Obstetrics, gynecology and reproductive medicine guidelines. Labor, delivery, postpartum. PubMed Free Full Text · Français – Español – Italiano – Deutsch. aprendiz bem como o registro e o feedback referente às suas tomadas de ou seja, uma tomada de decisão para que o bebê nasça; = Distócia de Ombro. Curso de Hemorrágia Pós Parto e Distocia de Ombro. Public. · Hosted by Midwife Education. Interested. clock. Saturday, November 24, at AM –

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Baseline patient characteristics for age, parity, BMI, weight gain did not vary significantly according to type of maneuver.

Shoulder dystocia : Guidelines, reviews, statements, recommendations, standards

To license this image for other purposes, click here. These custom illustration can show, side by side, the body before and after a catastrophic injury.

In our study the higher incidence of SD solved with the use of McRoberts and supra-pubic pressure may have two explanations. Baseline patient characteristics for ageparity, BMI, weight gain in pregnancy did not vary significantly according to type of maneuver used to resolve the SD.

Am J Obstet Gynecol ; Although the effort on trying to find risk factors ante and intrapartum, most of the cases can not be anticipated, therefore SD its known for being an unpredictable and unpreventable event. In order to compare rotational maneuvers with delivery of posterior arm, we performed a sub-analysis: If you have legal questions, you should find a lawyer with whom you can discuss your case issues.

Obstetric management is detailed in Table II. It occurs in 0. Read our License Agreement for details. We do not provide legal or medical advice. We recently settled two complicated catastrophic injury cases. A comparison of obstetric maneuvers for the acute management of shoulder dystocia. Bookmark this page on: Tough, it is acceptable that we should begin with the least invasive maneuvers suprapubic pressure and McRoberts tecnique and, if unsuccessful, moving on to more invasive ones 1,4.


Instrumental delivery was performed in the same proportion between groups. I highly recommend MLA to anyone seeking high quality, detailed medical legal artwork. Como citar este artigo. However, we believe this finding needs to be further evaluated in prospective studies where the fetal head position is recorded regardless of the type of delivery.

During the study period, there were cases 3.

The few studies reporting the neonatal morbidity according to the type of maneuvers used to resolve SD are retrospective and the data is not completely clear. I would not want to try a case without them. The median birth weight of the neonates was not different between the groups. Medical Legal Art creates medical demonstrative evidence medical illustrations, drawings, pictures, graphics, charts, medical animations, anatomical models, and interactive presentations for use during legal proceedings, including research, demand letters, client conferences, depositions, arbitrations, mediations, settlement conferences, mock jury trials and for use in the courtroom.

Interestingly, when the instruments where applied in a transverse fetal head position, there was a higher need for rotational maneuvers or delivery of posterior arm for solving a SD. In the same way, McFarland found higher neonatal injuries when three or more maneuvers were needed 9.

Curso de Hemorrágia Pós Parto e Distocia de Ombro

Shoulder dystocia; Obstetric emergency; Obstetric maneuvers; Maternal morbidity; Neonatal morbidity. We found an incidence of 3.

We found that when more extensive maneuvers were needed, newborns had lower Apgar score at the first minute and an higher rate of neonatal injuries, specifically clavicular fracture. McFarland found that Maternal demographics are presented in Table I. This image may only be used in support of a single legal proceeding and for no other purpose.


The choice of the maneuver should be based on the degree of invasiveness of the maneuvers, individual training and clinical experience, as well as the prevailing circumstances 3. I can certainly say that the medical illustrations prepared by Medical Legal Art have assisted us in bringing cases to a successful resolution. Internat J Gynecol Obstet ; After the diagnosis of shoulder dystocia, the operator has up to five minutes to deliver a previously well oxygenated fetus before an increased risk of asphyxia injury occurs 6,7.

Understandably, rotational maneuvers and delivery of posterior arm were associated with higher maternal morbidity – 3 rd or 4 th degree laceration. Head-to-body delivery interval and risk of fetal acidosis and hypoxic ischaemic encephalopathy in shoulder dystocia: In order to expedite the delivery, many maneuvers have been described for successful disimpact of the anterior shoulder behind symphysis pubis.

The cases were divided into the following two groups: The effect of this juxtaposition is unmatched by any testimony that can be adduced at the time of trial. The medical doctors, both treating physicians and expert witnesses, have commented on the accuracy and professionalism of the medical illustrations. Nucleus Medical Media does not dispense medical or legal advice. In our institution, prophylactic maneuvers are not performed routinely, but in case of SD, McRoberts and supra-pubic pressure are always the first maneuvers to perform.

I believe in large part, the amounts obtained were due to the vivid illustrations of my clients’ injuries and the impact on the finder of fact. Obstet Gynecol ;