1/2. Catastrophic shoulder dystocia.OBJECTIVE: The objective of this paper is to outline in a stepwise fashion a life-saving management sequence for catastrophic shoulder dystocia. METHOD: Five cases of catastrophic shoulder dystocia are analyzed to determine optimal management when confronted with this terrifying obstetric complication. RESULT: The management of these five cases reveals the importance of the early use of uterine relaxing agents and general anesthesia. A second physician is also ideal. The absence of a nuchal cord may result in more favorable outcomes. CONCLUSION: The key to achieving improved outcomes when confronted with catastrophic shoulder dystocia include (1) immediate availability of an operating room and anesthesia personnel, (2) the willingness to use uterine relaxing agents, (3) the availability of a second physician, (4) an understanding of the best sequence of remedial measures to follow, (5) total delivery within 12-13 min of the delivery of the head (almost impossible when the delivery process begins in a birthing room) and (6) a cesarean room should be considered for delivery of all massively obese women.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/2. Cervical neck dislocation associated with the Zavanelli maneuver.BACKGROUND: In the management of shoulder dystocia, fetal head replacement into the uterus has been advocated should delivery attempts remain unsuccessful. Reports of the Zavanelli maneuver have been remarkably optimistic despite the challenges of the procedure. CASE: A gravida 3 para 2 (two previous vaginal deliveries of more than 4,500-g infants) with gestational diabetes presented at term. Following a low forceps delivery, shoulder dystocia was encountered and was unable to be relieved with standard maneuvers. A cesarean delivery was performed, shoulders disimpacted, and the infant delivered abdominally. A 4,680-g stillborn infant was delivered with radiologic and autopsy evidence of cervical C5-C6 dislocation. CONCLUSION: Despite published reports of high success rates and limited fetal consequences, physicians should be aware of adverse consequences including cervical neck trauma associated with use of the Zavanelli maneuver.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |