Overview of techniques to manage shoulder dystocia during vaginal birth

Bothou, Anastasia; Apostolidi, D.; Tsikouras, Panagiotis; Iatrakis, Georgios; Sarella, Angeliki; Iatrakis, Dimitrios; Peitsidis, Panagiotis; Gerente, Aggeliki; Anthoulaki, Xanthoula; Nikolettos, Nikolaos; Zervoudis, Stefanos

doi:10.18332/ejm/142097

Cited by 10 publications

(9 citation statements)

References 39 publications

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“…These findings indicate that hEDS/HSD may be another risk factor to consider and is therefore recommended to be considered in the next revisions of the guidance on shoulder dystocia [74]. The McRobert's Manoeuvre is commonly recommended as first-line treatment [74,75]; however, this can result in maternal pubic symphysis diastasis [76] and other potential pelvic and hip injury. The Gaskin Manoeuvre in a hands-and-knees position has recently been found to be a safer first-line method reducing injury to the baby [77].…”

Section: Discussionmentioning

confidence: 99%

Childbearing with Hypermobile Ehlers–Danlos Syndrome and Hypermobility Spectrum Disorders: A Large International Survey of Outcomes and Complications

Pearce,

Bell,

Pezaro

et al. 2023

IJERPH

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One in 20 births could be affected by hypermobile Ehlers–Danlos syndrome or Hypermobility Spectrum Disorders (hEDS/HSD); however, these are under-diagnosed and lacking research. This study aimed to examine outcomes and complications in people childbearing with hEDS/HSD. A large online international survey was completed by women with experience in childbearing and a diagnosis of hEDS/HSD (N = 947, total pregnancies = 1338). Data were collected on demographics, pregnancy and birth outcomes and complications. Participants reported pregnancies in the UK (N = 771), USA (N = 364), Australia (N = 106), Canada (N = 60), New Zealand (N = 23) and Ireland (N = 14). Incidences were higher in people with hEDS/HSD than typically found in the general population for pre-eclampsia, eclampsia, pre-term rupture of membranes, pre-term birth, antepartum haemorrhage, postpartum haemorrhage, hyperemesis gravidarum, shoulder dystocia, caesarean wound infection, postpartum psychosis, post-traumatic stress disorder, precipitate labour and being born before arrival at place of birth. This potential for increased risk related to maternal and neonatal outcomes and complications highlights the importance of diagnosis and appropriate care considerations for childbearing people with hEDS/HSD. Recommendations include updating healthcare guidance to include awareness of these possible complications and outcomes and including hEDS/HSD in initial screening questionnaires of perinatal care to ensure appropriate consultation and monitoring can take place from the start.

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Section: Discussionmentioning

confidence: 99%

Childbearing with Hypermobile Ehlers–Danlos Syndrome and Hypermobility Spectrum Disorders: A Large International Survey of Outcomes and Complications

Pearce,

Bell,

Pezaro

et al. 2023

IJERPH

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“…An experienced team is necessary in this situation, but on the other hand it is more important to perform the maneuvers correctly, without losing time because every minute is crucial. 9 HELPERR mnemonic is very helpful in shoulder dystocia management, but it is does not always work. There are references in the literature that confirm it.…”

Section: Discussionmentioning

confidence: 99%

“…There are references in the literature that confirm it. 10 There are additional ways for successful management of the situation, such as Zavanelli maneuver and symphysiotomy 9 , but it is not always feasible to be performed. In the case we describe we could not use any of the other ways so we decided to perform the second episiotomy, which increased the available space so the trapped shoulder released.…”

Section: Discussionmentioning

confidence: 99%

Performing double episiotomy for shoulder dystocia management. Case report

Kostoglou¹

2022

HJOG

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Shoulder dystocia is an obstetric emergency that occurs in approximately 1% of vaginal deliveries. This situation is related with neonatal morbidity and mortality as long as maternal complications. The management of shoulder dystocia should be quick in order to avoid serious consequences. This case report is about the immediate diagnosis and successful management of shoulder dystocia through performing a second episiotomy after the HELPER mnemonic failed.

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“…Pueden partir desde cualquier posición y realizarse en contextos con mínimos recursos. Si bien en algunos textos estas posiciones no se recomiendan para gestantes con anestesia peridural, en tanto dicha anestesia no genere bloqueo motor, con cierto entrenamiento previo y ayuda pueden lograrse (53,54) . Por otro lado, estas maniobras permiten la participación de la gestante e incluso la colaboración del acompañante.…”

Section: Paciente En Posición Verticalunclassified

Distocia de hombros: propuestas de resolución de acuerdo con las diferentes posiciones de parto según la movilidad de la pelvis

Espinoza

Parés²,

Keklikian

et al. 2023

Rev peru ginecol obstet.

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Introducción. La distocia de hombros es una complicación del parto vaginal que se produce por dificultad en el parto de los hombros fetales. Puede desencadenarse en forma impredecible e imprevista, por lo que debería ser considerada como riesgo potencial de todo nacimiento. La mayoría de las recomendaciones sobre las maniobras de resolución de distocia de hombros lo hacen desde la posición de litotomía y sin considerar los movimientos intrínsecos de la pelvis durante el parto. Objetivos. Analizar las maniobras de resolución de distocia de hombros a partir del conocimiento de la biomecánica de la pelvis y su relación con los hombros fetales, teniendo en cuenta las diferentes posiciones de parto. Métodos. Revisión bibliográfica no sistematizada. Resultados. Ante la distocia del hombro anterior, si la gestante se encuentra en litotomía podría recomendarse la maniobra de McRoberts con presión suprapúbica seguida de la extracción del brazo posterior. Si la gestante se encuentra en posición vertical, se sugiere pasar a posición de cuatro apoyos y una variante original resultado del análisis de los movimientos de la pelvis llamada ‘cuatro apoyos en asimetría’. Esta puede ser realizada desde cualquier posición, no es invasiva y requiere un mínimo de entrenamiento. Conclusiones. La resolución de distocia de hombros no posee un único algoritmo; dependerá del tipo de distocia, la posición de la gestante, el contexto y la mayor o menor habilidad de una maniobra sobre otra. La postura de Gaskin y cuatro apoyos en asimetría debería ser tenida en cuenta antes de realizar maniobras internas para la resolución de la distocia de hombros.

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Overview of techniques to manage shoulder dystocia during vaginal birth

Cited by 10 publications

References 39 publications

Childbearing with Hypermobile Ehlers–Danlos Syndrome and Hypermobility Spectrum Disorders: A Large International Survey of Outcomes and Complications

Childbearing with Hypermobile Ehlers–Danlos Syndrome and Hypermobility Spectrum Disorders: A Large International Survey of Outcomes and Complications

Performing double episiotomy for shoulder dystocia management. Case report

Distocia de hombros: propuestas de resolución de acuerdo con las diferentes posiciones de parto según la movilidad de la pelvis

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