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PubMed2000

The Zavanelli manoeuvre in shoulder dystocia: case report and review of published cases.

A case of severe shoulder dystocia is reported in which, after other methods had failed, cephalic replacement succeeded but was very difficult. The infant suffered severe damage. A review of methods to relieve shoulder dystocia is given, with special attention to published cases of the Zavanelli manoeuvre. It could only be used when all other methods fail.

Adult↗
PubMed1989

[A 1-year study of the management of fetal breech presentation by monitoring follow-up during second-stage labor instead of using external version, x-ray pelvimetry and ultrasonic assessment of fetal weight].

The authors studied 246 parturients with breech presentation of the fetus. All women were examined by an obstetric monitor. Cesarean section was performed on 33 women/ = 13.41% of women with breech presentation). Perinatal morbidity and mortality were the same as those of women with vertex presentation. The frequency of cesarean section was 11.98% of multiparas and 31.57% of nulliparas. According to the authors careful observation of advancement of delivery as well as the state of the fetus (by an obstetric monitor) could lead to management of delivery with breech presentation just as that of vertex presentation. This management of breech presentations should reduce the fear of delivery, which is observed in most parturients with breech presentation of the fetus.

Body Weight↗
PubMed2003

Breech vaginal delivery at or near term.

Three percent to 4% of term fetuses will be breech at delivery. Evidence from randomized controlled trials has found a policy of planned cesarean section to be significantly better for the singleton fetus in breech presentation at term compared to a policy of planned vaginal birth. However, some women may wish to avoid cesarean section and for others, cesarean section may not be possible. We undertook this review to identify factors associated with higher and lower risk of adverse fetal or neonatal outcome at term during vaginal breech delivery. We searched MEDLINE from 1966 to 2002 using the search terms vaginal breech delivery and breech presentation and retrieved all relevant articles. We also reviewed personal references and reference lists of articles retrieved. Women who are older or who have a fetus that is either in footling presentation, has a hyperextended head or is estimated to weigh <2500 g or >4000 g may be at higher risk of adverse fetal outcome. Prolonged labor or not having an experienced clinician at vaginal breech birth may also increase the risk. Women with a fetus in breech presentation at term should be offered the option of delivery by planned cesarean section and should be informed that this will reduce their risk of adverse fetal or neonatal outcome. Practitioners should develop and maintain skills at vaginal breech delivery for those women not wishing or not able to be delivered by cesarean section.

Breech Presentation↗
PubMed1987

Maternal and fetal factors affecting success of antepartum external cephalic version.

We studied 172 patients who were considered for external cephalic version with tocolysis at term. Before a single attempt at version, a variety of maternal and fetal factors considered likely to affect success were coded for each patient. Maternal age, height, and Quetelet index did not affect success. However, successful version was more likely in parous women than in nulliparous women, and less likely with cornual than with other placentations. Amniotic fluid volume, fetal abdominal circumference, type of breech, and the specific nature of the maternal-fetal spatial relation were also important determinants of success. Fetal biparietal diameter, gestational age, and estimated fetal weight were not. All of these factors can be evaluated before attempting version and can be used when counseling candidates for version.

Adolescent↗
PubMed1995

Spontaneous rupture of the unscarred uterus.

OBJECTIVE: By presentation of cases of spontaneous (nontraumatic) ruptures of previously intact uteri, we sought to emphasize important aspects of this rare and dangerous event. STUDY DESIGN: Two case presentations of oxytocin-associated unscarred uterine rupture and review of pertinent literature are used to study risk factors and accompanying clinical characteristics. RESULTS: Both spontaneous ruptures of previous unscarred uteri were associated with low-dose oxytocin augmentation, bradycardia, and uterine hyperstimulation monitor patterns and occurred at the onset of the second stage of labor. CONCLUSION: Because of its rarity, further investigation of spontaneous uterine rupture will depend on case presentations where the associated events listed are noted and uterine hyperstimulation, fetal bradycardia, and second-stage onset are proved or disproved as valid clinical associations.

Adult↗
PubMed1985

Fetal movement and fetal presentation.

Fetal movements were analyzed by means of ultrasonography in an attempt to clarify the causative factor of frank breech presentation. Fetal posture, position, presentation and movements, as well as posture of the extremities and the volume of amniotic cavity were analyzed by ultrasonography in 112 fetuses ranging from 12 to 42 weeks of gestation. There existed three different fetal states: inactivity; slow sporadic movements without changes of presentations; active whole body movements with changes of presentations. It appears likely that version of fetal presentation from breech to cephalic occurs as the fetus tries to accommodate itself to the shape of the uterus during the state of active whole body movements, and the frank breech presentation of the fetus might result when the whole body movements are weak or absent.

