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Re: OB: How to deliver From: Braun, R. Daniel (rbraun@iupui.edu) Thu Jan 31 04:40:00 2002 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Braun, R. Daniel: "Re: OB: How to deliver" Previous message: Efrain Ramirez: "Re: OB: How to deliver" Maybe in reply to: Garry Siegel: "OB: How to deliver" Next in thread: Braun, R. Daniel: "Re: OB: How to deliver" OTOH: Perinatal implications of shoulder dystocia. Obstet Gynecol 1995 Jul;86(1):14-7 (ISSN: 0029-7844) Baskett TF; Allen AC Department of Obstetrics and Gynaecology, Grace Maternity Hospital, Halifax, Nova Scotia, Canada. OBJECTIVE: To assess the antecedents of shoulder dystocia, the risk of recurrence, and the perinatal morbidity associated with the different maneuvers used for its management. METHODS: We conducted a 10-year (1980-1989) retrospective case record review of all instances of shoulder dystocia in a teaching maternity hospital. RESULTS: There were 254 cases of shoulder dystocia in 40,518 vaginal cephalic deliveries (0.6%), with 33 cases (13.0%) of brachial plexus palsy and 13 fractures (5.1%). There were no perinatal deaths attributable to shoulder dystocia. The risk of shoulder dystocia was increased with prolonged pregnancy (threefold), prolonged second stage of labor (threefold), mid-forceps deliveries (tenfold), and increasing birth weight. Of the maneuvers used to deal with shoulder dystocia, strong downward traction on the head was significantly correlated with brachial plexus palsy compared with other individual methods of delivering the shoulders. There was only one case of recurrent shoulder dystocia in 80 women having 93 cephalic vaginal deliveries after their original delivery coded with shoulder dystocia. CONCLUSION: Shoulder dystocia is not a reliably predictable event in labor. Although the risk of shoulder dystocia is increased with prolonged pregnancy, prolonged second stage of labor, increasing birth weight, and mid-forcepts delivery, the majority of cases occur without these risk factors. Strong downward traction on the head is associated with the greatest degree of neonatal trauma, whereas McRoberts maneuver has the least. The risk of recurrent shoulder dystocia is low. To present a contradictory study. Less likely to recur in Halifax than in CHicago. Dan R. Daniel Braun, MD Laws to suppress tend to strengthen what they would prohibit. This is the fine point on which all the legal professions of history have based their job security. Bene Gesserit Coda -----Original Message----- From: evsono@pipeline.com [mailto:evsono@pipeline.com] Sent: Wednesday, January 30, 2002 5:14 PM To: Multiple recipients of list OB-GYN-L Subject: Re: OB: How to deliver previous hx of shoulder dystocia carries with it a relative risk of 10 for a repeat performance. Am J Obstet Gynecol 2001 Jun;184(7):1427-9; discussion 1429-30 How to predict recurrent shoulder dystocia. Ginsberg NA, Moisidis C. Department of Obstetrics and Gynecology, Northwestern University, Illinois, USA. OBJECTIVE: Our aim was to determine the rate and risk factors for recurrent shoulder dystocia. STUDY DESIGN: A retrospective analysis of patients diagnosed with shoulder dystocia was performed by searching a computerized database from January 1, 1993, to June 30, 1999 for the following information: (1) vaginal deliveries, either spontaneous or operative, (2) shoulder dystocia, (3) birth weight, (4) duration of second stage of labor, (5) parity, and (6) gestational diabetes. Statistical analyses included chi(2) and t test. RESULTS: There were 39,681 vaginal deliveries with 602 (1.5%) complicated by shoulder dystocia. Sixty-six patients underwent a subsequent vaginal delivery, and 11 (16.7%) experienced another shoulder dystocia. The odds ratio for a recurrent shoulder dystocia was 10.98 (P <.000001). Nine of the 11 patients with recurrent shoulder dystocia compared with 28 of 55 without a recurrence were nulliparous women in their index pregnancy (P <.001). The mean fetal weights were 3885 g in the recurrent dystocia group and 3702 g in the group without recurrence (P <.03). Gestational age, operative delivery, and gestational diabetes were similar in the two groups. CONCLUSION: Factors that appear to increase the recurrence risk of shoulder dystocia include fetal weight and maternal parity. Prior shoulder dystocia is the single greatest predictive factor. suggest this be presented to the patient before discussing options. art At Tue, 29 Jan 2002, Garry Siegel wrote: > >OK, here's one to kick around a bit. > >25 YO P1001 at 16 weeks, good dates, in for a routine visit. At her >first visit, with our CNM (who does office only), she described a >difficult vaginal delivery with a shoulder dystocia, of a 9 pound, 2 >ounce baby, who went home with her 3 days later, with no sequelae, birth >trauma, etc. The patient used the word, "Vaginal C/Section," duly >written onto our prenatal by our office RN. The patient was not >diabetic in that pregnancy. > >At the visit, the patient told the CNM that she was told that she should >have C/Sections in future pregnancies, and that apparently is how the >issue was left. 1 hour glucose screening was done, and was 111 mg/dl (I >think that those are the right units). > >Well, I just saw her and went over the above, and requested records (but >likely the progress notes/written delivery note will not have the detail >needed). I told her that I would like to review things, once available, >and then discuss options. > >Would you: > >1. Say "screw it" and just plan a section at term without labor. >2. Try to press her into a vaginal attempt, carefully conducted, or >course. >3. Hope the records come, review them, and then deal with it. That >said, the basic choices will still be "1" or "2". >4. Make a tentative plan to visit this near term, after a clinical >and/or ultrasonographic assessment of EFW, as well as a cervical >examination. >5. Have your partners deal with it :). >6. Other: please expand > >Garry > >-- >Garry E. Siegel, M.D., F.A.C.O.G. >Roswell, GA >Private Practice > -- art fougner, md ich bin ein New Yorker Next message: Braun, R. Daniel: "Re: OB: How to deliver" Previous message: Efrain Ramirez: "Re: OB: How to deliver" Maybe in reply to: Garry Siegel: "OB: How to deliver" Next in thread: Braun, R. Daniel: "Re: OB: How to deliver"

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