort analysis comparing all singleton deliveries with and without shoulder dystocia in their preceding delivery was conducted. Independent predictors of recurrent shoulder dystocia were investigated using a multiple logistic regression model.
RESULTS
Of the 201,422 deliveries included in the analysis, 307 occurred in women with a previous shoulder dystocia (0.015 %). Women with a history of shoulder dystocia were more likely to be older, experienced higher rates of gestational diabetes mellitus, polyhydramnios, prolonged second stage, operative delivery and macrosomia (>4000 g) in the following delivery. Previous shoulder dystocia was found to be an independent risk factor for recurrent shoulder dystocia (OR = 6.1, 95 % CI 3.2-11.8, p value <0.001) in the multivariable regression analysis.
CONCLUSIONS
Shoulder dystocia is an independent risk factor for recurrent shoulder dystocia. Deliveries in women with a history of shoulder dystocia are characterized by higher rates of operative delivery, prolonged second stage of labor and macrosomia.
Topics: Adult; Cohort Studies; Delivery, Obstetric; Dystocia; Female; Humans; Pregnancy; Pregnancy Complications; Retrospective Studies; Risk Factors; Shoulder
PubMed: 27338567
DOI: 10.1007/s00404-016-4139-1