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Shoulder dystocia

Erin McMahon, Cecilia Jevitt, Barbara Aronson
INTRODUCTION: Intrapartum emergencies occur infrequently but require a prompt and competent response from the midwife to prevent morbidity and mortality of the woman, fetus, and newborn. Simulation provides the opportunity for student midwives to develop competence in a safe environment. The purpose of this study was to determine the inter-rater reliability of the McMahon Competence Assessment Instrument (MCAI) for use with student midwives during a simulated shoulder dystocia scenario...
March 13, 2018: Journal of Midwifery & Women's Health
X Fritel, B Gachon, D Desseauve, T Thubert
Our main objectives were to identify risk factors, methods for early diagnosis, and prevention of obstetric anal sphincter injuries (OASIs), using a literature review. The main risk factors for OASIs are nulliparity, instrumental delivery, posterior presentation, median episiotomy, prolonged second phase of labor and fetal macrosomia. Asian origin, short ano-vulvar distance, ligamentous hyperlaxity, lack of expulsion control, non-visualization of the perineum or maneuvers for shoulder dystocia also appear to be risk factors...
February 27, 2018: Gynecologie, Obstetrique, Fertilite & Senologie
Aivara Urbutė, Marija Paulionytė, Domicelė Jonauskaitė, Eglė Machtejevienė, Rūta J Nadišauskienė, Žilvinas Dambrauskas, Paulius Dobožinskas, Mindaugas Kliučinskas
BACKGROUND AND OBJECTIVES: There are only few training programs in obstetric emergencies currently in use and only some of them were evaluated with an adequate sample of participants. Therefore, we present the evaluation of the novel Standardized Trainings in Obstetrical Emergencies (STrObE), conducted in Lithuania. The aim of this study was to analyze whether participants' self-reported knowledge and confidence increased after the trainings, and whether the impact of the trainings was long-lasting...
February 8, 2018: Medicina
Alaa Eldin A Youssef, Ahmed F Amin, Mohamed Khalaf, Marwa S Khalaf, Mohammed K Ali, Ahmed M Abbas
OBJECTIVE: The current study aims to evaluate a simple method for sonographic measurement of the fetal biacromial diameter for prediction of fetal macrosomia in term pregnancy. MATERIALS AND METHODS: The current study was a single center prospective observational study conducted in a tertiary University Hospital from January 2015 to May 2017. We included all consecutive term (37-42 weeks) pregnant women presented to the labor ward for delivery. Ultrasound parameters were measured as biparietal diameter, head circumference, transverse thoracic diameter, mid arm diameter, abdominal circumference, femur length, estimated fetal weight and amniotic fluid index...
February 25, 2018: Journal of Maternal-fetal & Neonatal Medicine
Michela Meregaglia, Livia Dainelli, Helen Banks, Chiara Benedetto, Patrick Detzel, Giovanni Fattore
BACKGROUND: The incidence of Gestational Diabetes Mellitus (GDM) is rising in all developed countries. This study aimed at assessing the short-term economic burden of GDM from the Italian healthcare system perspective. METHODS: A model was built over the last pregnancy trimester (i.e., from the 28th gestational week until childbirth included). The National Hospital Discharge Database (2014) was accessed to estimate delivery outcome probabilities and inpatient costs in GDM and normal pregnancies (i...
February 23, 2018: BMC Pregnancy and Childbirth
Nurul Iftida Basri, Zaleha Abdullah Mahdy, Shuhaila Ahmad, Abdul Kadir Abdul Karim, Lim Pei Shan, Mohd Rizal Abdul Manaf, Nor Azlin Mohd Ismail
Background Gestational diabetes mellitus (GDM) is a common medical complication in pregnancy. The aim of this study was to compare the prevalence of GDM using the World Health Organization (WHO) criteria and the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria in our population. We further compared the incidence of adverse maternal and neonatal outcomes in women diagnosed with GDM using these criteria and determined whether the IADPSG criteria is suitable in our population. Methods This randomized controlled trial was conducted at our antenatal clinic involving 520 patients from 1st February 2015 until 30th September 2017...
February 17, 2018: Hormone Molecular Biology and Clinical Investigation
Hadas Miremberg, Tal Ben-Ari, Tal Betzer, Hagit Raphaeli, Rose Gasnier, Giulia Barda, Jacob Bar, Eran Weiner
BACKGROUND: Patient compliance and tight glycemic control have been demonstrated to improve pregnancy outcome in pregnancies complicated by gestational diabetes mellitus (GDM). The use of advanced technological tools, including smartphone-based platforms, to improve medical care and outcomes has been demonstrated in various fields of medicine, but only few small studies were performed with GDM patients. OBJECTIVE: We aimed to study the impact of introducing a smartphone-based daily feedback and communication platform between GDM patients and their physicians, on patient compliance, glycemic control, pregnancy outcome, and patient satisfaction...
