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Re: Loevset's manoeuvreFrom: Ingvar Haukeland (ingvar@sn.no)Thu Oct 24 04:37:57 1996
>the way I was taught was to sweep the anterior arm down and out then rotate >the baby to make the other arm anterior and repeat > >David > >---------- >> From: R. Daniel Braun <rBraun@IUNET.IUPUI.EDU> >> To: Multiple recipients of list <ob-gyn-l@listserv.bcm.tmc.edu> >> Subject: Re: Loevset's manoeuvre -Reply >> Date: Wednesday, October 23, 1996 7:52 AM >> >> It is rotation away from the arm you want to deliver (clockwise if sacrum >> to the left as an example) - I had to look it up also - and found it in >> Plauche's Surgical Obstetrics - but not in Williams or in Hankins' >> Operative Ob >> >> I never heard this maneuver given a name before, but I was taught that it >> was the only way to deliver a breech. So I have used it for 30+ years >> and never knew there was any other way to do it. > >Joergen Loevset Prof GYN/OB at UiB Norway (1896-1981) He wrote a book " Vaginal operative delivery" 1968 Scandinavian University Books. In case it should interest anyone , I permit me to qoute from his book about rotating method (Loevset`s manoeuvre) " It consists of making the posterior shoulder the anterior one by rotating the body of the baby 180 ¤ or a little more. The rotation should take place in the hollow of the pelvis where all diameters have the same size. The rotation starts as soon as the angle of the scapula has arrived under the pubic arch. The baby`s body is kept horizontal and that keeps the posterior shoulder fairly well beyond the linea terminalis. To prevent it gliding above the pelvic inlet, the body should be kept in the horizontal plane during the first 90 ¤ of the rotation. If it were kept horizontal during the next 90 ¤ of the rotation, the shoulder would find its way above the symphysis. Therefore, the body of the baby is lowered as far as possible during that part of rotation. To get hold of the now anterior elbow without breaking the arm, rotation is continued until the elbow has come under the symphysis. As soon as the first shoulder and arm have been delivered, the body is rotated 180 - 200 ¤ in the opposite direction. The same rule applies for direction of the body, horizontally the first 90 dgr and lowered during the next 90-100 dgr In primiparae with an unprepared birth canal, it may be difficult to carry out the rotation in one movement. If the resistance seems to be quite strong, it is better to rotate back again from where the resistance seemd too strong to continue. This may be repeated several times until the rotation goes smoothly. This repeated rotation is only necessary for delivering the first shoulder in primiparae. This method is successful if the mother does not have a flat contracted pelvis. In that case, the shoulder will be blocked in the transverse diameter and the rotation will be impossible. But where the pelvis is not flatly contracted or where disproportion between foetus and pelvis does not make dilivery per vias naturalis impossible, rotation will succed, The first baby delivered by this method weighed 6 kg." Ingvar
-- Ingvar Haukeland
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