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
The maternal causes of dystocia in cattle and buffaloes are analyzed. Uterine torsion appears to be the most frequent maternal cause of dys-tocia in buffaloes whereas improper cervical dilation appears to be more freq...The maternal causes of dystocia in cattle and buffaloes are analyzed. Uterine torsion appears to be the most frequent maternal cause of dys-tocia in buffaloes whereas improper cervical dilation appears to be more frequent maternal cause of dystocia in cattle. Failure of uterine expulsive forces (Uterine Inertia) and neo-plasm’s of vagina, vulva and uterus are com-monly seen in cows and buffaloes. The various maternal causes of dystocia in cattle and buf-faloes and their management are described.展开更多
Dystocia in the camelids is rare, however the exceptionally long neck and the fetal extremities predispose to flexion of these as a common cause of dystocia. A prolonged (<2 hr) second stage of labor, bloody vagina...Dystocia in the camelids is rare, however the exceptionally long neck and the fetal extremities predispose to flexion of these as a common cause of dystocia. A prolonged (<2 hr) second stage of labor, bloody vaginal discharge or colic is the frequent sign of dystocia. The maternal causes of dystocia for camelids include uterine torsion, pelvic immaturity, uterine inertia and cervical dilation failure, whereas the fetal causes described are fetal malpostures and rarely fetal monsters like Schistosoma reflexus and Pero-somus elumbis or fetal dropsical conditions such as hydrocephalus. Dromedary camels must be restrained in a sternal recumbency for examination and vicious animals must be given xylazine (0.25 - 2.2 mg/Kg IM or IV). South American camelids may be restrained by using either xylazine or butarphanol (0.5 - 0.1 mg/Kg IM). Uterine torsion is much more common in llamas and alpacas whereas it is infrequent in the dromedary camel. The methods of dystocia correction by using mutations, fetotomy and cesarean section are described.展开更多
Purpose: The aim of this prospective study was to collect cases of dystocia in 4 rural veterinary practices in Switzerland over 12 months, focusing on calf vitality. Methods: During 12 months, data of 573 assisted par...Purpose: The aim of this prospective study was to collect cases of dystocia in 4 rural veterinary practices in Switzerland over 12 months, focusing on calf vitality. Methods: During 12 months, data of 573 assisted parturitions were collected. The age of the cows involved ranged from 2 to 17 years (median 5.2 yr) with a median gestation length of 288 days. Results: Overall, 651 calves were born (61.2% male). 481 were single and 85 were twin births. For 7 calves, no data were available. As to calf vitality: 66.1% of the calves were alive, 25.4% dead, 5.1% weak and 3.4% died during the assisted parturition process. The percentage of dead calves was higher in twins (43.5%) than in singletons (18.9%). The vitality was influenced by gestation length, parity and the time elapsed since the rupture of the amniotic sac. In this study, calf vitality was neither influenced by sex of the calf nor breed of the parents. A uterine torsion was found in 31.8% of the cases with the direction of the rotation anti-clockwise in 94%. Twins were twice as often in posterior presentation as single-born calves (31.4% versus 15.6%). Conclusion: Calf vitality was influenced by parity, gestation length and time from amniotic sac rupture to veterinary intervention.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
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
Dystocia is a serious problem for pregnant women, and it increases the cesarean section rate. Although uterine dysfunction has an unknown etiology, it is responsible for cesarean delivery and clinical dystocia, result...Dystocia is a serious problem for pregnant women, and it increases the cesarean section rate. Although uterine dysfunction has an unknown etiology, it is responsible for cesarean delivery and clinical dystocia, resulting in neonatal morbidity and mortality;thus, there is an urgent need for novel therapeutic agents. Previous studies indicated that statins, which inhibit the mevalonate (MVA) pathway of cholesterol synthesis, can reduce the incidence of preterm birth, but the safety of statins for pregnant women has not been thoroughly evaluated. Therefore, to unambiguously examine the function of the MVA pathway in pregnancy and delivery, we employed a genetic approach by using myometrial cell-specific deletion of geranylgeranyl pyrophosphate synthase (Ggps1) mice. We found that Ggps1 deficiency in myometrial cells caused impaired uterine contractions, resulting in disrupted embryonic placing and dystocia. Studies of the underlying mechanism suggested that Ggps1 is required for uterine contractions to ensure successful parturition by regulating RhoA prenylation to activate the RhoA/Rock2/p-MLC pathway. Our work indicates that perturbing the MVA pathway might result in problems during delivery for pregnant females, but modifying protein prenylation with supplementary farnesyl pyrophosphate or geranylgeranyl pyrophosphate might be a strategy to avoid side effects.展开更多
A two years'old,white and brown Yankassa ewe,weighing 20 kg was presented with dystocia of about 48 h duration at Mabs Veterinary Centre Ltd,Lagos.On thorough physical and vaginal examination,there were evidences ...A two years'old,white and brown Yankassa ewe,weighing 20 kg was presented with dystocia of about 48 h duration at Mabs Veterinary Centre Ltd,Lagos.On thorough physical and vaginal examination,there were evidences of feotal parts and foul smelling discharges per vagina.A systematic and calculated traction and retropulsion revealed schistosomus reflexus cojoined twins.There was a complete recovery of the ewe 3 days post operative management.Finally,this case reported a true schistosomus reflexus cojoined twins in Yankassa ewe which was successfully relieved through traction and retropulsion despite the supposedly small birth canal which precluded the procedure in ewes except for caesarian section or fetotomy.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
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The maternal causes of dystocia in cattle and buffaloes are analyzed. Uterine torsion appears to be the most frequent maternal cause of dys-tocia in buffaloes whereas improper cervical dilation appears to be more frequent maternal cause of dystocia in cattle. Failure of uterine expulsive forces (Uterine Inertia) and neo-plasm’s of vagina, vulva and uterus are com-monly seen in cows and buffaloes. The various maternal causes of dystocia in cattle and buf-faloes and their management are described.
