Shoulder Dystocia and Birth Injury (eBook)

Notice 3
Foreword 7
Preface 8
Contents 9
Contributors 11
Introduction 13
Overview 13
Definition 14
Recent Developments 15
Incidence 16
Discussion 17
Perspective 18
References 18
Part I Prevention 20
Preconceptual Risk Factors 21
1.1 Introduction 21
1.2 Maternal Birthweight 22
1.3 Maternal Age 23
1.4 Maternal Height 25
1.5 Obesity 26
1.7 Conclusion 29
References 29
Antepartum Risk Factors 32
2.1 Introduction 32
2.2 Gestational Diabetes and Borderline Diabetes 33
2.2.1 Identification 33
2.2.2 One Abnormal Value 35
2.2.3 Abnormal Screen, Normal 3-Hour GTT 36
2.3 Overt Diabetes 37
2.3.1 Incidence 37
2.3.2 Treatment 38
2.4 Postdate Pregnancy 40
2.5 Obesity 43
2.6 Excessive Weight Gain 43
2.7 Fundal Height 46
2.8 Conclusion 46
References 46
Role of Ultrasound in Shoulder Dystocia 49
3.1 Introduction 49
3.2 Early Macrosomia Detection 51
3.3 Estimation of Fetal Weight 52
3.4 Head Measurements 52
3.5 Abdominal Measurements 53
3.6 Diabetes and Ultrasound Measurements 55
3.7 Obesity and Ultrasound Measurements 56
3.8 Serial Measurements 57
3.9 Computed Tomography 57
3.10 Growth Rates 58
3.11 Soft Tissue Thickness 58
3.12 Shoulder Ratios 59
3.13 Conclusion 59
References 60
Intrapartum Risk Factors 64
4.1 Introduction 64
4.2 The Initial Exam 65
4.3 Labor: The End Point 66
4.4 Prior History 66
4.5 Risk Factors 67
4.6 Oxytocin 67
4.7 Midpelvic Delivery 68
4.8 Teaching Tools 70
4.9 Conclusion 72
References 72
Pelvimetry 74
5.1 Introduction 74
5.2 Clinical Pelvimetry 75
5.3 Prenatal Assessment 76
5.4 Mechanism of Labor and Delivery 78
5.5 Shoulder Dystocia Issues 78
5.6 Shoulder Impaction Mechanism 79
5.7 The Labor Exam 81
5.8 Conclusion 82
References 82
Part II Treatment 84
Recognition of Disproportion 85
6.1 Signs and Symptoms 86
6.2 Engagement 87
6.3 Intrapartum Reevaluation 89
6.4 Caput and Deflexion 90
6.5 Failure to Progress 91
6.6 Cephalopelvic Assessment 91
6.7 Muller-Hillis Maneuver 92
6.8 Fundal Height 93
6.9 Trial of Labor 94
6.10 Molding 95
6.11 Clinical Pearls 98
6.12 Active Management of Labor 99
6.13 Conclusion 100
References 101
Delivery Techniques 103
7.1 Overview 103
7.2 Current Practice 104
7.3 Treatment 105
7.4 Initial Techniques 106
7.5 Mild Dystocia (Grade I) 107
7.6 Moderate Dystocia (Grade II) 108
7.7 Severe Dystocia (Grade III) 111
7.8 Undeliverable Dystocia (Grade IV): Cephalic Replacement 112
7.9 Fundal Pressure 113
7.10 Comment 113
7.11 The Time Factor 115
7.12 Conclusion 117
References 118
The McRoberts Maneuver 120
8.1 Introduction 120
8.2 Literature Review 121
8.3 Technique 122
8.4 Suprapubic Pressure: The Mazzanti Maneuver 124
8.5 Delivery 125
8.6 Effects of the McRoberts Maneuver 126
8.7 Research 126
8.8 Improper McRoberts Maneuver 127
8.9 Clinical Experience 127
8.10 Conclusion 129
References 129
Cephalic Replacement: The Gunn-Zavanelli-O’Leary Maneuver 131
9.1 Introduction 131
9.2 Initial Clinical Experience 132
9.3 Technique and Results 133
9.4 Survey 134
9.5 Discussion 136
9.6 Abdominal Rescue 138
9.7 Conclusion 138
References 139
Infant Injury 140
10.1 Introduction 140
10.2 Classification of Injuries 141
10.3 Incidence and Prognosis 143
10.4 Pathophysiology 144
10.5 Anatomy of a Peripheral Nerve 145
10.6 Vulnerable Fetuses 146
10.7 Clinical Presentation 146
10.8 Mortality and Morbidity 147
10.9 Causation 149
10.10 Cesarean Injuries 152
10.11 Mechanism of Labor and Injury 152
10.12 Conclusion 152
References 153
Part III Clinical Considerations 155
In Utero Causation of Brachial Plexus Injury: Myth or Mystery? 156
11.1 Overview 156
11.2 Controversies Concerning Etiology 157
11.3 In Utero Research 159
11.3.1 Jennett Theory 159
11.3.2 Gherman Theory 160
11.3.3 Gonik Theory 162
11.3.4 Sandmire Theory 163
11.4 The Johns Hopkins Rebuttal 163
11.5 Engineering Research 165
11.6 Fundal Dominance: The Uterine Injury? 166
11.6.1 Differentiation of Uterine Activity 166
