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fatal shoulder dystociaFrom: STEWART PRINGLE (100724.2333@compuserve.com)Wed Dec 23 17:25:23 1998
I had my first fatal case yesterday. An 110kg, 1.62m, para 2 being induced at 41 weeks with a big baby. Ist baby 3.1 kg, 2nd 3.9 kg, both normal deliveries. Labour progressed quickly and the delivery was being managed ( as throughout the UK) by midwives. The head delivered after slow crowning and the shoulders got stuck. I was the second to be called after the registrar present couldn't deliver the baby. I arrived about 5 minutes after delivery of the head and took about 90 seconds to deliver the baby breaking the posterior arm in the process. I felt momentarily guilty but thought that at least the baby was alive. But there was no heart beat and resus abandonded after 25 minutes. I went home and found the December Brit J Obs Gynae on the door step. "A review of 56 fatal cases..." What surprised me most was the median delay in delivering the baby from delivery of the head - only 5 minutes. In my case it was about 8 minutes. Before today I would have felt sure that at least a heartbeat would have been present at that point. Furthermore I would have not believed the record keeping of the times in the published cases. Do we really have as little time as that to deliver the shoulders or is there is something else which contributes ( as the article suggests ) to the poor outcome in severe shoulder dystocia? By the way this baby at 4.86kg was bigger than any (surprisingly) in the series of 56.
-- Stewart Pringle Southern General Hospital Glasgow, UK 100724.2333@compuserve.com
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