Traditionally, brachial plexus damage was attributed to excessive traction applied on the fetal head at delivery. Recently, it was proposed that most injuries occur spontaneously in utero. The author has studied the m...Traditionally, brachial plexus damage was attributed to excessive traction applied on the fetal head at delivery. Recently, it was proposed that most injuries occur spontaneously in utero. The author has studied the mechanism of neurological birth injuries based on 338 actual cases with special attention to(1) fetal macrosomia;(2) maternal diabetes; and(3) methods of delivery. There was a high coincidence between use of traction and brachial plexus injuries. Instrumental extractions increased the risk exponentially. Erb's palsy following cesarean section was exceedingly rare. These facts imply that spontaneous neurological injury in utero is extremely rare phenomenon. Literary reports show that shoulder dystocia and its associated injuries increased in the United States several-fold since the introduction of active management of delivery in the 1970's. Such a dramatic change in a stable population is unlikely to be caused by incidental spontaneous events unrelated to external factors. The cited investigations indicate that brachial plexus damage typically is traction related. The traditional technique which precludes traction is the optimal method for avoiding arrest of the shoulders and its associated neurological birth injuries. Effective prevention also requires meticulous prenatal care and elective abdominal delivery of macrosomic fetuses in carefully selected cases.展开更多
Anecdotally, obstetricians have been known to sustain physical injuries whilst assisting deliveries but these are not always reported. This case describes how a mallet finger deformity was sustained by a consultant ob...Anecdotally, obstetricians have been known to sustain physical injuries whilst assisting deliveries but these are not always reported. This case describes how a mallet finger deformity was sustained by a consultant obstetrician whilst attempting to deliver a fetus with shoulder dystocia. Although this is a rare type of injury, it had significant impact on the consultant’s ability to provide clinical care for some time. Disruptions in service provision have direct financial consequences to the healthcare system. This case report highlights the importance of reporting these injuries at the workplace.展开更多
Background:McRoberts'maneuver,turning the woman's thighs up in the supine position,has become the dominant method for resolving shoulder dystocia(defined as failure to deliver the fetal shoulder(s)with gentle ...Background:McRoberts'maneuver,turning the woman's thighs up in the supine position,has become the dominant method for resolving shoulder dystocia(defined as failure to deliver the fetal shoulder(s)with gentle downward traction on the fetal head,requiring additional obstetric maneuvers to effect delivery).Another method that is less commonly used is the Gaskin maneuver,which was first described by the midwife Ina May Gaskin,who learned of it from traditional midwives in Central America,and involves turning women to the hands-and-knees position.One retrospective observational study reported an 84%higher resolution of shoulder dystocia and less injury to the baby with the use of the hands-and-knees position as the first approach to resolving shoulder dystocia.The hands-and-knees position was reported to result in a wider pelvic diameter than the supine position and hence facilitate rotation of the baby and delivery,so it is possibly to resolving shoulder dystocia.The purpose of this study is to explore whether applying the Gaskin maneuver as the first approach for resolving cases of shoulder dystocia is a safer and better method than applying the McRoberts'maneuver first.Methods:A time series cohort study was conducted in Laiwu Maternal and Child Health Hospital in Shandong,China over a seven-year period.Between January 2011 and July 2013 all women receiving traditional support at delivery were enrolled as a control group.During this time period,when shoulder dystocia was suspected,McRoberts’maneuver(MR)was the most commonly employed first maneuver as described in the HELPERR mnemonics.Between October 2013 and December 2017,a change of practice was implemented for all vaginal births at the site,whereby midwives were instructed to use the Gaskin maneuver(i.e.,moving