CASE PRESENTATION: A 23-year-old Sukuma woman, gravida 2, para 1 presented to an maternity emergency unit of Sengerema Designated District hospital at a gestation age of 35( 5) weeks as a referral from a rural health center due to arrested descent despite [ncbi.nlm.nih.gov]

• Nightmare

  Shoulder dystocia is the unpredictable and unpreventable nightmare of the obstetrician. We report a case of spontaneous pubic symphyseal separation, the first reported case to result in the resolution of shoulder dystocia. [ncbi.nlm.nih.gov]

  Shoulder dystocia: an evidence-based evaluation of the obstetric nightmare. Clin Obstet Gynecol. 2002 Jun. 45(2):345-62. [Medline]. Allen R, Sorab J, Gonik B. Risk factors for shoulder dystocia: an engineering study of clinician-applied forces. [emedicine.medscape.com]

• Prolapse

  Patient was immediately shifted to the operation theatre and prompt delivery was conducted by giving Duhrssen's incision on the highly vascular, oedematous prolapsed cervix. The outcome was an alive and healthy male baby. [ncbi.nlm.nih.gov]

  Other guides to emergency department obstetrics: The precipitous delivery Difficult delivery: shoulder dystocia Difficult delivery: breech delivery Difficult delivery: umbilical prolapse Postpartum hemorrhage Cardiac arrest and perimortem c-section Notes [first10em.com]

  […] distress, neonatal asphyxia, uterine rupture, and postpartum hemorrhage; it may also be a marker for an increased risk of maternal pelvic floor and genital trauma during delivery (with a subsequent increase risk for future incontinence and pelvic organ prolapse [effectivehealthcare.ahrq.gov]

  In human instances of obstetrical catastrophes where there is a sudden, acute, severe prolonged bradycardia, perhaps due to a ruptured uterus or placental abruption or cord prolapse, if one can deliver the baby within 10 to 12 minutes of the catastrophe [hindawi.com]

• Joint Dislocation

  Sacroiliac joint dislocation. Lateral femoral nerve neuropathy. [patient.info]

  Furthermore many injuries and neonatal complications caused by difficult childbirth have been shown including various fractures types of skull, clavicle, humerus and femur, glenohumeral joint dislocation, liver and spleen bleedings, nervous system injury [ncbi.nlm.nih.gov]

• Hip Pain

  Immediately after the epidural had worn off, the patient complained of hip pain and was found to have a significant symphyseal separation on radiography. [ncbi.nlm.nih.gov]

• Hip Dislocation

  CONCLUSION: Examining the anomalies all together, a case of anterior hip dislocation related to a McRoberts-like maneuver performed during labor is a plausible explanation of the findings. [ncbi.nlm.nih.gov]

• Musculoskeletal Pain

  Consider a physiotherapist review before discharge, as women are at increased risk of pelvic floor weakness/3rd degree tear, musculoskeletal pain and temporary nerve damage. [teachmeobgyn.com]

• Confusion

  The characteristic hallmark of clinical turtle sign ( which should not be confused with turtle sign on ultrasound or turtle back sign ) can often be seen. [radiopaedia.org]

  However, the authors hesitate to apply the diagnosis of abnormal labor during the latent phase because it is easy to confuse prodromal contractions for latent labor. [emedicine.medscape.com]

  Although contradictory views in medical publications dealing with this subject tend to confuse the picture, the basic issues are not particularly complex. [wjgnet.com]

• Urinary Incontinence

  Maternal morbidity including urinary incontinence was significant but responded to treatment. [ncbi.nlm.nih.gov]

• Bicarbonate Decreased

  RESULTS: Bicarbonate decreases the AFL levels (p CONCLUSIONS: An increase of spontaneous vaginal deliveries resulted from bicarbonate ingestion by dystocic women. A decreased level of AFL-level was shown. [ncbi.nlm.nih.gov]

Maternal morbidity including urinary incontinence was significant but responded to treatment. [ncbi.nlm.nih.gov]

PURPOSE: To describe the risk factors and labor characteristics of Clavicular fracture (CF) and brachial plexus injury (BPI); and compare antenatal and labor characteristics and prognosis of obstetrical BPI associated with shoulder dystocia with obstetrical [ncbi.nlm.nih.gov]

Risk factors advanced maternal age abnormal pelvic anatomy short stature maternal diabetes post dates macrosomia prolonged first or second stage of labor improper maneuver (fundal pressure) oxytocin augmentation Treatment and prognosis Complications Maternal [radiopaedia.org]

Prognosis : guarded to good. Pathogenesis Etiology Maternal vs Fetal (see above); combination of maternal and fetal causes most common. [vetstream.com]

The thickness of cerebral cortex which determines postpartum prognosis of the foetus can be measured by ultrasound. Complications Obstructed labour: with its sequel as rupture uterus. [gfmer.ch]

The prognosis of birth traumas is usually favorable, with most injuries resolving spontaneously within weeks to months. [amboss.com]

Geometric analysis reveals that borderline adequate pelvimetry likely played a significant role in severe shoulder dystocia etiology, even with a small-for-gestational-age infant. [ncbi.nlm.nih.gov]

Pathogenesis Etiology Maternal vs Fetal (see above); combination of maternal and fetal causes most common. Pathophysiology Deviation from normal labor Stages of normal labor First : uterine contractions increasing in frequency and duration. [vetstream.com]

[…] of 100% oxygen.[5][6] There is considerable controversy over the diagnosis of birth asphyxia due to medicolegal reasons.[7][8] Because of its lack of precision, the term is eschewed in modern obstetrics.[9] Cause[edit] Basically, understanding of the etiology [en.wikipedia.org]

Epidemiology Shoulder dystocia occurs in 0.58-0.70% of vaginal deliveries. [ 1 ] Aetiology These may be remembered as 'The Powers' (uterus), 'The Passenger' (fetus) and 'The Parts' (pelvis). [patient.info]

[…] symphysiotomy, which makes the opening of the birth canal laxer by breaking the connective tissue between the two pubes bones.[2] Abdominal rescue, described by O'Shaughnessy, where a hysterotomy facilitates vaginal delivery of the impacted shoulder[20] Epidemiology [en.wikipedia.org]

Pathophysiology Deviation from normal labor Stages of normal labor First : uterine contractions increasing in frequency and duration. Normally 12-24 h in duration. [vetstream.com]

(Please refer to the Pathophysiology for information regarding adequate contractions.) Abnormal labor constitutes any findings that fall outside the accepted normal labor curve. [emedicine.medscape.com]

Pathophysiology: To characterize a labor as abnormal, a basic understanding of normal labor is necessary. Normal labor starts with regular uterine contractions that are sufficient enough to result in cervical effacement and dilation. [www1.cgmh.org.tw]

The general principles guiding the causes and the pathophysiology of perinatal asphyxia are grouped into antepartum causes and intra partum causes. As these are the various points to which insults can occur to the foetus. [en.wikipedia.org]

Pathophysiology of uterine contractions in obstructed labour The obvious purpose of labour is to deliver the fetus and then placenta, whether the labour becomes obstructed or not. [doi.org]

As a result, the prediction of shoulder dystocia remains elusive, and the cost of trying to prevent one by performing a cesarean delivery remains high. [ncbi.nlm.nih.gov]