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FRI - Baby 1, Ob 0From: art fougner, md (evsono@pipeline.com)Fri Jan 21 08:20:11 2000
This from sat 1/22/2000 Lancet - Baby 1, obstetrician 0 Sir--If you think that newborn infants are helpless little creatures, think again! We present an unusual traumatic injury of childbirth to defy such simplistic notion. A 28-year-old woman was admitted to the delivery room in labour. Her pregnancy had been normal, and a routine glucose-challenge screening test done at 25 weeks was normal. Estimation of fetal weight at admission was 3600 g, and intravenous oxytocin was given in the second stage of labour for augmentation of contractions because the infant's head had stopped descending. 2 h after complete cervical dilatation, we noted a long period of fetal bradycardia and did a vacuum extraction. The infant's head was delivered, but delivery of the shoulders was unsuccessful, and shoulder dystocia was diagnosed. McRoberts manoeuvre (hyperflexion of the mother's hips) combined with suprapubic pressure did not resolve the critical situation. The obstetrician (UE) decided to do Wood's manoeuvre. With his right hand deep in the womans pelvis he tried to rotate the infant's posterior shoulder. However, while the shoulders were rotated a cracking sound was heard. The baby was delivered immediately. The infant's birthweight was 3800 g and the Apgar score was 9 and 10 at 1 min and 5 min, respectively. The baby had a very mild weakness of the right arm, with no fractures, which resolved completely on discharge from the hospital 2 days later. The obstetrician, however, felt excruciating pain in his right hand while doing the Wood's manoeuvre. His hand was swollen and painful immediately after delivery. A radiograph of his right hand showed a spiral fracture in the right fourth metacarpal bone and he needed a cast that immobilised his right hand for 6 weeks. Childbirth may sometimes be a traumatic event for the newborn. Shoulder dystocia is a particularly serious and unpredictable event with well-recognised traumatic complications to the newborn infant and mother.1 This childbirth was definitely a traumatic experience for the obstetrician who was wounded in the line of duty. To the best of our knowledge, this injury has not yet been mentioned as a complication of fetal shoulder dystocia. *Uriel Elchalal, Avi Tsafrir, Asher Shushan, Carole Pidhorz *Department of Obstetrics and Gynaecology, and Hand Unit, Hadassah University Hospital, Jerusalem, Israel 91120 1 Cunningham FG, MacDonald PC, Gant NF, et al, eds. Dystocia, abnormal presentation, position, and development of the fetus. Williams Obstetrics, 20th edn. Norwalk, CT: Appleton and Lange, 435-59. have a great weekend. Art
-- art fougner, md
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