Prediction, prevention and management of shoulder dystocia

2012 ◽  
Vol 153 (20) ◽  
pp. 763-767
Author(s):  
Roland Csorba
Keyword(s):  
Risk Factors ◽  
Perinatal Mortality ◽  
Maternal Morbidity ◽  
Shoulder Dystocia ◽  
Current Evidence ◽  
Sacral Promontory ◽  
Fourth Degree ◽  
Mortality And Morbidity ◽  
Perineal Tears ◽  
Fetal Complications

Shoulder dystocia is one of the most tragic, fatal and unexpected obstetrical events, which is mostly unpredictable and unpreventable. This clinical picture is defined as a delivery that requires additional obstetric maneuvers to release the shoulders after gentle downward traction has failed. Shoulder dystocia occurs when the fetal shoulder impacts on the maternal symphysis or sacral promontory. The incidence of shoulder dystocia is 0.2–0.6%. High perinatal mortality and morbidity is associated with the condition, even when it is managed appropriately. Obstetricians should be aware of the existing risk factors, but should always be alert to the possibility of shoulder dystocia in all labors. Maternal morbidity is also increased, particularly postpartum hemorrhage, rupture of the uterus, injury of the bladder, urethra and the bowels and fourth-degree perineal tears. Complications of the newborn include asphyxia, perinatal mortality, fracture of the clavicula and the humerus. Brachial plexus injuries are one of the most important fetal complications of shoulder dystocia, complicating 4–16% of such deliveries. The purpose of this article is to review the current evidence regarding the possible prediction, prevention and management of shoulder dystocia. Orv. Hetil., 2012, 153, 763–767.

scholarly journals Risk factors for third- and fourth-degree perineal tears during vaginal delivery

2011 ◽  
Vol 25 (1) ◽  
pp. 2
Author(s):  
Leonard Juul ◽  
Gerhard B. Theron
Keyword(s):  
Risk Factors ◽  
Shoulder Dystocia ◽  
Control Group ◽  
Study Group ◽  
Tertiary Referral Hospital ◽  
Retrospective Case ◽  
Fourth Degree ◽  
Perineal Tears ◽  
Vaginal Deliveries ◽  
Hiv Negative

<strong>Objective</strong>. To identify risk factors for thirdand fourth-degree perineal tears, so as to anticipate and intervene in order to prevent this complication that can severely affect a woman’s quality of life. The study design was a retrospective case control study. <strong>Method</strong>. Ninety-three cases of third- and fourth-degree perineal tears were identified from the birth register of a tertiary referral hospital (Tygerberg Hospital). One hundred and nine patients with normal vaginal deliveries in the same time period were used as control group. <strong>Results</strong>. An analysis of the results revealed that there were no significant differences between cases and controls with regards to age, body mass index (BMI), gestation at delivery, duration of second stage, episiotomy and birth weight. However, there were significantly more primigravidas, assisted deliveries (forceps and vacuum), occipitoposterior positions, HIV negative patients and shoulder dystocia in the study group. <strong>Conclusions</strong>. Antenatal risk factors for thirdand fourth-degree tears are difficult to identify. However, intrapartum occipitoposterior and assisted deliveries, especially in the primigravid patient, should warn the obstetrician/ midwife about the risk of a severe tear. A restrictive episiotomy policy should be practiced. Shoulder dystocia was invariably associated with third- and fourth-degree tears in this study. The higher incidence of HIV negative patients in the study group requires further research.

scholarly journals Evaluation of Suzor forceps training by studying obstetric anal sphincter injuries: a retrospective study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Perrine COSTE MAZEAU ◽  
Nedjma BOUKEFFA ◽  
Nathalie TICAUD BOILEAU ◽  
Samantha HUET ◽  
Maud TRAVERSE ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Retrospective Study ◽  
Observational Study ◽  
Anal Sphincter ◽  
University Hospital ◽  
Obstetric Anal Sphincter Injuries ◽  
Fourth Degree ◽  
Perineal Tears ◽  
Vacuum Extractor