the mother onto hands-and-knees position)as the first protocol if shoulder dystocia was suspected.Patients in this group were assigned to the experimental group.The neonatal outcomes including birth asphyxia and baby injury in both groups were recorded and analyzed.Results:The injuries in the control group included 14 clavicular fractures,and one permanent brachial plexus injury,three temporary arm movement disorders that resolved within 7 days and those cases were not calculated as baby injury cases(the same in experimental group).In the experimental group,58 cases of shoulder dystocia were reported,with one case of clavicular fracture,three temporary arm movement disorders that resolved within 3 days,and no permanent brachial plexus injuries.The rate of baby injury in the control group[14.6%(15/103)]was higher than that in the experimental group[1.7%(1/58)],and this difference was statistically significant[χ^(2)=6.834,P=0.009;OR=1.150(1.055–1.254)].Multiple logistic regression analysis showed that using the McRoberts'maneuver as the first approach in cases of shoulder dystocia[OR=19.609(1.620–273.430)],the mother's employment status[OR=1.909(1.118–3.262)],and intravenous dripping of oxytocin[OR=5.969(1.391–25.605)]are risk factors for baby injury.There was no difference in neonate Apgar score between the two groups,and no baby died in either group.展开更多
To editor:Shoulder dystocia(SD)constitutes an obstetric emergency,bearing associations with maternal and neonatal morbidity due to its unique pathophysiology.In a comprehensive series involving 228,438 women,SD occurr...To editor:Shoulder dystocia(SD)constitutes an obstetric emergency,bearing associations with maternal and neonatal morbidity due to its unique pathophysiology.In a comprehensive series involving 228,438 women,SD occurred in 2159 patients,accounting for 1.7%of the total.1 Various techniques have been described to facilitate successful delivery in SD patients;2 however,these maneuvers are not without associated complications.3 This correspondence highlights a case of a newborn experiencing a collapse following such a delivery.The guardian granted written and informed consent for the publication of the patient’s clinical information and associated images.展开更多
目的分析肩难产发生率、并发症及高危因素,降低母婴危害。方法收集2005-01～2011-12收治的2 000例孕妇资料,采用1∶2的病例对照研究方法,探讨肩难产的高危因素及其对产妇和新生儿的损伤作用。结果共搜集肩难产产妇23例,发生率为1.15%。...目的分析肩难产发生率、并发症及高危因素,降低母婴危害。方法收集2005-01～2011-12收治的2 000例孕妇资料,采用1∶2的病例对照研究方法,探讨肩难产的高危因素及其对产妇和新生儿的损伤作用。结果共搜集肩难产产妇23例,发生率为1.15%。其中巨大儿11例,占47.83%,孕妇合并糖尿病4例,占17.39%,肥胖3例,占13.04%,骨盆狭窄2例,占8.70%,过期妊娠2例,占8.70%,第二产程延长1例,占4.35%。肩难产组与自然分娩组产妇的腹围、宫高、第一产程和第二产程差异有统计学意义(P<0.05)。两组间新生儿的体重、身长、头围、胸围、1 min Apgar评分差异有统计学意义(P<0.05)。结论巨大儿肩难产发生率比较高,但要根据高危的因素进行预测。展开更多
巨大儿(macrosomia)是产科临床常见的现象,随着新生儿出生体质量增加,异常分娩、肩难产及产伤等发生率随之增加。目前临床缺乏产前准确诊断巨大儿的方法。2016年11月美国妇产科医师学会(The American College of Obstetricians and Gyne...巨大儿(macrosomia)是产科临床常见的现象,随着新生儿出生体质量增加,异常分娩、肩难产及产伤等发生率随之增加。目前临床缺乏产前准确诊断巨大儿的方法。2016年11月美国妇产科医师学会(The American College of Obstetricians and Gynecologists,ACOG)发布了巨大儿指南[1]。该指南的目的是量化巨大儿的风险,评价测量胎儿体质量方法的准确性及局限性,以及对疑似巨大儿的临床管理。本文对其要点进行解读。展开更多
目的：分析比较手膝俯卧位分娩与平卧位分娩在采用等待娩肩的措施时对母婴结局的影响。方法共有621例产妇进入临床研究，其中手膝卧位组364例，平卧位组257例，两组均采用等待至少1次宫缩娩肩助产方式。比较两组的肩难产发生率、产程时...目的：分析比较手膝俯卧位分娩与平卧位分娩在采用等待娩肩的措施时对母婴结局的影响。方法共有621例产妇进入临床研究，其中手膝卧位组364例，平卧位组257例，两组均采用等待至少1次宫缩娩肩助产方式。比较两组的肩难产发生率、产程时间、产后出血、新生儿评分、头-肩时间等指标。结果产妇分娩的头-肩时间为5～480 s，平均（53.6±40.1）s；头-肩时间≤60 s 与＞60s 比较，新生儿窒息率差异无统计学差异，头-肩时间≤120 s 与＞120 s 比较，新生儿窒息率增高，差异有统计学意义。手膝俯卧位组与平卧位组的头-肩时间分别为（60.1±46.8）s 和（44.5±25.6）s，差异有统计学意义。手膝俯卧位与平卧位的肩难产发生率分别为0，1.6％，差异有统计学意义。新生儿窒息的发生率分别为1.4％，1.9％，两组差异无统计学意义。结论采用手膝俯卧位分娩和等待至少一次宫缩自然娩肩，减少肩难产发生率，不增加新生儿窒息率，是安全可行的助产方法。展开更多
文摘Traditionally, brachial plexus damage was attributed to excessive traction applied on the fetal head at delivery. Recently, it was proposed that most injuries occur spontaneously in utero. The author has studied the mechanism of neurological birth injuries based on 338 actual cases with special attention to(1) fetal macrosomia;(2) maternal diabetes; and(3) methods of delivery. There was a high coincidence between use of traction and brachial plexus injuries. Instrumental extractions increased the risk exponentially. Erb's palsy following cesarean section was exceedingly rare. These facts imply that spontaneous neurological injury in utero is extremely rare phenomenon. Literary reports show that shoulder dystocia and its associated injuries increased in the United States several-fold since the introduction of active management of delivery in the 1970's. Such a dramatic change in a stable population is unlikely to be caused by incidental spontaneous events unrelated to external factors. The cited investigations indicate that brachial plexus damage typically is traction related. The traditional technique which precludes traction is the optimal method for avoiding arrest of the shoulders and its associated neurological birth injuries. Effective prevention also requires meticulous prenatal care and elective abdominal delivery of macrosomic fetuses in carefully selected cases.
