The problem of shoulder dystocia

McEwan, Alec; Johnson, I. R.

doi:10.1054/cuog.2000.0148

Cited by 4 publications

(9 citation statements)

References 5 publications

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“…Excessive head traction, fundal pressure, and inverse head rotation are prohibited ("No PULL, No PUSH, No PANIC!"). A large number of recommended maneuvers indicates the problem and the need to modify those that are manipulative, releasing, rotational, and/or extractive (▶ table 3) [1,3,9,10].…”

Section: Clinical Risk In Correlation With Maneuvers and Outcomesmentioning

confidence: 99%

“…Episiotomy is recommended in most guidelines; if the head is impacted at the perineum, it is often impossible to perform an episiotomy [3]. Fundal compression (Kristeller's procedure), a favored aid in Eastern Europe during delivery, is a prohibited procedure because it further affects the impacted shoulders and is associated with uterine rupture, intracranial hemorrhage, neonatal death, bone fractures, and lesions of the intra-abdominal fetal organs and thorax [9]. About 10 % of FSD cases are refractory to primary procedures, and advanced and difficult internal procedures that require extensive experience and skill are needed [9].…”

Section: Clinical Risk In Correlation With Maneuvers and Outcomesmentioning

confidence: 99%

“…Fundal compression (Kristeller's procedure), a favored aid in Eastern Europe during delivery, is a prohibited procedure because it further affects the impacted shoulders and is associated with uterine rupture, intracranial hemorrhage, neonatal death, bone fractures, and lesions of the intra-abdominal fetal organs and thorax [9]. About 10 % of FSD cases are refractory to primary procedures, and advanced and difficult internal procedures that require extensive experience and skill are needed [9]. Coordinated cautious traction of the head and maternal pushing are successful in 43-50 % of cases, but forced traction carries a 5-33 % risk of clavicle or humerus fracture, spinal cord injury without radiographic abnormality (SCIWO-RA), and BP.…”

Section: Clinical Risk In Correlation With Maneuvers and Outcomesmentioning

confidence: 99%

“…The diagnosis of FSD can be made based on several definitions: when the pelvis of a woman in labor is large enough to give birth to the fetal head but not large enough to give birth to the fetal shoulders; when the shoulder is not born in subsequent contractions after the birth of the head, a condition requiring some obstetric procedures to release the impacted fetal shoulders; when 2 or more maneuvers are required to release the FSD; or if > 60 sec have elapsed since the birth of the head and the inability to give birth to the shoulder [1][2][3][4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…Fetal macrosomia increases the risk of FSD, so children with birth weight of 4000 g have a 2 % risk, 4500 g a 10 % risk, and 5000 g a 40 % risk of accidental FSD, although it is known to occur in 50-90 % of infants of normal birth weight. Gestational diabetes mellitus increases the risk of FSD five-fold, with perinatal mortality of FSD in 28 % and obstetric trauma in 36 % of cases (Erb-Duchenne syndrome) [1][2][3][4][5][6][7][8][9][10][11][12]. FSD is an acute intrapartum fetal-maternal, obstetric clinical incident with short-and long-term consequences, and this paper presents a forensic view of FSD (▶table 1, 2).…”

Section: Introductionmentioning

confidence: 99%

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A Forensic Aspect of Fetal Shoulder Dystocia