February 6, 2018: American Journal of Obstetrics and Gynecology
A Gonzalves, C Verhaeghe, P E Bouet, P Gillard, P Descamps, G Legendre
The development of video tutorials is flourishing and may make it possible to maintain knowledge learned during instruction with simulation. The aim of this study was to assess the effect of adding a video tutorial to a lecture and simulation for learning the maneuvers and protocol for the management of shoulder dystocia.Student midwives and medical students attended a lecture class including instruction about maneuvers and a presentation of an algorithm for the management of shoulder dystocia. They were randomized into two groups...
January 29, 2018: Journal of Gynecology Obstetrics and Human Reproduction
Daniel W Robinson, Michael Anana, Mary A Edens, Marc Kanter, Sorabh Khandelwal, Kaushal Shah, Todd Peterson
Introduction: Obstetrical emergencies are a high-risk yet infrequent occurrence in the emergency department. While U.S. emergency medicine (EM) residency graduates are required to perform 10 low-risk normal spontaneous vaginal deliveries, little is known about how residencies prepare residents to manage obstetrical emergencies. We sought to profile the current obstetrical training curricula through a survey of U.S. training programs. Methods: We sent a web-based survey covering the four most common obstetrical emergencies (pre-eclampsia/eclampsia, postpartum hemorrhage (PPH), shoulder dystocia, and breech presentation) through email invitations to all program directors (PD) of U...
January 2018: Western Journal of Emergency Medicine
Edith D Gurewitsch Allen
Mastery of shoulder dystocia management skills acquired via simulation training can reduce neonatal brachial plexus injury by 66% to 90%. However, the correlation between simulation drills and reduction in clinical injuries has been inconsistently replicated, and establishing a causal relationship between simulation training and reduction of adverse clinical events from shoulder dystocia is infeasible due to ethical limitations. Nevertheless, professional liability insurance carriers increasingly are mandating simulation-based rehearsal and competency assessment of their covered obstetric providers' shoulder dystocia management skills-a high-stakes demand that will require rapid scaling up of access to quality shoulder dystocia simulation...
January 29, 2018: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
N Wah Cheung, Shan Jiang, Neil Athayde
BACKGROUND: The adoption of the International Association of Diabetes Study Groups (IADPSG) criteria for gestational diabetes mellitus (GDM) in Australia has been controversial. Obesity in pregnancy is also a growing concern. AIMS: To assess the impact of IADPSG criteria on the incidence of GDM and pregnancy outcomes, and to compare this to the effect of obesity, particularly among women who would not have GDM by the Australasian Diabetes in Pregnancy Society 1998 criteria (ADIPS1998)...
January 23, 2018: Australian & New Zealand Journal of Obstetrics & Gynaecology
Lisbet S Lundsberg, Henry C Lee, Grace Villarin Dueñas, Kimberly D Gregory, Holly K Grossetta Nardini, Christian M Pettker, Jessica L Illuzzi, Xiao Xu
OBJECTIVE: To assess hospital practices in obstetric quality management activities and identify institutional characteristics associated with utilization of evidence-supported practices. METHODS: Data for this study came from a statewide survey of obstetric hospitals in California regarding their organization and delivery of perinatal care. We analyzed responses from 185 hospitals that completed quality assurance sections of the survey to assess their practices in a broad spectrum of quality enhancement activities...
February 2018: Obstetrics and Gynecology
Matteo Frigerio, Stefano Manodoro, Davide P Bernasconi, Debora Verri, Rodolfo Milani, Patrizia Vergani
OBJECTIVE: This study aimed to evaluate III and IV degree tears rates and related risk factors in a single Italian centre. The secondary goal was to build a predictive model based on identified risk factors. STUDY DESIGN: This was a retrospective cohort study. All vaginal deliveries from 2011 to 2015 in a single Italian University Hospital were analysed. Univariate analysis was applied to evaluate the overall association between each factor and severe tear. Multivariate logistic regression was used to build a predictive model for the absolute risk of severe tear...