文摘Anecdotally, obstetricians have been known to sustain physical injuries whilst assisting deliveries but these are not always reported. This case describes how a mallet finger deformity was sustained by a consultant obstetrician whilst attempting to deliver a fetus with shoulder dystocia. Although this is a rare type of injury, it had significant impact on the consultant’s ability to provide clinical care for some time. Disruptions in service provision have direct financial consequences to the healthcare system. This case report highlights the importance of reporting these injuries at the workplace.
基金funded by Health commission of Hainan province 20A200201.
文摘Background:McRoberts'maneuver,turning the woman's thighs up in the supine position,has become the dominant method for resolving shoulder dystocia(defined as failure to deliver the fetal shoulder(s)with gentle downward traction on the fetal head,requiring additional obstetric maneuvers to effect delivery).Another method that is less commonly used is the Gaskin maneuver,which was first described by the midwife Ina May Gaskin,who learned of it from traditional midwives in Central America,and involves turning women to the hands-and-knees position.One retrospective observational study reported an 84%higher resolution of shoulder dystocia and less injury to the baby with the use of the hands-and-knees position as the first approach to resolving shoulder dystocia.The hands-and-knees position was reported to result in a wider pelvic diameter than the supine position and hence facilitate rotation of the baby and delivery,so it is possibly to resolving shoulder dystocia.The purpose of this study is to explore whether applying the Gaskin maneuver as the first approach for resolving cases of shoulder dystocia is a safer and better method than applying the McRoberts'maneuver first.Methods:A time series cohort study was conducted in Laiwu Maternal and Child Health Hospital in Shandong,China over a seven-year period.Between January 2011 and July 2013 all women receiving traditional support at delivery were enrolled as a control group.During this time period,when shoulder dystocia was suspected,McRoberts’maneuver(MR)was the most commonly employed first maneuver as described in the HELPERR mnemonics.Between October 2013 and December 2017,a change of practice was implemented for all vaginal births at the site,whereby midwives were instructed to use the Gaskin maneuver(i.e.,moving the mother onto hands-and-knees position)as the first protocol if shoulder dystocia was suspected.Patients in this group were assigned to the experimental group.The neonatal outcomes including birth asphyxia and baby injury in both groups were recorded and analyzed.Results:The injuries in the control group included 14 clavicular fractures,and one permanent brachial plexus injury,three temporary arm movement disorders that resolved within 7 days and those cases were not calculated as baby injury cases(the same in experimental group).In the experimental group,58 cases of shoulder dystocia were reported,with one case of clavicular fracture,three temporary arm movement disorders that resolved within 3 days,and no permanent brachial plexus injuries.The rate of baby injury in the control group[14.6%(15/103)]was higher than that in the experimental group[1.7%(1/58)],and this difference was statistically significant[χ^(2)=6.834,P=0.009;OR=1.150(1.055–1.254)].Multiple logistic regression analysis showed that using the McRoberts'maneuver as the first approach in cases of shoulder dystocia[OR=19.609(1.620–273.430)],the mother's employment status[OR=1.909(1.118–3.262)],and intravenous dripping of oxytocin[OR=5.969(1.391–25.605)]are risk factors for baby injury.There was no difference in neonate Apgar score between the two groups,and no baby died in either group.