Abstract Background Instrumental deliveries are an unavoidable part of obstetric practice. Dedicated training is needed for each instrument. To identify when a trainee resident can be entrusted with instrumental deliveries by Suzor forceps by studying obstetric anal sphincter injuries. Methods A French retrospective observational study of obstetric anal sphincter injuries due to Suzor forceps deliveries performed by trainee residents was conducted from November 2008 to November 2016 at Limoges University Hospital. Perineal lesion risk factors were studied. Sequential use of a vacuum extractor and then forceps was also analyzed. Results Twenty-one residents performed 1530 instrumental deliveries, which included 1164 (76.1%) using forceps and 89 (5.8%) with sequential use of a vacuum extractor and then forceps. Third and fourth degree perineal tears were diagnosed in 82 patients (6.5%). Residents caused fewer obstetric anal sphincter injuries after 23.82 (+/− 0.8) deliveries by forceps (p = 0.0041), or after 2.36 (+/− 0.7) semesters of obstetrical experience (p = 0.0007). No obese patient (body mass index> 30) presented obstetric anal sphincter injuries (p = 0.0013). There were significantly fewer obstetric anal sphincter injuries after performance of episiotomy (p <  0.0001), and more lesions in the case of the occipito-sacral position (p = 0.028). Analysis of sequential instrumentation did not find any additional associated risk. Conclusion Training in the use of Suzor forceps requires extended mentoring in order to reduce obstetric anal sphincter injuries. A stable level of competence was found after the execution of at least 24 forceps deliveries or after 3 semesters (18 months) of obstetrical experience.

Third- and fourth-degree perineal tears – incidence and risk factors

2012 ◽  
Vol 26 (7) ◽  
pp. 660-664 ◽  
Author(s):  
Nir Melamed ◽  
Oz Gavish ◽  
Michal Eisner ◽  
Arnon Wiznitzer ◽  
Nir Wasserberg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Fourth Degree ◽  
Perineal Tears

scholarly journals Maternal risk factors and fetal outcome in patients of abruption placentae.

2020 ◽  
Vol 27 (03) ◽  
pp. 613-617
Author(s):  
Humaira Tabassum ◽  
Memoona Faiyaz ◽  
Aasma Hanif ◽  
Uzma Fahim ◽  
Areeba Aftab
Keyword(s):  
Risk Factors ◽  
Perinatal Mortality ◽  
Placental Abruption ◽  
Tertiary Care ◽  
Case Series ◽  
Fetal Mortality ◽  
Maternal Risk Factors ◽  
Maternal Risk ◽  
Increased Risk ◽  
Fetal Complications

Abruption placentae are a major cause of maternal and perinatal morbidity and mortality. Placental abruption is due to the rupture of the uterine spiral artery. Bleeding into decidua leads to separation of the placenta. There are many major maternal and fetal complications associated with placental abruption. Objectives: To assess the maternal risk factors, perinatal mortality and morbidity in relation to the severity of placental abruption. Study Design: Descriptive case series. Setting: Department of Obstetrics and Gynecology, Jinnah Hospital, Lahore for one year. Period: From Jan 2016 to Dec 2016. Material & Methods: Hundred females were included with placental abruption and were followed-up till delivery. At the time of delivery maternal and fetal complications were noted. Results: Mean age of females was 29.24 + 3.58years. The mean gestational age at delivery was 32.95+3.12 weeks. About 64% underwent vaginal delivery while 36% underwent cesarean section. Among pre-disposing factors increased risk of anemia i.e. 46%, hypertension was found in 28%, multiple pregnancies with 18% and polyhydromnias were found in 8%. The incidence of fetal mortality was 58% and only 42% were born alive at time of delivery. Fetal morbidity is analyzed, 95.23% were in need of resuscitation, admission to nursery was done in 95.23%, neonatal jaundice was seen in 80.95%, anemia in 71.42% and respiratory problems were found in 85.71%. APGAR score at 5 minutes among 21 alive born fetuses was <8 in 85.71%. Conclusion: Resultantly maternal morbidity and perinatal mortality is significant, and this calls for early detection, regular visits, and special surveillance. There should be timely referral to tertiary care center where antenatal care plays an important role in decreasing the incidence of abruption placenta.

Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors

2013 ◽  
Vol 120 (12) ◽  
pp. 1516-1525 ◽  
Author(s):  
I Gurol-Urganci ◽  
DA Cromwell ◽  
LC Edozien ◽  
TA Mahmood ◽  
EJ Adams ◽  
...  
Keyword(s):  
Risk Factors ◽  
Time Trends ◽  
Fourth Degree ◽  
Perineal Tears ◽  
Primiparous Women

scholarly journals Prevalence of high-grade perineal tear during labor in Mexican adolescents

2018 ◽  
pp. 261-264
Author(s):  
María Teresa Sánchez-Ávila ◽  
Marisol Galván-Caudillo ◽  
Jaime Javier Cantú-Pompa ◽  
Natalia Vázquez-Romero ◽  
Jhanea Patricia Martínez-López ◽  
...  
Keyword(s):  
Risk Factors ◽  
Obstetric Care ◽  
Tertiary Hospital ◽  
High Rate ◽  
Adult Women ◽  
High Grade ◽  
Hospital Data ◽  
Perineal Tear ◽  
Fourth Degree ◽  
Perineal Tears

Introduction: There is a high rate of deliveries in adolescents in Mexico. This age group is vulnerable to obstetric complications, including lacerations of the anal sphincter. Objective: To determine the prevalence of third and fourth degree perineal tears in adolescents during childbirth, and to evaluate risk factors in comparison with deliveries with lacerations of adult women. Methods: All obstetric care episodes were reviewed from a public tertiary hospital data in Monterrey, Mexico in 2014. Age, primiparity, delivery instrumentation, episiotomy, body mass index, product weight and tear´s degree were documented at the deliveries with tears of third and fourth degree. Results: The prevalence of third and fourth degree tears of 2.0% was found in the general population, being adolescents the most affected with 2.5%. The unadjusted odds ratio of high-grade tears in adolescent females at delivery, compared to adult females, was 1.36 (95% CI = 0.99-1.86, p= 0.05). No difference was found when comparing risk factors among high-grade tear deliveries in adolescents versus adults. Conclusions: A higher prevalence than previous reported for high grade tears during delivery was found. The data suggest adolescence as a risk factor for high-grade tears during delivery.

Incidence and Risk Factors for Development of Third and Fourth Degree Perineal Tears: A Four Year Experience in a Single Saudi Center

2018 ◽  
Vol 07 (02) ◽  
Author(s):  
Thamer Al Ghamdi ◽  
Al Hanouf Al Thaydi ◽  
Ahmad Talal Chamsi ◽  
Elham Al Mardawi
Keyword(s):  
Risk Factors ◽  
Fourth Degree ◽  
Perineal Tears

Third- and fourth-degree perineal tears: prevalence and risk factors in the third millennium

2011 ◽  
Vol 204 (4) ◽  
pp. 347.e1-347.e4 ◽  
Author(s):  
Asnat Groutz ◽  
Joseph Hasson ◽  
Anat Wengier ◽  
Ronen Gold ◽  
Avital Skornick-Rapaport ◽  
...  
Keyword(s):  
Risk Factors ◽  
Fourth Degree ◽  
The Third ◽  
Perineal Tears ◽  
Third Millennium

scholarly journals Invasive Candida Infections in Neonates after Major Surgery: Current Evidence and New Directions

Pathogens ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 319
Author(s):  
Domenico De Rose ◽  
Alessandra Santisi ◽  
Maria Ronchetti ◽  
Ludovica Martini ◽  
Lisa Serafini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Neonatal Intensive Care ◽  
Antifungal Prophylaxis ◽  
Current Evidence ◽  
Major Surgery ◽  
Fungal Colonization ◽  
Candida Spp ◽  
Mortality And Morbidity ◽  
Innate Defense ◽  
Candida Infections