文摘Dystocia in the camelids is rare, however the exceptionally long neck and the fetal extremities predispose to flexion of these as a common cause of dystocia. A prolonged (<2 hr) second stage of labor, bloody vaginal discharge or colic is the frequent sign of dystocia. The maternal causes of dystocia for camelids include uterine torsion, pelvic immaturity, uterine inertia and cervical dilation failure, whereas the fetal causes described are fetal malpostures and rarely fetal monsters like Schistosoma reflexus and Pero-somus elumbis or fetal dropsical conditions such as hydrocephalus. Dromedary camels must be restrained in a sternal recumbency for examination and vicious animals must be given xylazine (0.25 - 2.2 mg/Kg IM or IV). South American camelids may be restrained by using either xylazine or butarphanol (0.5 - 0.1 mg/Kg IM). Uterine torsion is much more common in llamas and alpacas whereas it is infrequent in the dromedary camel. The methods of dystocia correction by using mutations, fetotomy and cesarean section are described.
文摘Purpose: The aim of this prospective study was to collect cases of dystocia in 4 rural veterinary practices in Switzerland over 12 months, focusing on calf vitality. Methods: During 12 months, data of 573 assisted parturitions were collected. The age of the cows involved ranged from 2 to 17 years (median 5.2 yr) with a median gestation length of 288 days. Results: Overall, 651 calves were born (61.2% male). 481 were single and 85 were twin births. For 7 calves, no data were available. As to calf vitality: 66.1% of the calves were alive, 25.4% dead, 5.1% weak and 3.4% died during the assisted parturition process. The percentage of dead calves was higher in twins (43.5%) than in singletons (18.9%). The vitality was influenced by gestation length, parity and the time elapsed since the rupture of the amniotic sac. In this study, calf vitality was neither influenced by sex of the calf nor breed of the parents. A uterine torsion was found in 31.8% of the cases with the direction of the rotation anti-clockwise in 94%. Twins were twice as often in posterior presentation as single-born calves (31.4% versus 15.6%). Conclusion: Calf vitality was influenced by parity, gestation length and time from amniotic sac rupture to veterinary intervention.
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.
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.
基金This work was supported by the National Natural Science Foundation of China(31530046)the National Science and Technology Major Project(SQ2018YFC100242).
文摘Dystocia is a serious problem for pregnant women, and it increases the cesarean section rate. Although uterine dysfunction has an unknown etiology, it is responsible for cesarean delivery and clinical dystocia, resulting in neonatal morbidity and mortality;thus, there is an urgent need for novel therapeutic agents. Previous studies indicated that statins, which inhibit the mevalonate (MVA) pathway of cholesterol synthesis, can reduce the incidence of preterm birth, but the safety of statins for pregnant women has not been thoroughly evaluated. Therefore, to unambiguously examine the function of the MVA pathway in pregnancy and delivery, we employed a genetic approach by using myometrial cell-specific deletion of geranylgeranyl pyrophosphate synthase (Ggps1) mice. We found that Ggps1 deficiency in myometrial cells caused impaired uterine contractions, resulting in disrupted embryonic placing and dystocia. Studies of the underlying mechanism suggested that Ggps1 is required for uterine contractions to ensure successful parturition by regulating RhoA prenylation to activate the RhoA/Rock2/p-MLC pathway. Our work indicates that perturbing the MVA pathway might result in problems during delivery for pregnant females, but modifying protein prenylation with supplementary farnesyl pyrophosphate or geranylgeranyl pyrophosphate might be a strategy to avoid side effects.
文摘A two years'old,white and brown Yankassa ewe,weighing 20 kg was presented with dystocia of about 48 h duration at Mabs Veterinary Centre Ltd,Lagos.On thorough physical and vaginal examination,there were evidences of feotal parts and foul smelling discharges per vagina.A systematic and calculated traction and retropulsion revealed schistosomus reflexus cojoined twins.There was a complete recovery of the ewe 3 days post operative management.Finally,this case reported a true schistosomus reflexus cojoined twins in Yankassa ewe which was successfully relieved through traction and retropulsion despite the supposedly small birth canal which precluded the procedure in ewes except for caesarian section or fetotomy.
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.
