ABSTRACT
Distocia de ombro é um evento imprevisível e profissionais habilitados para assistir ao parto devem estar capacitados para diagnosticar e instituir manobras efetivas para sua resolução. Tais manobras têm por objetivo aumentar a pelve funcional, reduzir o diâmetro biacromial e melhorar a relação feto-pélvica, facilitando o desprendimento do concepto dentro de sete minutos do diagnóstico, para prevenir complicações. Vários algoritmos têm sido propostos, com o desenvolvimento de mnemônicos para treinamento profissional, sendo o mais famoso o do Advanced Life Support in Obstetrics (ALSO), conhecido como HELPERR(em inglês) ou ALEERTA (em português). No entanto, estes são úteis quando a parturiente se encontra em decúbito dorsal. Propõe-se um novo protocolo, considerando os benefícios associados aos partos em posição não supina e a necessidade de iniciar a conduta das manobras menos para as mais invasivas. O mnemônico proposto é A SAIDA e consiste em: A = chamar ajuda, avisar parturiente, aumentar agachamento; S = pressãosuprapúbica; A = alterar posição para quatro apoios (manobra de Gaskin); I = manobras internas (Rubin II, Wood,parafuso invertido); D = desprender ombro posterior; A = avaliar manobras de resgate...
Shoulder dystocia is an unpredictable event and skilled birth attendants should be trained to diagnose and implement effective maneuvers to solve it. These maneuvers aim to increase the functional pelvis, to reduce biacromial diameter and to improve the relationship between the pelvis and the fetus, favoring the conceptus release within seven minutes of the diagnosis, in order to prevent complications.Several algorithms have been proposed including mnemonics for professional training, being the most famous the one developed by Advanced Life Support in Obstetrics (ALSO), known as HELPERR (in English) or ALEERTA(in Portuguese). However, these sequences of maneuvers are useful when the mother is in a supine position.A new protocol is proposed, considering the benefits of deliveries in non-supine positions, as well as the need for implementing less invasive maneuvers first. The proposed mnemonic is A SAÍDA and consists of A = ask for help, acquaint the mother, augment the squat; S = suprapubic pressure; A = alter the position to all fours (Gaskinmaneuver); I = internal maneuvers (Rubin II, Wood, inverted spin); D = deliver the posterior arm; A = assess theneed for rescue maneuvers...
Subject(s)
Humans , Female , Pregnancy , Clinical Competence , Dystocia/therapy , Delivery, Obstetric/methods , Emergency Medical Services , Algorithms , Clinical Protocols , Life Support Care/methods , Health Knowledge, Attitudes, Practice , Delivery, Obstetric/trendsABSTRACT
Cada vez mais os médicos e, principalmente, os obstetras são responsabilizados por eventos desfavoráveis ocorridos durante sua atividade profissional. Muitos advogados aproveitam esta ocorrência para denunciá-los com o intuito de ganhar causas milionárias. A distocia de ombros é um evento obstétrico incidental, imprevisível em muitos casos e que, na maioria das vezes, causa tocotraumatismo, principalmente no feto, levando muitos advogados a pedirem indenização reparatória, às vezes por toda a vida da criança afetada, o que implica um desgaste moral, profissional e patrimonial do obstetra, o qual não é o responsável por tal ocorrência. Este trabalho teve por finalidade colher dados da literatura e da medicina baseada em evidências para dar subsídios científicos para formar a defesa do profissional, que sofrer tal incidente.
Each new day, doctors and, mainly, obstetricians are responsible by occurred favorable events during its professional activity. Many lawyers try to take advantage of this occurrence, denouncing them with the intention of gaining millionaire causes. The shoulders' dystocia is an incidental and unexpected delivery event in many cases, that most of the time causes traumatic delivery, mainly fetal trauma, which leads many lawyers to ask for ensuing litigation indemnity, to the times for all the life of the child affected and that it implies in a moral consuming, professional and patrimonial of obstetrician, who is not the responsible for such occurrence. This paper has as a purpose to collect literature and medicine based on evidences data to give scientific subsidies to form the defense of the professional, who suffers such incident.
