Obstetric maneuvers for shoulder dystocia and associated fetal morbidity.
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.
SourceAvailable from: Tochukwu Okeke
Article: Shoulder Dystocia01/2014; 4(14):2414-2426. DOI:10.9734/ARRB/2014/8515
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ABSTRACT: Background. The obstetrical brachial plexus palsy requires differentiating from bone−joint system injuries. The simultaneous occurrence of the perinatal brachial plexus injuries with bone fractures and joint dislocations is rather rare in medical practice. Objectives. Analysis of the clinical data in cases with co−existent injuries of the brachial plexus and bone−joint system. Material and Methods. Clinical material consisted of 9 children with co−existent lesions of the brachial plexus and skeleton. This group was chosen from 83 children with obstetrical brachial plexus palsy treated at the Department of Trauma and Hand Surgery in the period 1994–2003. The following parameters were analysed statistically: duration of pregnancy, duration of the II stage of delivery, age of mother, birth weight, body length, head and chest circumfer− ence, Apgar scale at 1 min in scheme: control group – children with lesions of the brachial plexus without bone−joint injuries – children with co−existent injuries of the brachial plexus and bone−joint system. The control group consisted of 56 healthy born children. The other parameters including: presentation, shoulder dystocia, type of brachial plexus palsy and side affected, severity of injuries, kind of treatment and localisation of skeleton lesions were also analysed. Results. Co−existent injuries of the brachial plexus and skeleton made−up 10.8% of all cases (9 from 83 cases). In own material the authors found 7 cases of clavicle fracture, 1 case of humeral shaft fracture and 1 case of glenohumeral joint dislocation. Only in 1 case the breech presentation was observed. Shoulder dystocia was found in 4 deliveries. In these cases during the surgical treatment the authors observed injuries with discontinuity of the neural elements of the brachial plexus. There were no statistically important differences in the analysed parameters between group with isolated injuries of the brachial plexus and group with co−existent injuries of brachial plexus and skeleton. Conclusions. Injuries of the bone−joint system may co−exist with perinatal brachial plexus palsy with different local− isation and degree of injury severity. Classical risk factors of perinatal brachial plexus palsy do not influence signifi− cantly on the possibility of appearance of bone−joint system injury (Adv Clin Exp Med 2006, 15, 2, 297–301).
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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 · 0.60 Impact Factor