-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: Shoulder dystocia - Again! From: Braun, R. Daniel (rbraun@iupui.edu) Mon Sep 20 07:25:24 2004 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: RModugno@aol.com: "Re: Shoulder dystocia - Again!" Previous message: Braun, R. Daniel: "Re: Shoulder dystocia - Again!" Maybe in reply to: RModugno@aol.com: "Shoulder dystocia - Again!" Next in thread: RModugno@aol.com: "Re: Shoulder dystocia - Again!" YUP! Don't ever PULL on the head. BTW Traction means PULL R. Daniel Braun, MD "If everyone likes you, you're doing something wrong." Kinky Friedman I believe a self-righteous liberal or conservative with a cause is more dangerous than a Hell's Angel with an attitude. Andy Rooney -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of art fougner, md Sent: Sunday, September 19, 2004 4:32 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Shoulder dystocia - Again! question ... does not "traction on the head" aggravate pressure on the brachial plexus? art At Sun, 19 Sep 2004, RModugno@aol.com wrote: > >An interesting alternative manuever from OBG Management: > >LETTERS >Louis Freedman, MD Wilkes-Barre, Pa >An alternate maneuver for shoulder dystocia >I wish to add a postscript to the excellent article "Delivery dilemmas: >shoulder dystocia," by Drs. Gimovsky and Michael [December]. For many >decades, traditional rescue techniques for this unforeseeable emergency >changed little-until the Zavenelli maneuver (vertex replacement >followed by emergency cesarean section) came along several years ago. >Perhaps others had attempted this process but never reported it. I have >an alternative maneuver to suggest. > >Returning to my hometown in northeastern Pennsylvania from an academic >residency at the University of Pennsylvania in 1978, I had to adjust my >obstetrical techniques and adopt new skills to practice in one of the >nation's pioneer hospitals for family-centered obstetrics: Nesbitt >Memorial Hospital. > >Among these many adjustments was performing a bed delivery on an >old-fashioned flat stretcher. In this delivery environment, shoulder >dystocia typically is handled with McRobert's maneuver (flexion of the >mother's legs upward toward her abdomen), gentle and continuous >downward traction on the baby's head, a generous mediolateral >episiotomy, and suprapubic pressure. On a stretcher-bed, few of the >other maneuvers are applicable. > >Inspiration from desperation: If you cannot rotate the baby, rotate the >mother instead. Thus, with continuous, gentle downward traction on the >baby's head, rotate the mother completely onto her side, away from the >baby's face. If the shoulder does not slide easily out from under the >symphysis pubis, rotate the mother a full 180 degrees in the opposite >direction, to her other side. With continued gentle downward traction, >the impacted shoulder should deliver at some point in this rotational >process. > >This straightforward technique is simple to learn and execute, >especially on today's modern birthing beds. > >*********************************************** > >-- >*********************************************** >Robert Modugno MD MBA FACOG >Marietta, GA >http://www.novaobgyn.yourmd.com > -- art fougner, md ich bin ein New Yorker Next message: RModugno@aol.com: "Re: Shoulder dystocia - Again!" Previous message: Braun, R. Daniel: "Re: Shoulder dystocia - Again!" Maybe in reply to: RModugno@aol.com: "Shoulder dystocia - Again!" Next in thread: RModugno@aol.com: "Re: Shoulder dystocia - Again!"

Return to

Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Mon Nov 2 04:55:52 2009

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.