Cases reported "Dystocia"

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1/53. Prenatal pressure necrosis of the scalp.

    A case of full-thickness pressure necrosis of the scalp in a newborn is reported. This is a rare injury, with only four similar prior reports found in the literature. The presumed mechanism of injury is pressure of the infant's head against the mother's bony pelvis. A spectrum of injury can be seen, from temporary alopecia to complete scalp necrosis. risk factors include prolonged ruptured membranes and prolonged labor. ( info)

2/53. Symphyseal separation, sacroiliac joint dislocation and transient lateral femoral cutaneous neuropathy associated with McRoberts' maneuver. A case report.

    BACKGROUND: McRoberts' maneuver is often used prophylactically with the onset of active maternal expulsive efforts or immediately before delivery of the fetus. CASE: A 31-year-old woman, gravida 1, para 0, at 39 2 weeks' gestational age, was continuously maintained in an exaggerated lithotomy position while actively pushing during the second stage of labor. Immediately following spontaneous vaginal delivery of a 3,598-g infant, the patient noted left gluteal pain and left anterior thigh dysesthesia. Orthopedic evaluation revealed a 5-cm symphyseal separation, sacroiliac joint dislocation and transient lateral femoral cutaneous neuropathy. The patient underwent closed reduction of the left hemipelvis, followed by open reduction and internal fixation of the symphysis pubis two weeks later after failing conservative treatment. CONCLUSION: Although McRoberts' maneuver is generally safe, care should be exercised with use of excessive force or prolonged placement of the patient's legs in a hyperflexed position. ( info)

3/53. The Zavanelli manoeuvre in shoulder dystocia: case report and review of published cases.

    A case of severe shoulder dystocia is reported in which, after other methods had failed, cephalic replacement succeeded but was very difficult. The infant suffered severe damage. A review of methods to relieve shoulder dystocia is given, with special attention to published cases of the Zavanelli manoeuvre. It could only be used when all other methods fail. ( info)

4/53. An investigation into the feasibility of comparing three management options (augmentation, conservative and water) for nulliparae with dystocia in the first stage of labour.

    OBJECTIVE: to evaluate the feasibility of a randomised controlled trial (RCT) examining the effect of three options (augmentation, conservative and water) for the management of dystocia in nulliparae.The main objectives were to explore the feasibility of trial procedures in the clinical environment, consent rates and acceptability of the management options to women, local incidence of dystocia in nulliparae and the size of the subsequent study. DESIGN: a two part study: a pilot, RCT with follow-up through to delivery with postnatal maternal surveys, and a case review of nulliparae with dystocia. SETTING: a large maternity unit in the South of england in May-July 1997 inclusive. PARTICIPANTS: nulliparae with dystocia in the first stage of labour who had an otherwise uncomplicated obstetric background. INTERVENTIONS: women in the pilot RCT received one of three management options: labouring in a waterbirth pool, conservative management or augmentation of labour, which is the standard management of women with dystocia condition in the Unit. FINDINGS: it is feasible to conduct an RCT of management of dystocia in the Unit. Seventy per cent (95% confidence interval 47% to 87%) of women approached agreed to participate. Conservative management was the least acceptable option to women and has been dropped from the subsequent trial.The audit provided some idea of possible differences in operative delivery and epidural rates depending on augmentation or not. A sample of 220 women should be large enough to detect moderate changes and will require a 2-year recruitment period. CONCLUSIONS: a subsequent trial is feasible and is now underway. It has the potential to provide information enabling women and practitioners to have a greater choice of care options in the presence of dystocia, or provide a good basis for an even larger trial. ( info)

5/53. Gross deciduosis peritonei obstructing labor: a case report and review of the literature.

    Gross deciduosis peritonei is a rare lesion characterized by the presence of grossly visible peritoneal decidual tissue in pregnant women; we present the clinicopathologic features of one such case. A 24-year-old, G4P1A2, Hispanic female underwent cesarean section at 39 weeks' gestation for dystocia related to pelvic masses. Multiple, light tan peritoneal masses involved the cul-de-sac, both ovaries, pelvic wall, omentum, and the large and small bowel. The intraoperative appearance suggested peritoneal carcinomatosis. A right ovarian mass was excised and biopsies were obtained from other sites. Microscopic examination showed the typical features of decidua in all of the lesions. Two weeks postoperatively, the patient was admitted with nausea and vomiting suggestive of a small bowel obstruction, which resolved after 2 days of medical treatment. After a postpartum visit at 5 weeks, the patient was lost to follow-up. ( info)

6/53. pregnancy complicated with lactate dehydrogenase M-subunit deficiency: the first case report.

    A woman with lactate dehydrogenase M-subunit deficiency underwent two cesarean sections because of the risk of dystocia due to decreased adenosine triphosphate production in anaerobic glycolysis including uterine muscles. Frequent pains with increased serum pyruvate levels were observed during the third trimester of her pregnancies. ( info)

7/53. Modified Zavanelli maneuver for the alleviation of shoulder dystocia.

    BACKGROUND: The Zavanelli maneuver has typically been instituted when conventional maneuvers have failed to alleviate shoulder dystocia. Previously reported cases involving the Zavanelli maneuver have described cephalic replacement followed by immediate cesarean delivery. CASE: We encountered a case in which, despite the McRoberts maneuver, suprapubic pressure, wood's corkscrew manuever, and attempted extraction of the posterior fetal arm, the baby could not be delivered. The fetal vertex was partially reinserted into the vagina, and this dislodged the impacted shoulders. With expulsive efforts the mother was then able to achieve vaginal delivery of a 3870 g female infant.CONCLUSION: The modified Zavanelli maneuver may be used to successfully alleviate shoulder dystocia. ( info)

8/53. rupture of the symphysis pubis during vaginal delivery followed by two subsequent uneventful pregnancies.

    BACKGROUND: rupture of the symphysis pubis during vaginal delivery is a rare but debilitating complication. Factors contributing to rupture are poorly defined. CASE: A healthy primigravida suffered a rupture of her symphysis pubis during an otherwise uncomplicated vaginal delivery. She experienced significant pain and difficulty walking for 6 months after the injury. Her 5-cm symphyseal separation was managed successfully with physical therapy and activity restriction. The patient's two subsequent deliveries (one vaginal and one via cesarean delivery) were uneventful. CONCLUSION: Severe symphyseal rupture during vaginal delivery can be managed without surgery. risk factors for rupture are not well defined. Based on a literature review, there is a significant risk of repeat symphyseal rupture with subsequent vaginal delivery. ( info)

9/53. Vaginal surgical intervention for a sacro-coccygeal teratoma obstructing labor.

    Congenital sacro-coccygeal teratomas are rare tumors and may cause dystocia. The case presented was managed unusually by incisional drainage of the tumor through the vagina in a course of an obstructed labor, though the vaginal delivery resulted in the birth of a live, healthy infant. ( info)

10/53. The Zavanelli maneuver in two cases of shoulder dystocia.

    Several reports describe the replacement of the partially delivered fetus into the vagina followed by cesarean section after failed vaginal delivery. Undeliverable shoulder dystocia is by far the most common cause of failed vaginal delivery. The objective of this report was to review the safety and to reconsider when to perform the Zavanelli maneuver in the management of shoulder dystocia. We report two cases of severe shoulder dystocia in which commonly recommended therapeutic options failed. Cephalic replacement was performed with ease followed by cesarean section. endometritis was the maternal complication in both cases. Both infants had transient Erb's palsy. Although traditionally the Zavanelli maneuver is a method of last resort in the management of shoulder dystocia, consideration should be given to its use earlier in the treatment of obstructed vaginal delivery. ( info)
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