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Birth Injuries , Dystocia/therapy , Medical Errors/legislation & jurisprudence , Labor Presentation , Obstetric Labor Complications , Shoulder/injuries , Delivery, Obstetric/education , Clinical CompetenceSubject(s)
Humans , Female , Pregnancy , Infant, Newborn , Dystocia/epidemiology , Dystocia/etiology , Dystocia/therapy , Shoulder/injuries , Delivery, Obstetric/methods , Birth Injuries , Clavicle/injuries , Diabetes Complications , Fetal Macrosomia/etiology , Prenatal Care , Brachial Plexus/injuries , Risk FactorsABSTRACT
El objetivo que plantea este trabajo es reducir por medio de la rotación manual (RMC) del polo cefálico, el número de cesáreas causadas tanto por distocias de posición como por falta de encajamiento y evitar el riesgo de la rotación y extracción instrumental. Nuestra casuística está formada por 100 pacientes en las cuales se practicó la (RMC) en el segundo período del parto, en 59 multíparas y 41 primíparas; en 37 casos la posición fue transversa y en 63 oblicua posterior. Las indicaciones fueron dadas mayoritariamente por período expulsivo prolongado, abreviación del expulsivo, agotamiento materno, falta de encajamiento y sufrimiento fetal. El parto fue espontáneo en 57 casos: en 40 terminó por aplicaciones complementarias de fórceps con cabeza encajada en una variedad anterior, en su mayoría por sufrimiento fetal: hubo 3 fracasos, 2 occípito posteriores que no rotaron y hubo que rotarlas con el fórceps a occípito sacra y una cesárea por falta de encajamiento; los resultados fueron favorables en el 97 por ciento
Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Dystocia/therapy , Obstetric Labor Complications/therapy , Version, Fetal/methods , Cesarean Section , Fetal Distress/prevention & control , Obstetrical Forceps , Labor PresentationABSTRACT
Contenido: Parto de riesgo: Atención. Admisión de la embarazada. Morbilidad y mortalidad materna post parto. El recién nacido del parto de reisgo. Anexos: Control de la integridad del binomio madre-hijo. Normas de seguridad institucional
Subject(s)
Pregnancy , Perinatal Care/standards , Prenatal Care/standards , Dystocia/therapy , Maternal Mortality , Obstetrics/education , Perinatology/education , Pregnancy, High-Risk , Theft/prevention & control , Dystocia/diagnosis , Fetal Membranes, Premature Rupture , Patient Identification Systems , Placenta Previa , Pre-Eclampsia , Pregnancy Complications , Pregnancy in Diabetics , Security Measures , Obstetrics and Gynecology Department, Hospital/standardsSubject(s)
Female , Humans , Pregnancy , Patient Care Management/methods , Labor Presentation , Dystocia/therapy , Risk Factors , Shoulder , Patient Care Management/standards , Dystocia/complications , Fetus , Fetal Macrosomia/complications , Birth Injuries/complications , Birth Injuries/physiopathologyABSTRACT
To study the problem of shoulder dystocia regarding fetal and maternal features and its complications. A retrospective study of the records of 64,800 deliveries that occurred in the period between 1979 and 1997 was carried out. The study was conducted at the Obstetric and Gynecology Department at Prince Hashem Ben AI-Hussein Hospital, Zarqa, Royal Medical Services. Patients were divided into two groups:- those before and those after 1989. The frequency of shoulder dystocia was calculated for both groups. Maternal characteristics and fetal morbidity were compared in both groups. A total of 250 cases of shoulder dystocia were encountered. Whereas 231 cases of shoulder dystocia out of 28000 deliveries [0.825%] were found in the period 1979 through 1989, only 19 cases out of 36800 deliveries [0.051%] were reported in the period 1989 through 1997. The frequency of shoulder dystocia dropped from 0.825% to 0.051%. Shoulder dystocia represents an obstetric emergency because it holds a very high perinatal and maternal morbidity. The warning signs of shoulder dystocia should be taken seriously and the best method of delivery for each patient should be selected to avoid its occurrence anti to manage it quickly and properly should it occur
Subject(s)
Humans , Female , Shoulder , Delivery, Obstetric/adverse effects , Dystocia/therapy , Dystocia/epidemiologyABSTRACT
Induction of labour was carried out in 153 term pregnant women, all nulliparous, with unfavourable cervix and adequate pelvis. A Foley's catheter was passed into the cervix at night. After spontaneous expulsion of the Foley's balloon, a 3 mg. prostaglandin E [PGE] 2 pessary was introduced into the cervix and placed extra amniotically. Labour was established in 53.5% of the cases and uneventful delivery was conducted within 6-8 hours of insertion of prostaglandin pessary. Oxytocin infusion was used in later period of first stage or at the onset of second stage of labour in 75% of the cases while 25% required no oxytocin. In 39.2% of the cases, progress in first stage of labour was delayed and an oxytocin infusion was needed in the earlier period. Induction-delivery interval was not more than 14 hours from the insertion of the pessary in all the cases. Caesarean section had to be done in 16.3% of the cases due to various reasons
Subject(s)
Humans , Female , Pregnancy Complications/therapy , Cervix Uteri , Dinoprostone , Dystocia/therapySubject(s)
Humans , Female , Pregnancy , Dystocia/therapy , Labor Presentation , Patient Care Management/methods , Risk Factors , Shoulder , Birth Injuries/complications , Birth Injuries/physiopathology , Dystocia/complications , Fetus , Fetal Macrosomia/complications , Patient Care Management/standardsABSTRACT
En un trabajo prospectivo y controlado, realizamos versiones externas bajo tocólisis a un grupo de 45 pacientes con presentaciones podálicas y transversas entre las 36 y 40 semanas de gestación. Obtuvimos un 73 por ciento de éxito en el procedimiento con un 49 por ciento de cesáreas en el grupo de estudio comparado con un 87 por ciento en el grupo control. Los factores más importantes en el resultado fueron el tipo de presentación y la paridad. No observamos complicaciones maternas ni fetales significativas