Shoulder dystocia

Shoulder dystocia can be one of the most frightening emergencies in the delivery room. Although many factors have been associated with shoulder dystocia, most cases occur with no warning. Calm and effective management of this emergency is possible with recognition of the impaction and institution of specified maneuvers, such as the McRoberts maneuver, suprapubic pressure, internal rotation, or removal of the posterior arm, to relieve the impacted shoulder and allow for spontaneous delivery of the infant. The "HELPERR" mnemonic from the Advanced Life Support in Obstetrics course can be a useful tool for addressing this emergency. Although no ideal manipulation or treatment exists, all maneuvers in the HELPERR mnemonic aid physicians in completing one of three actions: enlarging the maternal pelvis through cephalad rotation of the symphysis and flattening of the sacrum; collapsing the fetal shoulder width; or altering the orientation of the longitudinal axis of the fetus to the plane of the obstruction. In rare cases in which these interventions are unsuccessful, additional management options, such as intentional clavicle fracture, symphysiotomy, and the Zavanelli maneuver, are described.     

Shoulder dystocia

Shoulder entrapment during delivery is a true obstetric emergency that can result in significant maternal and infant trauma. Fetal macrosomia, maternal obesity, maternal diabetes and prolonged second stage of labor are associated risk factors. Infant complications of shoulder dystocia include traumatic brachial plexus injury, humeral fracture, clavicular fracture and severe birth asphyxia. With fetal shoulder entrapment, the mother may have significant hemorrhage, fourth-degree perineal lacerations and endometritis. Maneuvers to release the shoulder include closed-fist suprapubic pressure, downward pressure on the posterior shoulder, rotation of the anterior shoulder to the oblique position, rotation of the posterior shoulder beneath the pubic symphysis, release of the posterior arm and anterior rotation of the fetal body.     

Shoulder dystocia: using simulation to train providers and teams

Shoulder dystocia is an obstetric emergency that requires immediate recognition and a well-coordinated response. This response must include effective application of the maneuvers proven to relieve the impaction of the fetal shoulder and timely hand-off of the newborn to the neonatology team. The rare frequency of shoulder dystocia, coupled with patient safety concerns and the medico-legal environment, limits the opportunity of providers to learn and practice the management of shoulder dystocia. Training, especially simulation-based training, has been demonstrated to improve the management of shoulder dystocia. This article presents a review of the literature that supports simulation training for shoulder dystocia and provides guidance on creating and implementing shoulder dystocia training.     

巨大儿肩难产八例教训分析

随着生活水平的提高及孕期营养的加强 ,巨大儿发生率呈逐年上升趋势。国外文献报道新生儿出生体重≥ 4 0 0 0 g的发生率为 5 3% ,我国天津医科大学报道为 4 2 % [1] 。巨大儿阴道分娩可引起母婴严重并发症 ,其中肩难产的发生率为 1 5 %～ 1 7% [2 ] 。我院1995年 1月～ 2 0 0     

Shoulder dystocia. Nursing interventions and risk-management strategies

Shoulder dystocia is unpredictable; however, once identified there are reasonable steps that perinatal providers will be expected to take to attempt to dislodge the impacted shoulder. Be aware of these interventions and have a plan for what to do should dystocia occur. Stay calm and help the woman and physician or CNM through the crisis. Call for additional help as appropriate. Provide emotional support to the woman and her family. Ensure that the medical record reflects the events as accurately as possible. If an injury results, the nurse can then be sure that the team did the best they could to intervene during the emergency.     

Shoulder dystocia: when to use suprapubic or fundal pressure.

"The delivery of the head with or without forceps may have been quite easy, but more commonly there has been a little difficulty in completing the extension of the head. The hairy scalp slides out with reluctance. When the forehead has appeared it is necessary to press back the perineum to deliver the face ... time passes. The child's head becomes suffused. It endeavors unsuccessfully to breathe. Abdominal efforts by the mother or by her attendants produce no advance; gentle head traction is equally unavailing. Usually equanimity forsakes the attendants. They push, they pull. Alarm increases. Eventually by greater strength of muscle or by some infernal juggle, the difficulty appears to be overcome, and the shoulders and trunk of a goodly child are delivered. The pallor of its body contrasts with the plum-colored cyanosis of the face, and the small quantity of freshly expelled meconium about the buttocks. It dawns upon the attendants that their anxiety was not ill-founded, the baby lies limp and voiceless, and too often remains so despite all efforts at resuscitation".     

