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Catastrophic shoulder dystocia.

H F Sandmire
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Abstract

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.

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Catastrophic IllnessDystociaExtraction, ObstetricalFemaleHumansPregnancyPregnancy OutcomeShoulderVersion, FetalCase ReportsJournal Article

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BibTeXRIS

H F Sandmire. 2004. Catastrophic shoulder dystocia.. https://doi.org/10.1016/j.ijgo.2003.09.004

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Household out-of-pocket payments for illness: evidence from Vietnam.

BACKGROUND: In Vietnam, illnesses create high out-of-pocket health care expenditures for households. In this study, the burden of illness in the Bavi district, Vietnam is measured based upon individual household health expenditures for communicable and non-communicable illnesses. The focus of the paper is on the relative effect of different illnesses on the total economic burden of health care on households in general and on households that have catastrophic health care spending in particular. METHODS: The study was performed by twelve monthly follow-up interviews of 621 randomly selected households. The households are part of the FilaBavi project sample--Health System Research Project. The heads of household were interviewed at monthly intervals from July 2001 to June 2002. RESULTS: For the population in the Bavi district, communicable illnesses predominate among the episodes of illness and are the reason for most household health care expenditure. This is the case for almost all groups within the study and for the study population as a whole. However, communicable illnesses are more dominant in the poor population compared to the rich population, and are more dominant in households that have very large, or catastrophic, health care expenditure, compared to those without such expenditures. CONCLUSION: The main findings indicate that catastrophic health care spending for a household is not usually the result of one single disastrous event, but rather a series of events and is related more to "every-day illnesses" in a developing country context than to more spectacular events such as injuries or heart illnesses.

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