文摘To editor:Shoulder dystocia(SD)constitutes an obstetric emergency,bearing associations with maternal and neonatal morbidity due to its unique pathophysiology.In a comprehensive series involving 228,438 women,SD occurred in 2159 patients,accounting for 1.7%of the total.1 Various techniques have been described to facilitate successful delivery in SD patients;2 however,these maneuvers are not without associated complications.3 This correspondence highlights a case of a newborn experiencing a collapse following such a delivery.The guardian granted written and informed consent for the publication of the patient’s clinical information and associated images.
文摘目的分析肩难产发生率、并发症及高危因素,降低母婴危害。方法收集2005-01～2011-12收治的2 000例孕妇资料,采用1∶2的病例对照研究方法,探讨肩难产的高危因素及其对产妇和新生儿的损伤作用。结果共搜集肩难产产妇23例,发生率为1.15%。其中巨大儿11例,占47.83%,孕妇合并糖尿病4例,占17.39%,肥胖3例,占13.04%,骨盆狭窄2例,占8.70%,过期妊娠2例,占8.70%,第二产程延长1例,占4.35%。肩难产组与自然分娩组产妇的腹围、宫高、第一产程和第二产程差异有统计学意义(P<0.05)。两组间新生儿的体重、身长、头围、胸围、1 min Apgar评分差异有统计学意义(P<0.05)。结论巨大儿肩难产发生率比较高,但要根据高危的因素进行预测。
文摘巨大儿(macrosomia)是产科临床常见的现象,随着新生儿出生体质量增加,异常分娩、肩难产及产伤等发生率随之增加。目前临床缺乏产前准确诊断巨大儿的方法。2016年11月美国妇产科医师学会(The American College of Obstetricians and Gynecologists,ACOG)发布了巨大儿指南[1]。该指南的目的是量化巨大儿的风险,评价测量胎儿体质量方法的准确性及局限性,以及对疑似巨大儿的临床管理。本文对其要点进行解读。
文摘目的：分析比较手膝俯卧位分娩与平卧位分娩在采用等待娩肩的措施时对母婴结局的影响。方法共有621例产妇进入临床研究，其中手膝卧位组364例，平卧位组257例，两组均采用等待至少1次宫缩娩肩助产方式。比较两组的肩难产发生率、产程时间、产后出血、新生儿评分、头-肩时间等指标。结果产妇分娩的头-肩时间为5～480 s，平均（53.6±40.1）s；头-肩时间≤60 s 与＞60s 比较，新生儿窒息率差异无统计学差异，头-肩时间≤120 s 与＞120 s 比较，新生儿窒息率增高，差异有统计学意义。手膝俯卧位组与平卧位组的头-肩时间分别为（60.1±46.8）s 和（44.5±25.6）s，差异有统计学意义。手膝俯卧位与平卧位的肩难产发生率分别为0，1.6％，差异有统计学意义。新生儿窒息的发生率分别为1.4％，1.9％，两组差异无统计学意义。结论采用手膝俯卧位分娩和等待至少一次宫缩自然娩肩，减少肩难产发生率，不增加新生儿窒息率，是安全可行的助产方法。
