Shoulder Dystocia: A Study of 47 Cases

Shoulder dystocia at vaginal delivery occurred in 0.2% of cases. Antenatal prediction of this complication was very difficult. In primigravidae in labour, delay late in the first stage was a warning sign; induction of labour, the use of regional analgesia, and forceps delivery for delay in the second stage of labour were associated with subsequent shoulder dystocia, although a cause-effect relationship was not established. The immediate maternal and fetal morbidity were high, nearly 30% of the babies suffering from a severe neural or bony injury. Forty-four per cent of the babies were beyond 41 weeks of gestation, and 70% weighed over 4,000 g. The avoidance of postmaturity by elective induction of labour at 41 weeks of gestation would significantly reduce the incidence of shoulder impaction at delivery.     

肩难产45例临床分析

目的:探讨肩难产发生的高危因素和母婴并发症及处理方法。方法:回顾性分析四川省安县妇幼保健院2000年10月至2010年10月45例肩难产的临床资料,根据肩难产时母婴并发症的发生率与新生儿体重、助产手法及娩肩时间的关系进行分组,并进行分析。结果:①肩难产发生的高危因素主要有巨大儿(62.2%),子宫收缩乏力(15.6%),妊娠期糖尿病(11.1%)。②肩难产母婴并发症主要有:母体会阴裂伤(17例,37.8%),产后出血(7例,15.6%),新生儿窒息(29例,64.4%)。巨大儿组的母婴并发症发生率高于正常体重儿组(P<0.05);母亲并发症发生率与助产手法及娩肩时间无明显关系(P>0.05),而新生儿并发症发生率随助产手法种类的增加及娩肩时间的增加而增加(P<0.05)。③助产手法:采用屈大腿法成功分娩10例(22.2%),屈大腿法+压前肩法成功16例(35.6%),屈大腿法+压前肩法+旋肩法成功12例(26.7%),屈大腿法+压前肩法+旋肩法+牵后臂法成功7例(15.6%)。结论:巨大儿是肩难产发生的首要高危因素。母体会阴裂伤、产后出血及新生儿窒息是肩难产的常见并发症,母亲并发症主要与胎儿体重有关,新生儿并...     

Cephalic Replacement (The Zavanelli Manoeuvre). A desperate Solution For Severe Shoulder Dystocia

Shoulder dystocia results from a disproportionate size in the fetus compared with the volume and shape of the pelvic area of the mother. It has been defined as impaction of the anterior shoulder behind the pubic symphysis impeding spontaneous vaginal delivery. Even after extensive manipulation, it may not always be possible to deliver an infant vaginally when severe shoulder dystocia is present.Br. Sandberg has described a “potentially revolutionary” method for managing severe bilateral shoulder impaction in which partially born but vaginally undeliverable fetuses have been returned to the vagina and subsequently extracted by Caesarean section. He named it the Zavanelli manoeuvre.     

The Nurse's Role in the Identification of Risks and Treatment of Shoulder Dystocia

Shoulder dystocia is a clinical emergency that requires immediate recognition and prompt treatment to minimize maternal and neonatal sequelae. The nurse's role is to recognize and report associated risk factors for shoulder dystocia, respond with appropriate assistance, and monitor the woman and her newborn after delivery. The nurse's calm demeanor, knowledge of treatment modalities, and prepared response are valuable assets in this clinical dilemma.     

Fetal-Maternal Macrotransfusion — A Study of 400 Postpartum Women

The results of postpartum fetal cell counting in 400 Rh-negative patients delivering Rh-positive infants are presented and correlated with the mode of delivery and the ABO blood group relationship of baby and mother. Manipulative procedures, especially Caesarean section, are shown to increase the incidence of macrotransfusion. To make the most economical use of the new 125 microgram doses of anti-D gamma globulin, quantitation of fetal-maternal transfusions is shown to be vital if the existing level of protection from rhesus sensitization is to be maintained or increased.     

