Obstetric Maneuvers Research Articles

An objective definition of shoulder ddystocia: Prolonged head to body delivery intervals and/or use of ancillary obstetrical maneuvers: [formula omitted]x, M Beall, D. Rodriguez x, MG Ross. Dept of Ob/Gyn, Harbor-UCLA Medical Center, Torrance, CA

An objective definition of shoulder ddystocia: Prolonged head to body delivery intervals and/or use of ancillary obstetrical maneuvers: [formula omitted]x, M Beall, D. Rodriguez x, MG Ross. Dept of Ob/Gyn, Harbor-UCLA Medical Center, Torrance, CA

Shoulder dystocia: An analysis of risks and obstetric maneuvers

The purpose of this study was to determine whether there is a risk profile for predicting or preventing shoulder dystocia and whether any of the obstetric maneuvers to disimpact a shoulder reduce the likelihood of permanent injury. A retrospective analysis of 14,297 parturients with 12,532 vaginal deliveries and 1765 cesarean sections (12.4%) from January 1986 through June 1990 was performed. A total of 204 maternal and infant charts, related to shoulder dystocia or neonatal injury, were reviewed in depth for age, parity, episiotomy, type of delivery, hemorrhage, maternal obesity, diabetes, weight gain, fetal weight, sex, and Apgar scores. In addition, the type of maneuver or combination thereof used to relieve the dystocia, type of injury to the infant, and follow-up of the injury were reviewed. The 185 coded episodes of shoulder dystocia represent 1.4% of all vaginal deliveries (12,532). There were 42 injuries recorded: 14 fractured clavicles and 28 brachial plexus injuries. An additional 19 patients, not coded for shoulder dystocia, sustained 14 fractured clavicles and five brachial plexus injuries. All but one of the brachial plexus injuries resolved by 6 months. The occurrence of shoulder dystocia increased in direct relationship to the birth weight and becomes significant in newborns over 4000 gm (p < 0.01). The occurrence of a previous large infant was also a significant risk factor (p < 0.01). Diabetes and midforceps delivery become significant factors only in the presence of a large fetus. Obesity, multiparity, postdate pregnancy, use of oxytocin, low forceps delivery, episiotomy, and type of anesthesia were unrelated to shoulder dystocia. No delivery method was without injury. This study clearly indicates that most of the traditional risk factors for shoulder dystocia have no predictive value, shoulder dystocia itself is an unpredictable event, and infants at risk for permanent injury are virtually impossible to predict. In addition, no delivery method in shoulder dystocia was superior to another with respect to injury. Thus no protocol should serve to substitute for clinical judgment.

Obstetric fractures.

The purpose of this study was to determine the risk factors predisposing to an obstetric fracture, and their long-term outcome. We reviewed 28 obstetric fractures treated in the County of Vaud, Switzerland, between 1976 and 1989. There were 12 fractures of long bones, 10 clavicles and 6 depressed skull fractures. The belief that obstetric fractures occur in large babies or after breech deliveries is no longer valid. The common risk factors of these fractures are obstetric maneuvers during delivery (75% of cases), especially Cesarean sections (35%), prolonged labor (33%), and prematurity (25%). Cephalic presentation (64.2% of cases) is more frequent than breech position (32.1%). Weight, size, age of gestation, age of the mother, parity, gestity, and time of delivery cannot be considered as risk factors for obstetric fractures. For each type of fracture some specific risk factors are pointed out: maneuvers at birth for depressed skull fracture, Cesarean section, breech delivery with assistance and low birth weight for the fractures of long bones. All fractures were treated conservatively, except for skull fractures with a depression of more than 2 cm. Early consolidation is achieved within 2 weeks. Long-term prognosis for obstetric fractures is good without sequelae.

Oxytocin treatment in twin pregnancy labour.

A continuous series of 483 twin deliveries was studied. In 30% of cases, intravenous oxytocic treatment was given for labour induction or to accelerate the first stage. In 13% of twin deliveries this treatment was applied only after the first twin's birth. In the group perfused during cervix dilatation, foetal mortality rate was significantly lower than in the nontreated group. In order to understand the reason(s) for this difference, the following factors were studied in relation to oxytocic treatment: parity, obstetrical complications, second stage duration, abnormal presentations, obstetrical maneuvers, and birth weight. Contrasting with mortality data, Apgar scores of first twins were significantly lower in the oxytocin-treated group. In summary, several variables indirectly linked to oxytocic treatment could have favoured or hampered foetal outcome in the treated group. Therefore, it is difficult to ascertain if the use of oxytocics is helpful in twin pregnancy management. In the majority of cases, however, it may at least be considered harmless.

Laminaria tent for gradual and safe cervical dilatation

Department of Obstetrics and Gynecology, Kyoto University School of Medicine, Kyoto, Japan I N T H E E A R L Y and middle stages oi plegnancy, obstetricians often need suficicnt cervical dilatation before performing certain intrairtl:rinc obstetric maneuvers. Hegar dilators c-an atl.ain rapid and direct cervical dilatation to a t.erlain extent. However, this method has limitations, and sometimes more gradual and extensive clil.ltatic)ll is necessary. Laminaria tents have been prcferrcd ior thth purpose of gradual cervical dilataCon for mott’ than 100 years in Germany, Japan, Switzt~rland,~ and elsewhere. Textbooks of obstetrics ii, (;crmany and Japan have devoted several parrc~s for this convenient material. Description of tllis material has appeared in textbooks puttlishecl in Great Britain,’ but American tcssthocrks I~:Iv(. never mentioned it. Laminaria tents arc n~atlr from the root of a seaweed, viz., Lnrnin~~ic~ di‘qitutu. Dried and rounded in a stick-likr sliapt‘, if is 5.5 to 6.0 cm. long and has a diantrtcht01 0.3 to 0.5 cm. with strong silk thrrad at on c*ter but it is also markedly softened. This thcqn pel’mits funher direct dilatation by means ot lil:zdl dilators, if necessary. Since mechvnic~al xtinlut;ltion works on the uterus. insertion of t!*llt ill the cewis sometimes wokcs weak zltc.titlt’ (YEW tractions, and rarely the undama#cd icitt’ and placenta in the unrupturcd membranc~s ;II t’ spantanrously delivered folltrwirrg rcwcwl r,i the