1
|
Tsikouras P, Kotanidou S, Nikolettos K, Kritsotaki N, Bothou A, Andreou S, Nalmpanti T, Chalkia K, Spanakis V, Peitsidis P, Iatrakis G, Nikolettos N. Shoulder Dystocia: A Comprehensive Literature Review on Diagnosis, Prevention, Complications, Prognosis, and Management. J Pers Med 2024; 14:586. [PMID: 38929807 PMCID: PMC11204412 DOI: 10.3390/jpm14060586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/15/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
The term dystocia refers to labor characterized by a slow progression with delayed rates or even pauses in the dilation of the cervix or the descent of the fetus. Dystocia describes the deviation from the limits that define a normal birth and is often used as a synonym for the term pathological birth. Shoulder dystocia, also known as the manual exit of the shoulders during vaginal delivery on cephalic presentation, is defined as the "failure of the shoulders to spontaneously traverse the pelvis after delivery of the fetal head". This means that obstetric interventions are necessary to deliver the fetus's body after the head has been delivered, as gentle traction has failed. Abnormal labor (dystocia) is expressed and represented in partograms or by the prolongation of the latent phase or by slowing and pausing in the phases of cervical dilatation and fetal descent. While partograms are helpful in visualizing the progress of labor, regular use of them has not been shown to enhance obstetric outcomes considerably, and no partogram has been shown to be superior to others in comparative trials. Dystocia can, therefore, appear in any phase of the evolution of childbirth, so it is necessary to simultaneously assess all the factors that may contribute to its abnormal evolution, that is, the forces exerted, the weight, the shape, the presentation and position of the fetus, the integrity and morphology of the pelvis, and its relation to the fetus. When this complication occurs, it can result in an increased incidence of maternal morbidity, as well as an increased incidence of neonatal morbidity and mortality. Although several risk factors are associated with shoulder dystocia, it has proven impossible to recognize individual cases of shoulder dystocia in practice before they occur during labor. Various guidelines have been published for the management of shoulder dystocia, with the primary goal of educating the obstetrician and midwife on the importance of a preplanned sequence of maneuvers, thereby reducing maternal and neonatal morbidity and mortality.
Collapse
Affiliation(s)
- Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, 681 00 Alexandroupolis, Greece; (S.K.); (K.N.); (N.K.); (S.A.); (T.N.); (K.C.); (V.S.); (N.N.)
| | - Sonia Kotanidou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, 681 00 Alexandroupolis, Greece; (S.K.); (K.N.); (N.K.); (S.A.); (T.N.); (K.C.); (V.S.); (N.N.)
| | - Konstantinos Nikolettos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, 681 00 Alexandroupolis, Greece; (S.K.); (K.N.); (N.K.); (S.A.); (T.N.); (K.C.); (V.S.); (N.N.)
| | - Nektaria Kritsotaki
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, 681 00 Alexandroupolis, Greece; (S.K.); (K.N.); (N.K.); (S.A.); (T.N.); (K.C.); (V.S.); (N.N.)
| | - Anastasia Bothou
- Midwifery Department of Neonatology, University Hospital Alexandra, Vasilissis Sofias Ave. 80, 115 28 Athens, Greece;
| | - Sotiris Andreou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, 681 00 Alexandroupolis, Greece; (S.K.); (K.N.); (N.K.); (S.A.); (T.N.); (K.C.); (V.S.); (N.N.)
| | - Theopi Nalmpanti
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, 681 00 Alexandroupolis, Greece; (S.K.); (K.N.); (N.K.); (S.A.); (T.N.); (K.C.); (V.S.); (N.N.)
| | - Kyriaki Chalkia
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, 681 00 Alexandroupolis, Greece; (S.K.); (K.N.); (N.K.); (S.A.); (T.N.); (K.C.); (V.S.); (N.N.)
| | - Vlassios Spanakis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, 681 00 Alexandroupolis, Greece; (S.K.); (K.N.); (N.K.); (S.A.); (T.N.); (K.C.); (V.S.); (N.N.)
| | - Panagiotis Peitsidis
- Department of Obstetrics and Gynecology, Fetal Medicine Hospital Helena Venizelou, Elenas Venizelou 2, 115 21 Athens, Greece;
| | - George Iatrakis
- Department of Midwifery, University of West Attica, Agiou Spyridonos 28, 122 43 Egaleo, Greece;
| | - Nikolaos Nikolettos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, 681 00 Alexandroupolis, Greece; (S.K.); (K.N.); (N.K.); (S.A.); (T.N.); (K.C.); (V.S.); (N.N.)
| |
Collapse
|
2
|
Callahan M. Emergency Delivery. Emerg Med Clin North Am 2023; 41:281-294. [PMID: 37024164 DOI: 10.1016/j.emc.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Despite the majority of US births occurring in hospitals and under the direct care of obstetricians, there is a subset of patients who will deliver imminently in the emergency department (ED). ED physicians must be skillfully trained to manage both uncomplicated and complicated delivery scenarios. An ED delivery may require resuscitation of both mother and infant, so supplies should be readily available and all necessary consultants and support staff should be involved to ensure the best outcome. Most births are uncomplicated and require no significant additional interventions but ED staff must be prepared for these more complicated scenarios.
