Cases reported "Dystocia"

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1/13. Symphyseal separation, sacroiliac joint dislocation and transient lateral femoral cutaneous neuropathy associated with McRoberts' maneuver. A case report.

    BACKGROUND: McRoberts' maneuver is often used prophylactically with the onset of active maternal expulsive efforts or immediately before delivery of the fetus. CASE: A 31-year-old woman, gravida 1, para 0, at 39 2 weeks' gestational age, was continuously maintained in an exaggerated lithotomy position while actively pushing during the second stage of labor. Immediately following spontaneous vaginal delivery of a 3,598-g infant, the patient noted left gluteal pain and left anterior thigh dysesthesia. Orthopedic evaluation revealed a 5-cm symphyseal separation, sacroiliac joint dislocation and transient lateral femoral cutaneous neuropathy. The patient underwent closed reduction of the left hemipelvis, followed by open reduction and internal fixation of the symphysis pubis two weeks later after failing conservative treatment. CONCLUSION: Although McRoberts' maneuver is generally safe, care should be exercised with use of excessive force or prolonged placement of the patient's legs in a hyperflexed position.
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keywords = gestation
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2/13. Gross deciduosis peritonei obstructing labor: a case report and review of the literature.

    Gross deciduosis peritonei is a rare lesion characterized by the presence of grossly visible peritoneal decidual tissue in pregnant women; we present the clinicopathologic features of one such case. A 24-year-old, G4P1A2, Hispanic female underwent cesarean section at 39 weeks' gestation for dystocia related to pelvic masses. Multiple, light tan peritoneal masses involved the cul-de-sac, both ovaries, pelvic wall, omentum, and the large and small bowel. The intraoperative appearance suggested peritoneal carcinomatosis. A right ovarian mass was excised and biopsies were obtained from other sites. Microscopic examination showed the typical features of decidua in all of the lesions. Two weeks postoperatively, the patient was admitted with nausea and vomiting suggestive of a small bowel obstruction, which resolved after 2 days of medical treatment. After a postpartum visit at 5 weeks, the patient was lost to follow-up.
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keywords = gestation
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3/13. Diabetes, hypertension and birth injuries: a complex interrelationship.

    Seemingly coincidental occurrence of various pathological conditions may derive from common etiologic denominators. While reviewing 240 malpractice claims involving shoulder dystocia related fetal injuries, we found two antenatal complications in the background conspicuously often. Chronic or pregnancy induced hypertension was identifiable in 80 instances (33%). pregnancy induced or preexisting diabetes was diagnosed 48 times (20%). Many of these patients were poorly controlled. The blood pressure was usually checked during the antenatal visits. However, about one-half of all patients received no diabetic screening. Therefore, this study may underestimate the actual incidence of diabetes. It has been calculated that the frequency of diabetes in pregnancy and that of hypertension, is about 5% in the united states. Thus, the rates of these complications in this selected group of gravidas was severalfold higher than in the general population. Since hypertension causes retarded fetal growth, it cannot be a direct cause of arrest of the shoulders at delivery. The likely common denominator is maternal diabetes a known predisposing factor both for preeclampsia and shoulder dystocia at birth. In the course of litigations for fetal injuries, demonstration of the predisposing role of seemingly unrelated shortcomings of the medical management may profoundly influence the outcome. This principle is demonstrated by the presentation of an actual malpractice action which resulted in a substantial settlement.
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ranking = 4.6708732056859
keywords = pregnancy
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4/13. Arrest of descent in second stage of labour secondary to macrosomia: a case report.

    BACKGROUND: fetal macrosomia, defined as birth weight greater than 4000 g, complicates 10% of pregnancies and is a well-documented cause of prolonged second stage of labour, as well as of arrest of descent of the fetal presenting part. CASE: A multigravida woman with gestational diabetes mellitus was admitted in labour at term, and progressed to full dilatation. The fetal vertex failed to descend beyond -3 station. An emergency Caesarean section was performed and a 6452 g male infant was delivered. CONCLUSION: physicians should be aware of the possibility of macrosomia as the cause of failure of descent in the second stage. A heightened state of suspicion should be maintained, particularly in a multigravida woman with a prior macrosomic baby and the presence of other predisposing factors such as gestational diabetes mellitus.
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ranking = 2
keywords = gestation
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5/13. Temporary Erb-Duchenne palsy without shoulder dystocia or traction to the fetal head.

