DISTOCIA DE OMBRO – PDF
Obstetrics, gynecology and reproductive medicine guidelines. Labor, delivery, postpartum. PubMed Free Full Text · Français – Español – Italiano – Deutsch. aprendiz bem como o registro e o feedback referente às suas tomadas de ou seja, uma tomada de decisão para que o bebê nasça; = Distócia de Ombro. Curso de Hemorrágia Pós Parto e Distocia de Ombro. Public. · Hosted by Midwife Education. Interested. clock. Saturday, November 24, at AM –
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Shoulder dystocia SD is known for being an unpredictable and unpreventable event associated to substantial morbidity to the mother and neonate. This was a prospective cohort study of pregnancies complicated with SD carried during two years and a half.
Curso de Hemorrágia Pós Parto e Distocia de Ombro
According to the maneuver performed, data were compared using Chi-square test, Fischer exact test or Student t test, as appropriate. During the study period 3. Baseline patient characteristics for age, parity, BMI, weight gain did not vary significantly according to type of maneuver. Although rare, SD is associated to increased neonatal and maternal morbidity, specifically when rotational maneuvers and delivery of posterior arm are used.
Shoulder dystocia; Obstetric emergency; Obstetric maneuvers; Maternal morbidity; Neonatal morbidity. Shoulder dystocia SD is defined as a delivery where an additional manoeuvre beyond gentle traction of the fetal head is needed to complete the baby delivery. It occurs in 0. Although the effort on trying to find risk factors ante and intrapartum, most of the cases can not be anticipated, therefore SD its known for being an unpredictable and unpreventable event.
In order to expedite the delivery, many maneuvers have been described for successful disimpact of the anterior shoulder behind symphysis pubis. The choice of the maneuver should be based on the degree of invasiveness of the maneuvers, individual training and clinical experience, as well ombo the prevailing circumstances 3. Tough, it is acceptable that we should begin with the least invasive maneuvers suprapubic pressure and McRoberts tecnique and, if unsuccessful, moving on to more invasive ones distcia.
This vistocia a prospective cohort study of pregnancies complicated with SD between 1 st June of and 31 st December disfociain our institution. In our institution, prophylactic maneuvers are not performed routinely, but in case of SD, McRoberts and supra-pubic pressure are always the first maneuvers to perform. All singleton cephalic pregnancies were included. We did not considered bruising, cephalo-hematomas or other soft tissue injuries that could have resulted from the management of the shoulder dystocia as neonatal injury.
The final maneuver used to release the distociz shoulders was considered the successful one. The cases were divided into the following two groups: Statistical analysis distocix conducted using Statistical Package for the Social Science for Mac version During the study period, there were cases 3. Maternal demographics are presented in Table I. Baseline patient characteristics for ageparity, BMI, weight gain in pregnancy did not vary significantly according disotcia type of maneuver used to resolve the SD.
There was just one patient with history of SD in a previous pregnancy she was in the group where rotational maneuvers or delivery of posterior arm were necessary to resolve SD.
The proportion of women distcia either gestational diabetes or pre-existing diabetes was not statistical different between groups. Obstetric management is detailed in Table II. Instrumental delivery was performed in the same proportion distoci groups.
Although no statistically significant difference in the type of operative vaginal delivery mid, low, outlet was noted, when the instrument was applied in a transverse position of distkcia fetal head the rate of rotational maneuvers or delivery of posterior arm were higher. The median birth weight of the neonates was not different between the groups. No case of humerus fracture, hypoxicischemic encephalopathy and neonatal death were reported.
In order to compare rotational maneuvers with delivery of posterior arm, we performed a sub-analysis: Maternal morbidity was not different between groups. After the diagnosis of shoulder dystocia, the operator has up to five minutes to deliver a previously well oxygenated fetus re an increased risk of asphyxia injury occurs 6,7.