11.7 Intraabdominal Forces 168
11.8 Discussion 168
11.9 Conclusion 170
References 170
Recurrent Shoulder Dystocia 172
12.1 Introduction 172
12.2 Defeatist Attitude 173
12.3 Mathematical Calculations 173
12.4 Prior Knowledge 174
12.5 Predictability 175
12.6 Conclusion 176
References 176
Predisposing Factors for Shoulder Dystocia-Related Birth Injuries: Causation Analysis 178
13.1 Clinical Background 178
13.2 Database 179
13.3 Data Analysis 182
13.4 Clinical Interpretation 182
13.5 Conclusion 184
References 185
Recognition, Classification, and Management of Shoulder Dystocia: The Relationship to Causation of Brachial Plexus Injury 187
14.1 Introduction 187
14.2 Definition and Incidence 189
14.3 Modern-Day Classification 193
14.3.1 Shoulder Dystocia at Cesarean Section 194
14.3.2 Shoulder Dystocia at Vaginal Delivery 194
14.3.3 Soft Tissue Dystocia After Restitution 194
14.3.4 Bony Dystocia After Restitution 195
14.3.5 Bony Dystocia Due to Failure of Restitution 196
14.4 Management 198
14.5 Causation of Brachial Plexus Injury 210
14.6 Conclusion 213
References 214
Minimizing the Risks of Shoulder Dystocia-Related Fetal Injuries 217
15.1 Introduction 217
15.2 Preconceptual Risk Factors 219
15.3 Antenatal Risk Factors 220
15.4 Intrapartum Risk Factors 221
15.5 Diagnosis of Shoulder Dystocia 222
15.6 Childbirth in America and Abroad 225
15.7 Etiology and Prevention 227
15.8 Considerations Pertaining to Method of Delivery 227
15.9 Conclusion 227
References 230
The Maternal Fetal Medicine Viewpoint: Causation and Litigation 234
16.1 Definition 234
16.2 Incidence and Etiology 236
16.3 Mechanism of Shoulder Dystocia 238
16.4 Fetal Risk Factors 239
16.5 Labor Risk Factors 239
16.6 Prediction Models 240
16.7 Clinical Management 241
16.8 Documentation 244
16.9 Defining the Standard of Care 245
16.9.1 Responsibilities of the Physician 246
16.9.2 Responsibilities of the Nursing Staff 247
16.10 Pitfalls in Diagnosis and Management 247
16.11 Legal Implications 248
16.12 Conclusion 251
References 251
Brachial Plexus Injury at Cesarean Section 255
17.1 Introduction 255
17.2 Incidence 256
17.3 Mechanism 256
17.4 Discussion 259
17.5 Clinical Experience 261
17.6 Conclusion 261
References 261
Delivery of the Nondiabetic Macrosomic Infant 262
18.1 Macrosomia 262
18.2 Complications 263
18.3 Macrosomia and Shoulder Dystocia 263
18.4 Ultrasound and Macrosomia 264
18.5 Obesity and Macrosomia 265
18.6 Previous Macrosomia 266
18.7 Labor Abnormalities 267
18.8 Elective Cesarean Section and Induction of Labor 267
18.9 Instrumental Delivery 268
18.10 Management Recommendations 269
18.11 Conclusion 270
References 271
The Midwifery View of Shoulder Dystocia 274
19.1 Introduction 275
19.2 Management Issues 275
19.3 Labor and Birth Factors 276
19.4 Maternal Positions in Labor 276
19.5 Positions at Birth 277
19.6 The Gaskin ‘‘All-Fours’’ Maneuver 277
19.7 Running Start 278
19.8 Using Restitution to One’s Advantage 278
19.9 Releasing the Anterior Shoulder 279
19.10 Suprapubic Not Fundal Pressure 279
19.11 Pushing 279
19.12 Avoid Assisted Delivery 279
19.13 Algorithms and Mnemonics 280
19.14 Is Routine Episiotomy Essential? 280
19.15 Safeguarding the Newborn 280
19.16 Delayed Cord Clamping 281
19.17 Cord Clamping Before Shoulder Delivery 281
19.18 Nuchal Cord Management 282
19.19 Education and Clinical Competency 283
19.20 Midwife and Physician Responsibilities 284
19.21 Legal Issues 285
19.22 Documentation 286
19.23 Conclusion 286
References 287
Recent Research: Relevant and Reliable 289
References 291
Observations on the Etiology of Brachial Plexus Birth Palsy Based on Radiographic, Intraoperative, and Histologic Findings 292
21.1 Introduction 292
21.2 Radiographic Findings in Brachial Plexus Birth Palsy 293
21.3 Operative Findings in Brachial Plexus Birth Palsy 293
21.4 Histologic Findings in Brachial Plexus Birth Palsy 296
21.5 Conclusion 296
References 297
Index 298