Habek

Cerovac

2020

Z Geburtshilfe Neonatol

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Fetal shoulder dystocia (FSD) is an unpredictable and critical obstetric intrapartum emergency, where an objective problem is the relationship between the mother's pelvis and the child, i. e., an anthropometric disorder of delivery mechanics and dynamics. It is evident that the need to perform other maneuvers indicates the severity of FSD, which in turn correlates with the consequent iatrogenic injury of the fetus and/or mother. FSD is certainly the most controversial forensic obstetric problem, with the most disputes, compensation for damages due to peripartum injury to the child and/or mother, pain suffered, the need for someone else's care, and permanent disability. Suboptimal procedures and inadequate documentation are factors of forensic risk and subsequent litigations. Prevention of FSD is generally not possible, although good antenatal care can sometimes exclude risky cases of FSD, and some rare, chronic intrauterine disorders can result in orthopedic and neurological sequelae, which is especially important in forensic analysis. Because FSD is largely impossible to predict, it must be viewed as an intrapartum acceptable risk. During childbirth, FSD may compromise the safety of the mother and unborn child, therefore education and skills acquisition are necessary for obstetric work. Risk control, proper procedures, and proper documentation, along with good communication with the pregnant women and their families, significantly reduce litigation procedures.

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Section: Clinical Risk In Correlation With Maneuvers and Outcomesmentioning

confidence: 99%

Section: Clinical Risk In Correlation With Maneuvers and Outcomesmentioning

confidence: 99%

Section: Clinical Risk In Correlation With Maneuvers and Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Forensic Aspect of Fetal Shoulder Dystocia

Habek

Cerovac

2020

Z Geburtshilfe Neonatol

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Shoulder dystocia

Baskett

2002

Best Practice & Research Clinical Obstetrics & Gynaecol

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Shoulder dystocia is an uncommon but not rare obstetric emergency. Death of the infant is unusual but perinatal morbidity is frequent and can result in permanent injury. These cases carry significant medico-legal implications. This chapter covers the mechanisms, predisposing factors and management of shoulder dystocia. A well-rehearsed sequence of manoeuvres to manage shoulder dystocia will minimize fetal trauma.

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Forensic Obstetrics and Clinical Risk Factors

Habek,

Petrovečki,

Cerovac

et al. 2024

Z Geburtshilfe Neonatol

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Forensic obstetrics attracts much attention from forensic experts and the public owing to the professional, legal, public health, and not inconsiderable social-emotional aspects and directly correlates with maternal, fetoneonatal, and iatrogenic risk factors. Modern obstetrics and fetomaternal medicine must not be quantified and qualified based only on perinatal disease but also according to current obstetric problems that burden forensic obstetrics. Therefore, high-risk obstetrics as a significant medico-legal problem should be viewed from the point of view of the entire perinatal period with possible long-term consequences, hence the monitoring of complete perinatal and infant morbidity is of immediate importance for quality control and risk control in the profession. The task of forensic obstetrics is to assess the impact of risk factors on the occurrence of an adverse event and to assess whether it is an obstetric complication or obstetric malpractice. Acknowledging the mentioned facts is the only way we will develop high obstetric awareness, and we and pregnant women, birth attendants, midwives and patients, fetuses, and newborns will have professional safety with imminent but controlled obstetric risk and controlled expected complications. On the other hand, the fact that the statistics of perinatal (obstetrical) malpractice globally is not abating requires a change in obstetrical philosophy, especially the unreasonable epidemic increase of cesarean sections with a significant percentage of cesarean sections without medical indication and complications. It is necessary to introduce and maintain solid professionalism and bioethical norms in obstetrics with constant training of skills, which is emphasized by numerous authors and with which we fully agree. Forensic obstetrics is based on the principles of good clinical practice, professional guidelines of modern obstetrics, and ethical and deontological principles. It clearly shows the perfection and imperfection of biological systems that we can and cannot influence. However, we must act according to the rules of the clinical profession, deontological rules, and health laws to reduce clinical risk to the smallest possible extent. Attention should certainly be focused on reducing the disproportion between iatrogenic and maternal-fetoneonatal risk factors, which is the most common reason for litigation today.

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The problem of shoulder dystocia

Cited by 4 publications

References 5 publications

A Forensic Aspect of Fetal Shoulder Dystocia

A Forensic Aspect of Fetal Shoulder Dystocia

Shoulder dystocia

Forensic Obstetrics and Clinical Risk Factors

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