Strategies to Improve Management of Shoulder Dystocia Under the AHRQ Safety Program for Perinatal Care

Objective

To assess implementation of safety strategies to improve management of births complicated by shoulder dystocia in labor and delivery units.

Philippino and Vietnamese Women — A Study of Intrapartum Differences

The pregnancies of 140 Philippino women (168 deliveries) and 198 Vietnamese women (250 deliveries) were compared to those of Australian-born women delivered at the Mater Mothers' Hospital, Brisbane over the 5-year period 1980-1984 with the aim of detecting differences in their labour and mode of delivery. The Philippino women were predominantly married to Caucasian men whereas the Vietnamese women were married to Vietnamese men. The study assesses the clinical impression that this difference between the 2 groups affects intrapartum outcome. Birth-weights of the babies of Philippino women followed the same pattern as those of Australian women while Vietnamese women delivered smaller babies. Philippino primiparas had increases in all parameters of labour studied, notably an increased Caesarean section rate, especially those performed in the second stage. Comparable increases were not found in either Philippino multiparas or Vietnamese women. Based on these results 'relative' cephalopelvic disproportion is postulated among the Philippino women.     

米非司酮用于紧急避孕600例临床观察

探讨小剂量米非司酮150mg、50mg及25mg应用于紧急避孕的效果.对避孕失败或无避孕措施的性交后72h内就诊的健康妇女6o0例,随机分成3组.Ⅰ组:单次口服米非司酮150mg.Ⅱ组:单次口服米非司酮50mg.Ⅲ组:单次口服米非司酮25mg.结果:Ⅰ组200例.3例妊娠.Ⅱ组200例,4例妊娠.Ⅲ组200例,3例妊娠.均明显低于预期妊娠数(3组相应预期妊娠数分别为17.O30、15.000、14.868),两者之间存在显著差异(P<0.01).避孕有效率Ⅰ组为82.3%、Ⅱ组为73.3%、Ⅲ组为79.8%,3组之间无显著差异.服药后下次月经周期的改变,3组中以Ⅰ组变化较大;Ⅱ、Ⅲ组变化较小,Ⅰ组与Ⅱ、Ⅲ组之间存在显著差异(P<0.01),但3组总共有80.3%月经周期无改变,从总体上看对月经影响较少.仅有4.8%的人有轻微的副反应.表明150mg、50mg或25mg米非司酮作为性交后72h内的紧急避孕是有效的.建议用25mg米非司酮作为紧急避孕药.     

Sexual Counselling — A Dual Counselling Approach

A technique has been described which utilises a dual counselling approach to handle problems of a sexual nature. The methods used to structure counselling sessions are discussed as well as the benefits and the drawbacks of using a male and female counsellor to assist people who have some failure in their sexual lifestyle.     

Trauma During Pregnancy — A Review of Management

The assessment and management of 22 pregnant patients who were admitted after trauma to Westmead Hospital between July, 1987 and October, 1988 was reviewed. Thirteen of the 22 patients were victims of motor vehicle accidents. Despite the fact that an injury research unit, responsible for the clerking and review of all trauma patients, is well established at our institution, only 6 patients in this series had been assessed in this fashion. Although a number of important obstetric investigations (albeit uncommon in the accident and emergency room situation) are well described in the literature, these were not performed in a number of patients. A protocol for the management of such patients is recommended so that more standardized and appropriate care might be given to the injured pregnant patient.     

A Case Study of Maternal Response to the Implied Antepartum Diagnosis of Inevitable Labor Dystocia

Two pregnant women, one obese and one of extremely small stature, received antepartum recommendations from their health care providers to schedule cesarean births. In response, both women sought providers who would support their desire to attempt vaginal birth. The women's perspectives on their birth experiences along with the pertinent medical record data from their pregnancies and births provide a reminder about the inherent normalcy of birth amid the current culture of interventive obstetrical practices.