Article

Obstetric maneuvers for shoulder dystocia and associated fetal morbidity

Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, USA.
American Journal of Obstetrics and Gynecology (Impact Factor: 3.97). 07/1998; 178(6):1126-30. DOI: 10.1016/S0002-9378(98)70312-6
Source: PubMed

ABSTRACT We sought to determine the fetal injury rate associated with shoulder dystocia and to determine whether there is a higher rate of brachial plexus injury or bone fracture when fetal manipulation techniques are required for delivery.
A retrospective review of 285 cases of shoulder dystocia that occurred between January 1991 and December 1995 was performed. The type, sequence, and combination of obstetric maneuvers used to relieve the shoulder dystocia were noted. These cases were divided into two groups, as follows: (1) those resolved with McRoberts' maneuver, suprapubic pressure, or proctoepisiotomy or a combination of these and (2) those that required the addition of direct fetal manipulative maneuvers (Woods, posterior arm, or Zavanelli). Fetal injury was defined as the occurrence of brachial plexus palsy, clavicular fracture, humeral fracture, or fetal death caused by asphyxial complications.
The fetal injury rate was 24.9% (71/285), including 48 (16.8%) brachial plexus palsies, 27 (9.5%) clavicular fractures, and 12 (4.2%) humeral fractures. Sixteen infants had both nerve injury and bone fracture. Four (8.9%) brachial plexus palsies had documented persistence at 1 year of follow-up. One neonatal death occurred at age 3 months after an episode of hypoxic ischemic encephalopathy. The incidence of bone fracture was not higher when direct fetal manipulation was required: 21 of 127 (16.5%) versus 18 of 158 (11.4%), p = 0.21. The incidence of brachial plexus palsy was also similar in both groups (27/127 vs 21/158, p = 0.1).
Direct fetal manipulation techniques used to alleviate shoulder dystocia are not associated with an increased rate of bone fracture or brachial plexus injury.

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    • "Both perinatal morbidity and mortality are higher in deliveries complicated by shoulder dystocia. Brachial plexus injury is one of the most important foetal complications, complicating 2 – 16% of such deliveries (Gherman et al. 1998). Poor neonatal outcomes aft er shoulder dystocia have been associated with inappropriate management (Croft s et al. 2008). "
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    ABSTRACT: Condensation: In our questionnaire, a video tutorial illustrating the management of shoulder dystocia was considered by health personnel as a useful complementary training tool. We prepared a 5-min video tutorial on the management of shoulder dystocia, using a simulator that includes maternal pelvic and baby models. We performed a survey among obstetric personnel in order to assess their opinion on the tutorial by inviting them to watch the video tutorial and answer an online questionnaire. Five multiple-choice questions were set, focusing on the video's main objectives: clarity, simplicity and usefulness. Following the collection of answers, global and category-weighted analyses were conducted for each question. Out of 956 invitations sent, 482 (50.4%) answered the survey. More than 90% of all categories found the video tutorial to be clinically relevant and clear. For revising the management of shoulder dystocia most obstetric personnel would use the video tutorial together with traditional textbooks. In conclusion, our video tutorial was considered by health personnel as a useful complementary training tool.
    Journal of Obstetrics and Gynaecology 10/2014; DOI:10.3109/01443615.2014.969208
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    • "Shoulder dystocia can feel like an " obstetric nightmare " for both women and healthcare workers [3]. It is associated with significant maternal and fetal morbidity, including postpartum hemorrhage and fetal brachial plexus injury [4]. Following concerns about the safety of vaginal breech deliveries [5], planned cesareans for breech presentation have led to a reduction in the amount of exposure that healthcare professionals have to the former type of delivery. "
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    ABSTRACT: Objective To evaluate whether eponymous maneuvers and mnemonics taught for the management of shoulder dystocia, vaginal breech delivery, and uterine inversion were remembered and understood in practice. Methods A questionnaire was distributed to obstetricians and midwives collecting information about the HELPERR and PALE SISTER mnemonics. Three extended matching questions evaluated participants’ knowledge of the correct maneuvers, with their matching eponyms, used in the management of shoulder dystocia, vaginal breech delivery, and uterine inversion. Results Of the 112 participants, 90% were familiar with the HELPERR mnemonic, with 79% using it in their practice. Of those who used it, only 32% could correctly decipher it (P = 0.032). PALE SISTER was mostly unfamiliar. The percentages of correct maneuvers used for managing shoulder dystocia, breech delivery, and uterine inversion were 84.6%, 58.3%, and 28.6%, respectively. However, the eponyms were correctly matched to their maneuvers in only 33.3%, 14.3%, and 0% of cases, respectively (P < 0.01). Conclusion The meanings of the mnemonics for obstetric emergencies were frequently recalled incorrectly. This, together with the poor correlation between knowledge of maneuvers and their eponyms, limits their usefulness and indicates that teaching should focus on learning without relying on mnemonics and eponyms.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 06/2014; 125(3). DOI:10.1016/j.ijgo.2013.12.011
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    • "It should be noted that while clavicle fracture is one of the risks associated with shoulder dystocia (incidence 0.2 per cent to 0.6 per cent vaginal birth), the most frequently encountered complication is brachial plexus injury (BPI) which is seen in 2.3 to 16 per cent of births when shoulder dystocia is present (Royal College of Obstetricians and Gynaecologists (RCOG) 2012; Csorba 2012). Another injury seen is humeral fracture, which in one case series was noted in 12 per cent of newborns with a shoulder dystocia where birth was facilitated by delivery of the posterior arm (RCOG 2012; Gherman et al 1998). "
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    ABSTRACT: Birth injuries are frequently seen in newborn infants. Clavicular fractures are the most commonly encountered bony injuries seen in clinical practice. The incidence of clavicle fracture ranges from 0.35 per cent to 2.9 per cent of births and remains undetected at the time of discharge from hospital in up to 40 per cent of cases. Clinical suspicion of fractured clavicle may be raised from history (shoulder dystocia) or clinical examination (spongy feeling or crepitus on palpation). This should be confirmed with imaging studies. Parents should have the diagnosis explained and be reassured that healing without residual deformity will occur without any medical intervention. Careful documentation of any confirmed clavicle fracture is important from medico-legal aspects. We present the case of a newborn clavicular fracture associated with shoulder dystocia, following a vaginal birth,.
    The practising midwife 10/2013; 16(9):31-4.
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