February 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Jill McArdle, Asta Sorensen, Christina I Fowler, Samantha Sommerness, Katrina Burson, Leila Kahwati
OBJECTIVE: To assess implementation of safety strategies to improve management of births complicated by shoulder dystocia in labor and delivery units. DESIGN: Mixed-methods implementation evaluation. SETTING/LOCAL PROBLEM: Labor and delivery units (N = 18) in 10 states participating in the Safety Program for Perinatal Care (SPPC). Shoulder dystocia is unpredictable, requiring rapid and coordinated action. PARTICIPANTS: Key informants were labor and delivery unit staff who implemented SPPC safety strategies...
January 2, 2018: Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN
Linda M Biesty, Aoife M Egan, Fidelma Dunne, Eugene Dempsey, Pauline Meskell, Valerie Smith, G Meabh Ni Bhuinneain, Declan Devane
BACKGROUND: Gestational diabetes is a type of diabetes that occurs during pregnancy. Women with gestational diabetes are more likely to experience adverse health outcomes such as pre-eclampsia or polyhydramnios (excess amniotic fluid). Their babies are also more likely to have health complications such as macrosomia (birthweight > 4000 g) and being large-for-gestational age (birthweight above the 90th percentile for gestational age). Current clinical guidelines support elective birth, at or near term in women with gestational diabetes to minimise perinatal complications, especially those related to macrosomia...
January 5, 2018: Cochrane Database of Systematic Reviews
Or Maoz, Tamar Wainstock, Eyal Sheiner, Asnat Walfisch
OBJECTIVE: To investigate whether postterm pregnancy (≥42 0/7 weeks' gestation) increases the risk for adverse perinatal outcome. STUDY DESIGN: In this population based cohort study, all singleton deliveries occurring between 1991 and 2014 in a tertiary medical center were included. Pregnancy and perinatal outcomes were compared between postterm and term deliveries (37 0/7 to 41 6/7 weeks' gestation). Preterm deliveries, unknown gestational age, congenital malformations, and multiple gestations, were excluded...
January 4, 2018: Journal of Maternal-fetal & Neonatal Medicine
Guillaume Ducarme, François Desroys Du Roure, Aurélie Le Thuaut, Joséphine Grange, Jérôme Dimet, Ingrid Crepin-Delcourt
OBJECTIVE: Gestational diabetes mellitus (GDM) is independently associated with an increased risk of maternal-fetal complications. Improved glycemic control allows reducing perinatal morbidity and mortality and, specifically, the risk of macrosomia and shoulder dystocia which are the most common complications associated with GDM. Nonetheless, a need for early antenatal predictor of neonatal morbidity in women suffering from GDM is required. The objective of the study was to evaluate the efficacy of different maternal, biological, and antenatal parameters at the time of diagnosis of GDM or perinatal variables as predictors of neonatal morbidity...
February 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Jennifer Webb, Asta Sorensen, Samantha Sommerness, Beth Lasater, Kamila Mistry, Leila Kahwati
BACKGROUND: The use of health information technology (IT) has been shown to promote patient safety in Labor and Delivery (L&D) units. The use of health IT to apply safety science principles (e.g., standardization) to L&D unit processes may further advance perinatal safety. METHODS: Semi-structured interviews were conducted with L&D units participating in the Agency for Healthcare Research and Quality's (AHRQ's) Safety Program for Perinatal Care (SPPC) to assess units' experience with program implementation...
December 19, 2017: BMC Medical Informatics and Decision Making
Palmira Santos, Jennifer Gaudet Hefele, Grant Ritter, Jennifer Darden, Cassandra Firneno, Ann Hendrich
OBJECTIVE: To re-examine the risk factors for shoulder dystocia given the increasing rates of obesity and diabetes in pregnant women. DESIGN: Retrospective observational study. SETTING: Five hospitals located in Wisconsin, Florida, Maryland, Michigan, and Alabama. PARTICIPANTS: We evaluated 19,236 births that occurred between April 1, 2011, and July 25, 2013. METHODS: Data were collected from electronic medical records and used to evaluate the risk of shoulder dystocia...
January 2018: Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN
Amanda Ali, Sangeetha Shastry, Ratnasingam Nithiyananthan, Amira Ali, Ramesh Ganapathy
OBJECTIVE: Evaluate patient characteristics that are predictors of treatment response and outcomes in gestational diabetes STUDY DESIGN: Retrospective cohort of 265 women with gestational diabetes treated with diet/metformin and/or insulin in a single centre over 2 years. RESULTS: Multinomial logistic regression showed that (after adjusting for age and ethnicity) women who were of normal weight were more likely to be on diet and women who were obese were more likely to be on metformin or metformin and insulin(p=0...
January 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
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