Infections represent a serious health problem in neonates. Invasive Candida infections (ICIs) are still a leading cause of mortality and morbidity in neonatal intensive care units (NICUs). Infants hospitalized in NICUs are at high risk of ICIs, because of several risk factors: broad spectrum antibiotic treatments, central catheters and other invasive devices, fungal colonization, and impaired immune responses. In this review we summarize 19 published studies which provide the prevalence of previous surgery in neonates with invasive Candida infections. We also provide an overview of risk factors for ICIs after major surgery, fungal colonization, and innate defense mechanisms against fungi, as well as the roles of different Candida spp., the epidemiology and costs of ICIs, diagnosis of ICIs, and antifungal prophylaxis and treatment.

scholarly journals The Scandinavian Small-for-Gestational Age (SGA) pregnancy and birth cohort – A source to continual insight into fetal growth restriction and long term physical and neurodevelopmental health in mother and offspring

2016 ◽  
Vol 26 (1-2) ◽  
Author(s):  
Eli Kjøbli ◽  
Ragnhild Bach ◽  
Haakon Skogseth ◽  
Geir W. Jacobsen
Keyword(s):  
Risk Factors ◽  
Perinatal Mortality ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Birth Outcome ◽  
The Body ◽  
Growth Restriction ◽  
Mortality And Morbidity ◽  
Increased Risk ◽  
Pregnancy And Birth

Human<em> in utero</em> growth restriction (IUGR) is associated with an increased risk for perinatal mortality and morbidity<br />among newborns and infants. To pursue this challenge, a Request For Proposals (RFP) was issued in 1983<br />by The U.S. Epidemiology and Biometry Research Program at the National Institute of Child Health and Human<br />Development (NICHD). A consortium was set up at the universities and university hospitals in Trondheim,<br />Bergen (Norway) and Uppsala (Sweden) and was funded by the NICHD to conduct the <em>Scandinavian Successive</em><br /><em>Small-for-Gestational Age (SGA) pregnancy and birth outcome study</em>. The study design included a comprehensive<br />biobank with maternal and cord serum samples, placental tissue, and a multitude of data collected from<br />interviews, questionnaires, and clinical examinations.<br /> The SGA cohort study involved 6,354 Caucasian pregnant women in the three study sites who expected their<br />second or third child from 1986-88. The study women were screened in early second trimester and mothers who<br />had an increased risk to deliver a smaller than expected newborn were followed in detail through the second half<br />of pregnancy and at birth. Selected children were screened several times through their first and up to five years<br />of age. Moreover, a highly selected subgroup in Trondheim has been followed at 14, 19, and 26 years’ age.<br /> Almost thirty years later, we have searched the body of scientific publications that originated from this cohort<br />study in an attempt to assess if and to what extent the main aims and objectives were achieved and to summarize<br />the overall outcomes. The SGA cohort has resulted in close to 100 published papers in peer reviewed journals<br />and some 40 graduate and undergraduate degrees. Risk factors of SGA, like maternal smoking, low prepregnancy<br />weight and education attainment, and a previous SGA birth outcome were confirmed. Conversely, no<br />totally new and unknown risk factors were identified. Serial ultrasound measures have enabled a distinction<br />between SGA with restricted and normal intrauterine growth, and has further indicated that being born SGA is<br />mainly a problem in combination with IUGR. Further, the consequences of IUGR are more pronounced at<br />adolescence and young adulthood than at five years of age.<br /> An increased understanding of the pathogenesis of different categories of growth restriction is essential to<br />recognize and diagnose IUGR properly, and to reduce the perinatal mortality and morbidity from SGA. Moreover,<br />SGA is a significant predictor at follow-up of the child. An up to date biobank has ensured the quality of data<br />and biological samples, and has been crucial for the outcome of the entire SGA study. It continues to be a<br />valuable resource in future research.

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