NEC: etiology, treatment, prevention, and nursing care

NEC, a highly lethal disease that affects premature/compromised infants, is characterized by ischemic necrosis of the gastrointestinal tract. While risk factors can be identified, pathogenesis is uncertain. Protective factors in breast milk promote intestinal maturation and protect the newborn gut from pathologic penetration of macromolecules. Medical and surgical treatments have improved the prognosis of those diagnosed with NEC; however, prevention appears to be the most effective way to decrease mortality rates in the ever-increasing premature population.     

便秘的预防及护理进展

从调整饮食、增加运动、指导养成良好排便习惯等方面综述了便秘的预防；从灌肠及腹部按摩、神厥穴贴敷等方面综述了便秘的护理。     

浅谈护理工作在预防保健中的作用

随着护理模式的转变,护理服务在预防保健中发挥着越来越重要的作用,护理健康教育是预防保健工作的基础。护理工作是控制院内感染的关键环节,在开展社区预防疾病、消毒防疫、预防接种工作中处于重要地位。县级疾病预防控制中心要加强护理队伍建设,重视护理工作。     

Falls prevention for elders in acute care: an evidence-based nursing practice initiative

The purpose of this article is to describe and measure the impact of a multifaceted program developed to reduce the falls rate on an acute medical unit at an academic tertiary care center. According to national benchmarks, this unit was one of the hospital's top 3 units for numbers of falls for several years. That distinction drove the hospital and unit leadership and a staff-led unit practice council to develop an evidence-based intervention plan. Interventions included a campaign to raise geriatric awareness, creation of "falls tool boxes," education of staff and family, and implementation of a structured hourly patient rounds schedule. The success of these interventions is discussed, including the effect on the falls rate benchmark. The discussion addresses implications and outcomes associated with the empowerment of nursing staff to respond to benchmarking measures, implement evidence-based practices, and use the same benchmarking procedure to measure outcomes.     

实施产时心理护理 降低难产发生率

对无明显头盆不称的初产妇３００例实施心理护理,以无明显头盆不称的初产妇３００例实施一般护理为对照组。两组产妇的年龄、孕周、妊娠次数、胎儿大小、健康状况及文化程度等无差异。结果表明,心理护理组难产发生率明显降低,较对照组约降低２３．３％,提示由专人负责实施心理护理,对防止无明显头盆不称的产妇由于产力异常所致的难产有积极作用     

纽曼保健系统模式在前列腺癌预防护理中的应用

近年来．前列腺癌发病率呈显著增长趋势，与人口老龄化、饮食结构和生活方式的改变及生态环境的破坏有关。泌尿外科采用纽曼保健系统模式进行三级预防护理干预，即通过健康教育、健康促进手段提高病人及家属预防管理疾病的能力和积极性，取得了良好的效果。现报道如下。     

纽曼保健系统模式在前列腺癌预防护理中的应用

近年来,前列腺癌发病率呈显著增长趋势[1],与人口老龄化、饮食结构和生活方式的改变及生态环境的破坏有关.泌尿外科采用纽曼保健系统模式进行三级预防护理干预,即通过健康教育、健康促进手段提高病人及家属预防管理疾病的能力和积极性,取得了良好的效果.现报道如下.     

心血管疾病预防护理的研究进展

我国心血管疾病发病人数不断增加,心血管病死亡居各类疾病之首,已成为重要的公共卫生问题和国家社会经济发展面临的巨大挑战。本文从心血管病预防中的护理干预方法、护士在心血管病预防中的角色和作用等方面对国外最新研究进展进行综述,旨在为我国护理工作者在心血管病预防中发挥积极作用提供理论依据。