Female↗
PubMedDate not supplied

Umbilical cord prolapse: a true obstetrical emergency.

The case of a 23-year-old woman with umbilical cord prolapse and fetal distress is described. This serious obstetrical complication is unfamiliar to many emergency physicians although it represents an acute emergency with high mortality. Appropriate prehospital, emergency department, and obstetrical suite care is discussed including a bladder-filling technique and tocolysis that can buy valuable time by temporarily relieving pressure on the cord.

Administration, Intravesical↗
PubMed1990

[Delivery in cases of twin pregnancy].

A retrospective analysis of 233 cases of twin pregnancies has demonstrated an increased frequency of prophylactic caesarean sections (27%) due to an increased performance of caesarean sections when the first twin is a breech and when premature babies are delivered before the 34th week of amenorrhea. When the first twin is a head, a natural delivery is possible with the same criteria as a single pregnancy. The vaginal delivery is also possible if the 2nd twin is a head. In deliveries where the 2nd twin is a breech, there is an increased frequency of early neonatal mortality and Apgar tests under 7 at 5 min, in comparison with the 2nd twin when it is a head. The type of delivery does not seem affected for babies over 1,500 grams. If the 2nd twin is a breech and under 1,500 g, a review of the literature and our results prompt us to broaden the indications of caesarean section. A delay before the birth of the 2nd twin, of under 10 min is usually associated with a better Apgar score at 1 min. without any significant differences at 5 min. It is advisable, at 38 weeks, to induce labor by rupturing the membranes and starting a perfusion of Syntocinon. If the conditions are unfavorable, pursuing the pregnancy requires a close supervision until term.

Apgar Score↗
PubMed2005

Maternal morbidity associated with obstetrical maneuvers in shoulder dystocia.

OBJECTIVES: To determine whether shoulder dystocia and obstetrical maneuvers used for its relief have detrimental effects on perineum or immediate postpartum outcome. DESIGN: Case-control study. SETTING: Tertiary maternity ward in Marseille, France. POPULATION: A total 140 cases with shoulder dystocia and 280 controls without shoulder dystocia were enrolled by reviewing charts for the period between January 1999 and December 2004. METHODS: Demographic data including obstetrical history, age, height, weight before pregnancy and at the time of delivery, and respective body mass index (BMI) and obstetrical data including analgesic technique, duration of first and second stage of labor were compared in function of outcome and of the type and number of maneuvers used to relieve shoulder dystocia. RESULTS: Resolving shoulder dystocia required one obstetrical maneuver in 41 cases (29.3%) and two obstetrical maneuvers in 48 cases (34.3%). Third-degree tears occurred in one patient in the case group versus five in the control group. No correlation was found between the number of obstetrical maneuvers needed to relieve shoulder dystocia and risk for third-degree tear (OR: 0.8; 95% CI: 0.1-7.6). Mean hemoglobin values were 96.1 g/l in the case group and 96.0 g/l in the control group (p=0.95). There was no difference between the two groups regarding duration of postpartum hospitalization. The incidence of urinary incontinence was similar in the group that underwent obstetrical maneuvers: 4.7% (6/127) and in the control group: 3.7% (13/352). Only two patients reported de novo anal symptoms, both in the control group. CONCLUSION: Shoulder dystocia and obstetrical techniques used for its relief did not result in adverse maternal outcome.

Adult↗
PubMed1996

Controversies: selective vaginal delivery for breech presentation.

Within two last decades many centers have adopted a policy of abdominal delivery, in particular of nulliparous women with breech presentations. In this review of the literature the justification for this policy is questioned. Instead, a recommendation for judicious attempts of vaginal delivery for some breech presentations is emphasized. The maternal complication rates associated with Cesarean deliveries are remarkable higher than those of vaginal deliveries. The list of contraindications to vaginal breech delivery include: feto-pelvic disproportion, hyperextension of the fetal head, umbilical cord presentation, objection on the part of the mother. Relative contraindications include a fetal weight of less than 1500 g, footling presentation, and premature rupture of membranes with a unripe cervix. Overall meta-analysis of the literature gives as neonatal mortality and morbidity rate which is 4 times higher after vaginal breech delivery than after Cesarean delivery. The majority of the studies are non-randomized, comparative and descriptive. In two randomized studies of term breeches, no differences in neonatal outcome was found when Cesarean deliveries were compared to vaginal deliveries. A universal policy of Cesarean delivery of breech presentations may lead to unnecessary maternal complications without any benefit to the fetus or newborn. It is reasonable to assume that about 40% of breech presentations could be delivered vaginally without endangering the neonatal outcome.

Breech Presentation↗