Collapse
|
3
|
Bothou A, Apostolidi DM, Tsikouras P, Iatrakis G, Sarella A, Iatrakis D, Peitsidis P, Gerente A, Anthoulaki X, Nikolettos N, Zervoudis S. Overview of techniques to manage shoulder dystocia during vaginal birth. Eur J Midwifery 2021; 5:48. [PMID: 34723155 PMCID: PMC8527401 DOI: 10.18332/ejm/142097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/05/2021] [Accepted: 09/09/2021] [Indexed: 01/13/2023] Open
Abstract
Shoulder dystocia is an obstetric emergency which is unpredictable and complicates approximately 0.5-1% of vaginal births. This article discusses the risk factors and the associated fetal and maternal complications, while it is also an overview of techniques and algorithms to handle shoulder dystocia.
Collapse
Affiliation(s)
- Anastasia Bothou
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece.,Department of Obstetrics and Gynecology, Health Sciences School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitra-Maria Apostolidi
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, Health Sciences School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios Iatrakis
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece.,REA Maternity Hospital, Athens, Greece
| | - Aggeliki Sarella
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
| | | | - Panagiotis Peitsidis
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece.,REA Maternity Hospital, Athens, Greece
| | - Aggeliki Gerente
- Department of Obstetrics and Gynecology, Health Sciences School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Xanthoula Anthoulaki
- Department of Obstetrics and Gynecology, Health Sciences School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikolaos Nikolettos
- Department of Obstetrics and Gynecology, Health Sciences School, Democritus University of Thrace, Alexandroupolis, Greece
| | | |
Collapse
|
4
|
Nickerson JE, Webb T, Boehm L, Neher H, Wong L, LaMonica J, Bentley S. Difficult Delivery and Neonatal Resuscitation: A Novel Simulation for Emergency Medicine Residents. West J Emerg Med 2019; 21:102-107. [PMID: 31913828 PMCID: PMC6948703 DOI: 10.5811/westjem.2019.10.43913] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/07/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction Newborn delivery and resuscitation are rare, but essential, emergency medicine (EM) skills. We evaluated the effect of simulation on EM residents’ knowledge, confidence, and clinical skills in managing shoulder dystocia and neonatal resuscitation. Methods We developed a novel simulation that integrates a shoulder dystocia with neonatal resuscitation and studied a convenience sample of EM residents. Each 15-minute simulation was run with one learner, a simulated nurse, and a standardized patient in situ in the emergency department. The learner was required to reduce a shoulder dystocia and then perform neonatal resuscitation. We debriefed with plus/delta format, standardized teaching points, and individualized feedback. We assessed knowledge with a nine-question multiple choice test, confidence with five-point Likert scales, and clinical performance using a checklist of critical actions. Residents repeated all measures one year after the simulation. Results A total of 23 residents completed all measures. At one-year post-intervention, residents scored 15% higher on the knowledge test. All residents increased confidence in managing shoulder dystocia on a five-point Likert scale (1.4 vs 2.8) and 80% increased confidence in performing neonatal resuscitation (1.8 vs 3.0). Mean scores on the checklist of critical actions improved by 19% for shoulder dystocia and by 27% for neonatal resuscitation. Conclusion Implementing simulation may improve EM residents’ knowledge, confidence, and clinical skills in managing shoulder dystocia and neonatal resuscitation.
Collapse
Affiliation(s)
- Jillian Elizabeth Nickerson
- Children's National Medical Center, Department of Emergency Medicine and Trauma Services, Washington, District of Colombia
| | - Taryn Webb
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York
| | - Lorraine Boehm
- Elmhurst Hospital Center, Simulation Center, Elmhurst, New York
| | - Hayley Neher
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York
| | - Lillian Wong
- Elmhurst Hospital Center, Department of Emergency Medicine, Elmhurst, New York
| | - Julia LaMonica
- Elmhurst Hospital Center, Department of Emergency Medicine, Elmhurst, New York
| | - Suzanne Bentley
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York.,Elmhurst Hospital Center, Department of Emergency Medicine, Elmhurst, New York
| |
Collapse
|