Implementation of a multicenter shoulder dystocia injury prevention program

Maneuvering Through a Birth Complicated by Shoulder Dystocia

Shoulder dystocia is an unpredictable intrapartum emergency with potentially devastating consequences. In this article, the etiology, pathophysiology, and clinical management of shoulder dystocia are reviewed; institutional readiness and potential legal implications are discussed. Also considered are posttraumatic stress disorder and secondary traumatic stress, adverse psychological consequences that may be experienced by women, midwives, and other intrapartum care providers, including staff.

Using briefing, simulation and debriefing to improve human and system performance

Safety, effectiveness and efficiency are keys to performance in all high-risk industries; healthcare is no exception, and neonatal-perinatal medicine is one of the highest risk subspecialties within healthcare. Briefing, simulation and debriefing are methods used by professionals in high-risk industries to reduce the overall risk to life and enhance the safety of the human beings involved in receiving and delivering the services provided by those industries. Although relatively new to neonatal-perinatal medicine, briefing, simulation and debriefing are being practiced with increasing frequency and have become embedded in training exercises such as the Neonatal Resuscitation Program (NRP) of the American Academy of Pediatrics (AAP). This chapter will define these terms and offer examples as to how they are used in high-risk activities including neonatal-perinatal medicine.

General anesthesia combined with epidural anesthesia on the postoperative cognitive functions in pregnant women with dystocia

Effects of general anesthesia combined with epidural anesthesia on the postoperative cognitive functions in pregnant women with dystocia were investigated. Postoperative cognitive functions of 84 dystocia pregnant women treated with cesarean section were retrospectively analyzed. Patients who received general anesthesia were included in group A (n=42), and those who received general anesthesia combined with epidural anesthesia were included in group B (n=42). Mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS) at different time-points after anesthesia in the two groups of patients were observed and compared. Recovery of anesthesia such as the recovery time of spontaneous breathing, recovery time of orientation and time of eye opening were observed and compared between two groups of patients. Mini mental state examination (MMSE) scores were obtained and compared between the the groups of patients at different time-points after operation. Three vital signs (MAP, HR and BIS) were not significantly different between group A and B at the same time-point (P>0.05) and the maintenance of anesthesia was satisfactory. Compared with group A, postoperative recovery time of spontaneous breathing, recovery time of orientation and the time of eye opening in group B were all significantly shorter (P<0.05). In addition, MMSE scores of patients in group B, 2 and 12 h after operation were 24.33±1.61 and 26.41±1.83 points, respectively, which were significantly improved compared with those of patients in group A (20.45±1.58 and 22.39±1.72 points, respectively) (P<0.05). In conclusion, recovery of postoperative cognitive functions in pregnant women with dystocia who received general anesthesia combined with epidural anesthesia was shorter to that of those who only received general anesthesia.