Publication
Shoulder dystocia: obstetric maneuvers and its morbidity
| Summary: | Introduction: Shoulder dystocia (SD) is known for being an unpredictable and unpreventable event associated to substantial morbidity to the mother and neonate. The aim of this study was to determine the incidence of SD in a tertiary care hospital and the morbidity according to the type of maneuvers (McRoberts' maneuver and suprapubic pressure versus rotational maneuvers or delivery of the posterior arm) used to resolve the dystocia. Methods: This was a prospective cohort study of pregnancies complicated with SD carried during two years and a half. Maternal characteristics, duration of second stage of labor, type of delivery, fetal weight, neonatal morbidity (Apgar score <7 at 1st minute, type of injury, neonatal intensive care unit admission) and maternal morbidity (3rd or 4th degree laceration, cervical tear, post-partum hemoglobin < 8g/dL, perineal haematoma, post-partum fever, dehiscence of episiotomy) were collected. According to the maneuver performed, data were compared using Chi-square test, Fischer exact test or Student t test, as appropriate. A p-value of < 0,05 was considered significant. Results: During the study period 123 (3.3%) pregnancies were complicated with SD. Baseline patient characteristics for age, parity, BMI, weight gain did not vary significantly according to type of maneuver. Rotational maneuvers and delivery of the posterior arm were associated to longer second stage of labour (60 min vs 45 min), higher proportion of instruments applied in a transverse fetal head position (30%) and increased neonatal (45%) and maternal (27%) morbidity. Conclusion: Although rare, SD is associated to increased neonatal and maternal morbidity, specifically when rotational maneuvers and delivery of posterior arm are used. |
|---|---|
| Main Authors: | Afonso,Maria Carvalho |
| Other Authors: | Fonseca,Andreia; Clode,Nuno; Graça,Luis Mendes |
| Subject: | Shoulder dystocia Obstetric emergency Obstetric maneuvers Maternal morbidity Neonatal morbidity |
| Year: | 2017 |
| Country: | Portugal |
| Document type: | article |
| Access type: | open access |
| Associated institution: | Fundação para a Ciência e Tecnologia |
| Language: | English |
| Origin: | SciELO Portugal |
| _version_ | 1868441862185943040 |
|---|---|
| author | Afonso,Maria Carvalho |
| author2 | Fonseca,Andreia Clode,Nuno Graça,Luis Mendes |
| author2_role | author author author |
| author_facet | Afonso,Maria Carvalho Fonseca,Andreia Clode,Nuno Graça,Luis Mendes |
| author_role | author |
| country_str | PT |
| creators_json_txt | [{\"Person.name\":\"Afonso,Maria Carvalho\"},{\"Person.name\":\"Fonseca,Andreia\"},{\"Person.name\":\"Clode,Nuno\"},{\"Person.name\":\"Graça,Luis Mendes\"}] |
| datacite.creators.creator.creatorName.fl_str_mv | Afonso,Maria Carvalho Fonseca,Andreia Clode,Nuno Graça,Luis Mendes |
| datacite.rights.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| datacite.subjects.subject.fl_str_mv | Shoulder dystocia Obstetric emergency Obstetric maneuvers Maternal morbidity Neonatal morbidity |
| datacite.titles.title.fl_str_mv | Shoulder dystocia: obstetric maneuvers and its morbidity |
| dc.creator.none.fl_str_mv | Afonso,Maria Carvalho Fonseca,Andreia Clode,Nuno Graça,Luis Mendes |
| dc.format.none.fl_str_mv | text/html |
| dc.identifier.none.fl_str_mv | http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302017000100005 |
| dc.language.none.fl_str_mv | eng |
| dc.publisher.none.fl_str_mv | Euromédice, Edições Médicas Lda. |
| dc.rights.none.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| dc.source.none.fl_str_mv | Acta Obstétrica e Ginecológica Portuguesa v.11 n.1 2017 |
| dc.subject.none.fl_str_mv | Shoulder dystocia Obstetric emergency Obstetric maneuvers Maternal morbidity Neonatal morbidity |
| dc.title.fl_str_mv | Shoulder dystocia: obstetric maneuvers and its morbidity |
| dc.type.none.fl_str_mv | http://purl.org/coar/resource_type/c_6501 |
| description | Introduction: Shoulder dystocia (SD) is known for being an unpredictable and unpreventable event associated to substantial morbidity to the mother and neonate. The aim of this study was to determine the incidence of SD in a tertiary care hospital and the morbidity according to the type of maneuvers (McRoberts' maneuver and suprapubic pressure versus rotational maneuvers or delivery of the posterior arm) used to resolve the dystocia. Methods: This was a prospective cohort study of pregnancies complicated with SD carried during two years and a half. Maternal characteristics, duration of second stage of labor, type of delivery, fetal weight, neonatal morbidity (Apgar score <7 at 1st minute, type of injury, neonatal intensive care unit admission) and maternal morbidity (3rd or 4th degree laceration, cervical tear, post-partum hemoglobin < 8g/dL, perineal haematoma, post-partum fever, dehiscence of episiotomy) were collected. According to the maneuver performed, data were compared using Chi-square test, Fischer exact test or Student t test, as appropriate. A p-value of < 0,05 was considered significant. Results: During the study period 123 (3.3%) pregnancies were complicated with SD. Baseline patient characteristics for age, parity, BMI, weight gain did not vary significantly according to type of maneuver. Rotational maneuvers and delivery of the posterior arm were associated to longer second stage of labour (60 min vs 45 min), higher proportion of instruments applied in a transverse fetal head position (30%) and increased neonatal (45%) and maternal (27%) morbidity. Conclusion: Although rare, SD is associated to increased neonatal and maternal morbidity, specifically when rotational maneuvers and delivery of posterior arm are used. |