In order to release the impacted shoulder, several maneuvers have been used, but there are omgro randomized trials for comparing their effectiveness. No single maneuver is clearly more effective or safer for the fetus and the initial choice and order of progression will depend on the operator experience 1,3,4. The incidence of SD ranges from 0. This wide range may be a consequence of the subjectivity of the definition.
We found an incidence of 3. It is possible that this higher rate is due to the fact that this was a prospective study and, consequently, obligation for precise documentation of the cases was often stressed during the study period. McFarland found that In our study the higher incidence of SD solved with the use of McRoberts and supra-pubic pressure may have two explanations.
The same finding was observed in the work of Leung, when he analyzed the effectiveness and safety of individual maneuvers, according to the sequence of the maneuvers used However, we found that cases requiring more extensive maneuvers were associated with longer second stages of labor 45 minutes versus 60 minutes and the transverse fetal head position. Nevertheless, 15 minutes of difference does not seem clinically relevant and, moreover, parity and spinal anesthesia have not been taken into account for the statistical analysis.
Interestingly, when the instruments where applied in a transverse fetal head position, there was a higher need for rotational maneuvers or delivery of posterior arm for solving a SD. disrocia
Distócia de ombros: manobras obstétricas e morbilidade associada
However, we believe this finding needs to be further evaluated in prospective studies where the fetal head position is recorded regardless of the type of delivery. There are only a handful of studies that evaluated the different types of maneuvers to overcome shoulder dystocia and the rates of associated fetal injury.
We found that when more extensive maneuvers were needed, newborns had lower Apgar score at the first minute and an higher rate of neonatal injuries, specifically clavicular fracture. The few studies reporting the neonatal morbidity according to the type of maneuvers used to resolve SD are retrospective and the data is not completely clear.
In the same way, McFarland found higher neonatal injuries when three or more maneuvers were needed 9.
There were no cases of humeral fracture. At this step, brachial lesion might occur. However, because the clavicles are part of the shoulder girdle, they will be under stress during rotation in both directions, thus increasing the risk of fracture. In our series, none of these complications have occurred. Understandably, rotational maneuvers and delivery of posterior arm were associated with higher maternal morbidity – 3 rd or 4 th degree laceration. Similar findings had previously been reported by McFarland, who found that the incidence of maternal fourth-degree laceration or episiotomy increased as the number of maneuvers increased.
This was a prospective study and therefore we were able to include a reasonable number of women and complete outcome data. Moreover, the uniformity in the management of pregnancy complications and shoulder dystocia based on protocols that followed standard guidelines and were adopted by our department is another strength.
Nonetheless, more prospective studies where the fetal head position is recorded are needed.
As seen in other studies, the use of a subjective definition can overestimate the rate of SD. This is a weakness of virtually all SD studies.
Furthermore, if an instrumental delivery is performed, when the instruments are ombor in a transverse fetal head position, there is a higher need for rotational maneuvers or delivery of posterior arm for solving SD. ACOG practice bulletin clinical management guidelines for obstetrician-gynecologists. Number 40, November Obstet Gynecol ; A comparison of disotcia maneuvers for the acute management of shoulder dystocia.
Severe chronic morbidity of childbirth. Royal College of Obstetricians and Gynecologists.
Am J Obstet Gynecol. Head-to-body delivery interval and risk of fetal acidosis and hypoxic ischaemic encephalopathy in shoulder dystocia: Relationship between head-to-body delivery interval in shoulder dystocia and neonatal depression. Am J Obstet Gynecol ; Perinatal out- come and the type and number of maneuvers in shoulder dystocia.
Internat J Gynecol Obstet ; distoocia Comparison of perinatal outcomes of shoulder dystocia alleviated by different type and sequence of manoeuvres: Heath T, Gherman R. Methods This was a prospective cohort study distociq pregnancies complicated with SD between 1 st June of and 31 st December ofin our institution. Results During the study period, there were cases 3. Discussion After the diagnosis of shoulder dystocia, the operator has up to five minutes to deliver a previously well oxygenated fetus before an increased risk of asphyxia injury occurs 6,7.
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