Is fetal manipulation during shoulder dystocia management associated with severe maternal and neonatal morbidities?

Gachon, Bertrand; Desseauve, David; Fritel, Xavier; Pierre, Fabrice H.F.

doi:10.1007/s00404-016-4013-1

Cited by 8 publications

(4 citation statements)

References 18 publications

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“…McRoberts maneuver and posterior arm rescue (21.2%). Gachon et al reported in their study that episiotomy was more common in patients who performed the maneuver with SD (p < 0.05) [11]. In our study, episiotomy was also more common in patients with SD (p < 0.001).…”

Section: Discussionsupporting

confidence: 65%

Risk Factors in Prediction of Shoulder Distocia

Kose¹,

Baran

OZBEK³

et al. 2022

Preprint

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Purpose The aim of this study was to evaluate the maternal, obstetric, and fetal risk factors, shoulder dystocia maneuvers, and perinatal outcomes of shoulder dystocia cases. Methods In this descriptive retrospective cross-sectional study, 66 documented shoulder dystocia (incidence 0.18%) groups from 36390 singleton vaginal deliveries between 2017 and 2022 in a gynecology&obstetrics hospital and 201 control groups selected from the computer-assisted randomization program on pregnancy, delivery, fetal and newborn outcomes data were evaluated and compared. Regression analysis were used to explain the relationship between the shoulder dystocia and risk factors. Results Mean age was significantly higher in the shoulder dystocia group (p < 0.05). In the stepwise binary logistic regression model analysis, hemoglobin level, abdominal circumference, femur length, estimated fetal weight, birth weight and second stage of labor were found to be significant risk factors for shoulder dystocia (p < 0.05). Measurement of abdominal circumference (sensitivity 81.8%, specificity 91.0%) and birth weight (sensitivity 62.4%, specificity 91.5%) were found to be the most significant risk factors for shoulder dystocia, while the other risk factors had low sensitivity (< 60.0%). Conclusion The low sensitivity of shoulder dystocia risk factors other than birth weight and abdominal circumference measurement indicates that the unpredictable feature of shoulder dystocia is preserved.

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Section: Discussionsupporting

confidence: 65%

Risk Factors in Prediction of Shoulder Distocia

Kose¹,

Baran

OZBEK³

et al. 2022

Preprint

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“…Last resort maneuvers may be more associated with uterine rupture, pubic symphysis diastasis and urinary tract injuries. 36 …”

Section: What Are the Main Maternal And Neonatal Complications Associ...mentioning

confidence: 99%

“…Last resort maneuvers may be more associated with uterine rupture, pubic symphysis diastasis and urinary tract injuries. (36) Neonatal injuries aff ect 5% of cases of shoulder dystocia. They can occur even when treatment is properly instituted.…”

Section: Introductionmentioning

confidence: 99%

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Management of shoulder dystocia

Alves

Nozaki²,

Andreucci

et al. 2022

Rev Bras Ginecol Obstet

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Shoulder dystocia is a predominantly unpredictable and non-preventable event.• The progressive incidence of obesity and diabetes has determined the contemporary increase in shoulder dystocia incidence. • The main risk factors for shoulder dystocia are fetal macrosomia, diabetes mellitus, dystocia in the functional periods of labor and operative vaginal delivery. • Clinical imaging and pelvimetry are not helpful in identifying women at higher risk for shoulder dystocia.• Diagnosis and severity of shoulder dystocia are subjective. Failure of the head-shoulder maneuver and the turtle sign are the main diagnostic criteria. The need for multiple delivery maneuvers and the occurrence of maternal and/or neonatal injuries better evidence the severity of cases. • Professionals involved in childbirth care must be prepared to recognize shoulder dystocia and immediately perform a sequence of maneuvers for its correction in a timely manner. • Control of body weight and blood glucose levels is the main strategy likely to reduce the risk of shoulder dystocia. • The most common serious maternal complications of shoulder dystocia are postpartum hemorrhage and complicated perineal lacerations. • The most frequent neonatal complication of shoulder dystocia is transient brachial plexus palsy.• Skills training and simulation improve the care and documentation of shoulder dystocia, promoting evidence-based management and reducing transient brachial plexus injuries. Recommendations• In pregnancies with diabetes and estimated fetal weight above 4,500 grams (g) and in those without diabetes and estimated fetal weight above 5,000 g, cesarean section appears to prevent shoulder dystocia. • In the prolongation of the second stage of labor in diabetic parturient women with an estimated fetal weight between 4,000 and 4,500 g, and in non-diabetic women with an estimated fetal weight between 4,500 and 5,000 g, cesarean section for the prevention of shoulder dystocia is also applicable. • In the prolonged pelvic period of fetuses with estimated weight of more than 4,500 g, intrapartum cesarean section for prevention of shoulder dystocia is preferable to low operative vaginal delivery or forceps delivery.Similarly, operative vaginal delivery with the fetal head in the mid-pelvis should be avoided in fetuses estimated to weigh more than 4,000 g, and intrapartum cesarean section is indicated. In these situations, birth instrumentation should only be considered in the presence of experienced operators, through an individualized assessment of fetal position and size, history of previous deliveries and maternal habits. • Induction of labor to prevent shoulder dystocia is indicated in pregnant women with gestational diabetes at 39 weeks and estimated fetal weight between 4,000 and 4,500 g. In pregnant women without diabetes, induction can also be offered at 39 weeks when the estimated fetal weight is between 4,000 and 5,000 g, but expectant management is also a reasonable alternative. • A sequence of maneuvers that may vary according to the parturient ...

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