    BACKGROUND: Although many retrospective studies report that brachial plexus palsies occur after vaginal delivery in the absence of recorded shoulder dystocia, there are no known prospective reports by a treating clinician (pubmed, English language only, 1952-June 2004, search terms: shoulder dystocia, nonshoulder dystocia, obstetric brachial plexus injury, Erb's palsy, Erb-Duchenne palsy, spontaneous vaginal delivery). CASE: A multiparous patient presented with a birth plan requesting that the baby be allowed to deliver on its own, without traction on the head and without suctioning. Although induced at term for elevated blood pressure, the otherwise healthy patient experienced a normal labor with a 30-minute second stage. At delivery, which was videotaped by the father, the fetal head presented over an intact perineum in a right-occiput-anterior position. Without traction, the anterior shoulder delivered spontaneously with the next contraction and Valsalva, followed by the posterior shoulder. The trunk followed routinely. The average-weight for gestational age neonate exhibited an Erb-Duchenne palsy of the right (posterior) arm that resolved on the fourth day of life. CONCLUSION: Temporary Erb-Duchenne palsy can occur in the posterior arm after normal labor and spontaneous delivery without shoulder dystocia or traction on the fetal head.
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ranking = 1
keywords = gestation
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6/13. Thoracopagus conjoint twins presenting as shoulder dystocia: a case report.

    A thirty-eight year old, gravida seven, para six mother presented to the outpatient department of Saint Paul's General Specialized hospital on September 11, 2003 after attempted delivery of the shoulder failed at Meta Robi health center. Referral note indicated that she presented at the health center in the second stage of labor, which was delayed for more than two hours. Ventouse delivery was effected at the health center following which the shoulder could not be delivered and mother was referred to Addis for further management of the shoulder dystocia. Upon presentation to the hospital further delivery of the fetus was difficult and an ultrasound exam showed a twin pregnancy. A caesarean delivery was effected with the possibility of conjoined twinning. Stillborn 5100 grams thoracopagus twins were delivered with intraoperative decapitation of the head of the vaginally delivered twin. Mother was discharged after seven days in good condition. literature on the diagnosis and management of conjoint twinning is reviewed and the rare situation in which a conjoined twin might be a differential diagnosis of shoulder dystocia is noted.
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ranking = 2.3354366028429
keywords = pregnancy
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7/13. 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.
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ranking = 1
keywords = gestation
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8/13. uterine rupture due to traumatic assisted fundal pressure.

    OBJECTIVE: uterine rupture is potentially a life-threatening condition for both mother and infant. In this article, we report a rare occurrence of uterine rupture due to traumatic assisted fundal pressure associated with hydrops fetalis and shoulder dystocia. CASE REPORT: A 29-year-old woman was admitted for termination of pregnancy at 34 weeks' gestation because of fetal hydrops. Assisted uterine fundal pressure was done during delivery because of coexistent shoulder dystocia. After a series of assisted uterine fundal pressure, a dead hydropic baby weighing 4,000 g was delivered, and persistent postpartum hemorrhage occurred. An emergency laparotomy was performed, which revealed a large left broad ligament hematoma with multiple bleeding points. The bleeders were safely sutured and the tears of the left lateral uterine wall were primarily restored. The patient was discharged 8 days later. CONCLUSION: Assisted fundal pressure during painful delivery can be traumatic and results in uterine rupture. In this article, we suggest that uterine rupture should be considered whenever a pregnant woman experiences a sudden onset of abdominal pain during the course of assisted uterine fundal pressure.
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ranking = 3.3354366028429
keywords = pregnancy, gestation
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9/13. Ovarian pregnancy causing obstructed labor at term in a heterotopic gestation.

    A case of advanced heterotopic pregnancy in which an ovarian pregnancy caused obstructed labour with incomplete uterine rupture is presented. A live baby that weighed 3.25 kg was delivered at caesarean section. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The left ovarian mass contained a fetus papyraceus of about 24 weeks gestation.
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ranking = 19.012619617058
keywords = pregnancy, gestation
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10/13. fetus papyraceus causing dystocia: inability to detect blighted twin antenatally.

    A case is reported of fetus papyraceus diagnosed intrapartum. There was no clinical evidence in early and midpregnancy to suggest such a diagnosis. Ultrasound examination performed 1 week prior to delivery was nondiagnostic, but an x-ray taken intrapartum revealed dystocia caused by fetus papyraceus, thus necessitating cesarean section. It is suggested that the clinician consider x-ray as well as ultrasound in the diagnosis of fetus papyraceus. In addition to the obstetric morbidity, there is considerable neonatal morbidity which further increases the importance of antenatal diagnosis of fetus papyraceus.
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ranking = 2.3354366028429
keywords = pregnancy
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