Stratification of outcome of shoulder dystocia according to maneuver used for delivery, retrospective cohort and meta-analysis.

BACKGROUND: Shoulder dystocia is an unpredictable obstetric condition with potential long-term neonatal complications. The risk of neonatal injury might be related to the condition itself as well as to the obstetrics maneuvers used for its release. OBJECTIVES: To examine the available evidence to assess current management and possible improvement of outcomes. SEARCH STRATEGY: A comprehensive search of MEDLINE, EMBASE, EMCARE, and The Cochrane Library database was performed, all studies reporting on neonatal outcomes in cases of shoulder dystocia stratified by obstetric maneuvers used for delivery were included. Data abstraction was performed and checked by two independent reviewers. RESULTS: McRoberts maneuver was the least associated with risk of neonatal injury (odds ratio 0.6, 95% confidence interval 0.4-0.9), followed by delivery of posterior arm. CONCLUSION: Delivery of posterior arm might be prioritized in cases of shoulder dystocia after failed McRoberts. Neonatal hypoxic injury correlates with the duration of dystocia rather than the maneuver used.

Maternal and neonatal complications of shoulder dystocia with a focus on obstetric maneuvers: A case-control study of 1103 deliveries.

INTRODUCTION: Shoulder dystocia is a severe obstetric emergency that can cause substantial neonatal and maternal complications. This study aims to assess the performed obstetric maneuvers and their frequency, success, and association with maternal and neonatal complication rates. MATERIAL AND METHODS: The study population was collected among all deliveries in the Hospital District of Helsinki and Uusimaa between 2006 and 2015 (n = 181 352) by searching for ICD-10 codes for shoulder dystocia, brachial plexus injury and clavicle fracture. Shoulder dystocia cases (n = 537) were identified by reviewing the medical records. Shoulder dystocia cases treated with one or two maneuvers were compared with those treated with at least three. Medical records of a matched control group constituting of 566 parturients without any of the forementioned ICD-10 codes were also scrutinized. RESULTS: Using the four most common obstetric maneuvers (McRoberts maneuver, suprapubic pressure, rotational maneuvers, the delivery of the posterior arm) significantly increased during the study period with individual success rates of 61.0%, 71.9%, 68.1% and 84.8%, respectively. Concurrently, the rate of brachial plexus injury and combined neonatal morbidity significantly declined from 50% to 24.2% (p = 0.02) and from 91.4% to 48.5% (p < 0.001). Approximately 75% of shoulder dystocia cases treated with maneuvers were resolved by the McRoberts maneuver and/or suprapubic pressure, but each of the four most performed maneuvers significantly increased the cumulative success rate individually and statistically (p < 0.001). The rates of brachial plexus injury and combined neonatal morbidity were at their highest (52.9% and 97.8%) when none of the maneuvers were performed and at their lowest when two maneuvers were performed (43.0% and 65.4%). The increasing number (≥3) of maneuvers did not affect the combined maternal or neonatal morbidity or brachial plexus injury but increased the risk for third- or fourth-degree lacerations (odds ratio 2.91, 95% confidence interval 1.17 to 7.24). CONCLUSIONS: The increased use of obstetric maneuvers during the study period was associated with decreasing rates of neonatal complications; conversely, the lack of obstetric maneuvers was associated with the highest rate of neonatal complications. These emphasize the importance of education, maneuver training and urgently performing shoulder dystocia maneuvers according to the international protocol guidelines.

Mechanics of vaginal breech birth: Factors influencing obstetric maneuver rate, duration of active second stage of labor, and neonatal outcome.