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| eu_rights_str_mv | openAccess |
| format | article |
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| identifier.url.fl_str_mv | http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302017000100005 |
| instacron_str | SciELO |
| institution | Fundação para a Ciência e Tecnologia |
| instname_str | Fundação para a Ciência e Tecnologia |
| language | eng |
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| network_name_str | SciELO Portugal |
| oai_identifier_str | oai:scielo:S1646-58302017000100005 |
| organization_str_mv | urn:organizationAcronym:scielo |
| person_str_mv | Afonso,Maria Carvalho Fonseca,Andreia Clode,Nuno Graça,Luis Mendes |
| publishDate | 2017 |
| publisher.none.fl_str_mv | Euromédice, Edições Médicas Lda. |
| reponame_str | SciELO Portugal |
| repository_id_str | urn:repositoryAcronym:scielopt |
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| spelling | Shoulder dystocia: obstetric maneuvers and its morbidityAfonso,Maria CarvalhoFonseca,AndreiaClode,NunoGraça,Luis MendesShoulder dystociaObstetric emergencyObstetric maneuversMaternal morbidityNeonatal morbidityopen accesshttp://purl.org/coar/access_right/c_abf2http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302017000100005URLhttp://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302017000100005URLHasVersion2017-03-01Introduction: Shoulder dystocia (SD) is known for being an unpredictable and unpreventable event associated to substantial morbidity to the mother and neonate. The aim of this study was to determine the incidence of SD in a tertiary care hospital and the morbidity according to the type of maneuvers (McRoberts' maneuver and suprapubic pressure versus rotational maneuvers or delivery of the posterior arm) used to resolve the dystocia. Methods: This was a prospective cohort study of pregnancies complicated with SD carried during two years and a half. Maternal characteristics, duration of second stage of labor, type of delivery, fetal weight, neonatal morbidity (Apgar score <7 at 1st minute, type of injury, neonatal intensive care unit admission) and maternal morbidity (3rd or 4th degree laceration, cervical tear, post-partum hemoglobin < 8g/dL, perineal haematoma, post-partum fever, dehiscence of episiotomy) were collected. According to the maneuver performed, data were compared using Chi-square test, Fischer exact test or Student t test, as appropriate. A p-value of < 0,05 was considered significant. Results: During the study period 123 (3.3%) pregnancies were complicated with SD. Baseline patient characteristics for age, parity, BMI, weight gain did not vary significantly according to type of maneuver. Rotational maneuvers and delivery of the posterior arm were associated to longer second stage of labour (60 min vs 45 min), higher proportion of instruments applied in a transverse fetal head position (30%) and increased neonatal (45%) and maternal (27%) morbidity. Conclusion: Although rare, SD is associated to increased neonatal and maternal morbidity, specifically when rotational maneuvers and delivery of posterior arm are used.Euromédice, Edições Médicas Lda.Acta Obstétrica e Ginecológica Portuguesa v.11 n.1 2017text/htmlengjournal articlehttp://purl.org/coar/resource_type/c_6501literature |
| spellingShingle | Shoulder dystocia: obstetric maneuvers and its morbidity Afonso,Maria Carvalho Shoulder dystocia Obstetric emergency Obstetric maneuvers Maternal morbidity Neonatal morbidity |
| status | SINGLETON |
| subject.fl_str_mv | Shoulder dystocia Obstetric emergency Obstetric maneuvers Maternal morbidity Neonatal morbidity |
| title | Shoulder dystocia: obstetric maneuvers and its morbidity |
| title_full | Shoulder dystocia: obstetric maneuvers and its morbidity |
| title_fullStr | Shoulder dystocia: obstetric maneuvers and its morbidity |
| title_full_unstemmed | Shoulder dystocia: obstetric maneuvers and its morbidity |
| title_short | Shoulder dystocia: obstetric maneuvers and its morbidity |
| title_sort | Shoulder dystocia: obstetric maneuvers and its morbidity |
| topic | Shoulder dystocia Obstetric emergency Obstetric maneuvers Maternal morbidity Neonatal morbidity |
| topic_facet | Shoulder dystocia Obstetric emergency Obstetric maneuvers Maternal morbidity Neonatal morbidity |
| url | http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302017000100005 |
| visible | 1 |