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Shoulder Dystocia
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Risk factors for shoulder dystocia include prior shoulder dystocia (recurrence risk ∼1%–15%), maternal diabetes mellitus, obesity, postterm pregnancy, labor induction, epidural anesthesia, labor abnormalities (e.g. prolonged second stage), operative vaginal delivery, and fetal macrosomia (Table 27.1).
Shoulder dystocia
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Randall C. Floyd, James S. Smeltzer
The reported incidences of shoulder dystocia with a fetus over 4500 g vary from 2% to 35%, with most studies reporting incidences of 20% to 40% among infants of diabetic mothers delivering vaginally (20,24,36) and less than half that risk among nondiabetic patients (20,24). The risk for permanent brachial plexus neurologic injury arising from shoulder dystocia varies from 0.6% (19) to 27.5% (37). The risk for perinatal mortality varies between zero (36) and 28% (21). There appears to be considerable variation in the ability to diagnose and safely manage shoulder dystocia. The advocacy for elective cesarean section based on estimated weight by the various authors may be directly proportional to their own morbidity and mortality rates.
Shoulder Dystocia
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
Shoulder dystocia is an emergency concerning the maternal bony pelvis instead of a soft tissue problem. However, an episiotomy may be necessary after external measures have failed to resolve the shoulder dystocia in order to gain more access within the vagina to be able to perform internal manoeuvres.
Is Uterine Myomectomy a Real Contraindication to Vaginal Delivery? Results from a Prospective Study
Published in Journal of Investigative Surgery, 2022
Marco La Verde, Luigi Cobellis, Marco Torella, Maddalena Morlando, Gaetano Riemma, Antonio Schiattarella, Anna Conte, Domenico Ambrosio, Nicola Colacurci, Pasquale De Franciscis
Neonatal complications analyzed were the following: shoulder dystocia as previously described 14 access to the neonatal intensive care unit (NICU) as achieved after the clinical appraisal of the neonatologist.17 Hypoxic-ischemic encephalopathy was diagnosed in case of distressed neurologic function after clinical demonstration of perinatal hypoxia,18 which was characterized as either a 5-minutes APGAR score less than 5, umbilical artery cord pH of lower than 7.0 or base deficit up to at least 12 mmol/L,19,20 featured by neuroimaging proofs of acute brain injury.21 Hypoglycemia was set at a neonatal serum glucose level lower than 2.6 mmol/L.22 For every delivery, we recorded APGAR score on minutes 1 and 5.23
Correlation of Maternal Neck/Waist Circumferences and Fetal Macrosomia in Low-Risk Turkish Pregnant Women, a Preliminary Study
Published in Fetal and Pediatric Pathology, 2021
Necati Hancerliogullari, Hatice Kansu-Celik, Z. Asli Oskovi Kaplan, Aysegul Oksuzoglu, A. Seval Ozgu-Erdinc, Yaprak Engin-Ustun
Fetal macrosomia rate is approximately 10% among pregnant women [13]. These pregnancies have a higher risk for obstetric complications, especially for shoulder dystocia and admission to neonatal care unit [14, 15]. It is reported that intrauterine fetal development is affected by fat distribution regardless of total fat mass in pregnancy; especially central fat accumulation has an association with fetal macrosomia [16]. In pregnant women, central obesity is also related with metabolic status; which causes decreased insulin sensitivity, increased fasting glucose and decreased HDL levels [17]. Complex mechanisms play role on macrosomic fetuses; the most well-known mechanism is higher blood glucose causing increased insulin secretion which also induces growth factors. Limitation of weight gain in obese women also decreases fetal macrosomia [18]. In both primiparous and multiparous women, pre-pregnancy BMI≥ 30 kg/m2 increases the risk of delivery of a macrosomic fetus; however since BMI does not describe fat distribution, its use is limited for prediction of fetal macrosomia [19–22].
Consent Related Challenges for Neonatal Clinical Trials
Published in The American Journal of Bioethics, 2020
Katherine F. Guttmann, Yvonne W. Wu, Sandra E. Juul, Elliott M. Weiss
Imagine a woman is pregnant and has gone into labor at term. The pregnancy has been uncomplicated with good prenatal care, the fetus is well grown, and there are no concerns. The parents expect a healthy baby. At delivery, a shoulder dystocia is called: the obstetric team cannot extract the baby. An alarm goes off and a dozen healthcare workers instantaneously appear, trying to get the baby out of the birth canal. Six minutes later the baby emerges limp, blue and without spontaneous cry or respiratory effort. She does not respond to initial resuscitative efforts and so a breathing tube is placed and chest compressions initiated, all just feet away from the new parents. Within two minutes she is taking some breaths, however she remains limp, encephalopathic, and is rushed to the NICU before her parents are able to see her. The parents, who had anticipated a joyous event, are now encountering a nightmare. They are told that their baby is too fragile to hold, that she cannot be fed, that she might die, and that if she survives she may have sustained permanent brain injury. She is rushed to a tertiary NICU at a Children’s hospital 30 miles away for a higher level of care. Meanwhile her mother is recovering from a traumatic delivery complicated by severe post-partum hemorrhage. Alone in the NICU, her father is approached to enroll in a clinical trial and told he has a few hours to decide whether to consent.