BACKGROUND: We investigated possible parameters that could predict the need for obstetric maneuvers, the duration of the active second stage of labor (i.e., the duration of active pushing), and short-term neonatal outcome in vaginal breech births. MATERIALS AND METHODS: We performed a retrospective analysis of 268 successful singleton vaginal breech births in women without previous vaginal births from January 2015 to August 2022. Multivariable regression was used to investigate associations between maternal and fetal characteristics (including antepartum magnetic resonance (MR) pelvimetry) with obstetric maneuvers, the duration of active second stage of labor, pH values, and admission to the neonatal unit. Models for the prediction of obstetric maneuvers were built and internally validated. RESULTS: Obstetric maneuvers were performed in a total of 130 women (48.5%). A total of 32 neonates (11.9%) had to be admitted to the neonatal unit. The intertuberous distance (ITD) (p < 0.001), epidural analgesia (p < 0.001), and birthweight (p = 0.026) were associated with the duration of active second stage of labor. ITD (p = 0.028) and birthweight (p = 0.011) were also independently associated with admission to the neonatal unit, while pH values below 7.10 dropped significantly (p = 0.0034) if ITD was ≥13 cm. Furthermore, ITD (p < 0.001) and biparietal diameter (p = 0.002) were independent predictors for obstetric maneuvers. CONCLUSIONS: ITD is independently associated with the duration of active second stage of labor. Thus, it can predict suboptimal birth mechanics in the last stage of birth, which may lead to the need for obstetric maneuvers, lower arterial pH values, and admission to the neonatal unit. Consequently, MR pelvimetry gives additional information for practitioners and birthing people preferring a vaginal breech birth.

Distocia em éguas ­ Estudo retrospectivo de cinco casos / Dystocia in mares ­ Retrospective study of five cases

O objetivo deste trabalho foi realizar um estudo retrospectivo de cinco casos de cesarianas em éguas, atendidos no Hospital Veterinário da Universidade Estadual de Maringá, campus Umuarama (HVGA-UEM), no período de 2019 a 2021, em quatro éguas da raça Quarto de Milha e uma da Crioula, com queixa principal de parto prolongado e distocias por diferentes motivos. Destes, três casos (60%) tiveram alta médica (3/5), enquanto 40% (2/5) em consequência de complicações pós-operatórias e pela gravidade do quadro clínico evoluíram para o óbito. As distocias são raras em éguas, quando comparados com outras espécies e, essa particularidade, pode ser justificada pela conformação anatômica do sistema reprodutivo e a classificação placentária das éguas, que propiciam contrações rápidas e efetivas facilitando a progressão do parto normal. Dessa forma, nos casos de distocia, em que as manobras obstétricas são incapazes de corrigir o mau posicionamento fetal, a cesariana passa a ser o procedimento de eleição, no presente estudo, nenhuma égua apresentou dilatação suficiente para que fosse conduzida a fetotomia. Como medida complementar, norteada pelos princípios de bem-estar animal, foi sugerido aos proprietários, que não colocassem esses animais na estação reprodutiva seguinte, restringindo-se a sua utilização somente como doadoras de embriões. Portanto, foi possível concluir que a sobrevida das éguas submetidas a cesariana é de 60% nas condições deste estudo, o monitoramento das éguas gestantes é um fator determinante sobre os índices de mortalidade materno-fetal.

The objective of this study was to make a descriptive analysis of 5 cases of caesarean sections in mares. The five reported cases were treated at the Veterinary Hospital of the State University of Maringa, campus Umuarama (HVGA-UEM), from 2019 to 2021. Four Quarter Horse mares and one Crioula, complaining of prolonged delivery and dystocia due to different reasons. Of these, three cases were discharged 60% (3/5), while the other three 40% (2/5), due to postoperative complications and the severity of the clinical condition, progressed to death. Dystocia births are rare in mares, when compared to other species, this particularity, can be justified by the anatomical conformation of the reproductive system and the placental classification of mares, which provide rapid and effective contractions, which facilitate the progression of normal or eutocia birth. Thus, in cases of dystocia in mares, those in which obstetric maneuvers are unable to correct fetal malposition, cesarean section becomes the emergency procedure of choice. As a complementary measure, guided by the principles of animal welfare, owners were suggested not to place these animals in the next reproductive season, restricting their use only as embryo donors. Thus, it was possible to conclude that the survival of mares undergoing cesarean is 60% under the conditions of this study, uses had no vital signs at the time of the procedure and/or evolved to death during the post-surgical period immediate.