dystocia

Pelvic deformities leading to dystocia

1. Exostoses (”outgrowths”) at the sacro-iliac junctions
2. Knob-like exostosis on the promontory
3. Acanthopelys (”spine-bowl”)
4. Rachitic (ricket-affected) pelvis with abnormal blunt projection of ileo-pectineal eminences
5. Endochondroma (”tumor of the cartilage”)
6. Fracture of the pelvis
7. Fracture of the acetabula in consequence of coxalgia
8. Fracture of the right ala of the sacrum

Dystocia comes from the roots dys-, meaning “bad”, and -tocia, meaning “to birth”.

Anything that obstructs labor can be considered a dystocia, and the most common cause in today’s world is girls who are married at a young age. The pelvis is only fully formed, on average, around age 20-22. While many women successfully give birth before then, the younger the pregnancy, the more risky the birth is. Prolonged labor can lead to fetal mortality, maternal mortality, and obstetric fistula, which can have lifelong consequences.

An American Text-Book of Obstetrics for practitioners and students. Edited by Richard C. Norris, 1895.

Shoulder Dystocia- During delivery, the baby’s head is delivered but his shoulder gets caught behind the mother’s pubic bone.

[Dystocia means slow or difficult delivery.]

Complications include, injury to nerves of the baby’s shoulder; broken arm or collarbone; or decreased oxygenation to the baby.

If this occurs during delivery - the RN should, press the mother’s thighs against her abdomen to help widen the vaginal opening; apply pressure on the suprapubic area [to help release the shoulder]; and call the MD [may need an emergency c-section.]

NEVER APPLY PRESSURE TO THE UTERUS FUNDUS. It can worsen the damage to the baby.

youtube

Dr Billy Smith explains the use of a calving jack for bovine dystocia.
Really well explained demonstration.

Nikki’s ½ day old #Shetland #ram #lambs, waiting on names(thinking ‘N’), healthy at 6lbs each, after a very long night. We thank each & every one of you for your support, care & encouraging words. These 2 are the first of 45 lambs delivered here over the years to have required a vet to come out to help. If we hadn’t had Dr. Sarah from Granville Veterinary Services come at midnight, it might’ve been too late to help Nikki & the boys. Nikki had not dilated at all in all of her laboring, her boys were large, she was fatigued & her breathing was weak. Dr. Sarah helped to get her dilated & we pulled the lambs for Nikki. As soon as the babies cried, we could breathe ourselves. We then went to help Padme, our other first time mom. She had only begun to labor in the time I called Dr. Sarah & had stopped pushing altogether while we assisted Nikki. Padme’s very large ram lamb was still born. His cord had gotten wrapped while he was in the birth canal. When he stopped living, she stopped contracting. If Dr. Sarah hadn’t been here, I might’ve waited too long to check her and Padme may have died as well.
Padme is still grieving her little guy & when she tells me it’s ok, I’ll remove him from her stall. She will be able to have lambs again. Who knows? She may end up with an adopted lamb by the time the rest of our ewes have finished lambing. We will see. Meanwhile, she is just as affectionate as ever with me, and has resumed eating & drinking.
#lambing #lambing2015 #sheep #lambs #dystocia (at Wing And A Prayer Farm)

Dystocia

What is it?

Dystocia is when a foal is in an abnormal position during parturition. There are many different forms of dystocia, the most common being malposition of the foal.

Common types of dystocia:

  • Breech Birth 

When I foal presents itself in the breech position, the foal is positioned in the opposite direction. In a normal birthing situation, the foal should come out front feet and head first. a breech birth is when this is not the case, and the foal is position to come out with his back end first.

How do you know if it’s breech?

  • labor will not progress (typically)
  • none of  (or the wrong parts) the foal will be present after about 20 minutes of the water breaking

 Make sure to call your vet IMMEDIATELY if you suspect any complications

  • Unilateral carpal flexion

When a normal birth occurs, a foal’s front legs should be neatly stacked one on top of the other, with the head tucked between and following behind. Sometimes, however one, or both, of the legs may be positioned incorrectly, causing the overall position of the foal to change. Unilateral carpal flexion is when one foreleg is in the correct position, but the other is not. This causes an improper angle for the foal’s shoulders which is then to large to fit through the birth canal. 

How do you know if its unilateral carpal flexion?

  • You will only see one leg presenting when the foal is passing through the vulva
  • When feeling the mare/foal, the position of the foal will feel incorrect

What can you do if any of these situations occur?

  • Call your vet - in some cases, a C-section is necessary, such as when a foal is in breech position.
  • When a foal is presented in unilateral carpal flexion, If caught early enough and a vet is present, the foal can actually be pushed back a little bit inside the mare and the second leg can be readjusted to the correct position. This can be relatively simple, depending on how far back the foot is and how much room there is to work inside the mare.If the position of the retained limb is corrected before the mare is too exhausted to push anymore, the rest of the birth usually progresses quite quickly.

 

What the foal should look like, in a normal birthing position

What a breech birth may look like. The back legs may also be extended outward and exit the mare first.

What unilateral carpal flexion may look like.

“The possible causes of labor dystocia are numerous. Some are intrinsic:
• The powers (the uterine contractions)
• The passage (size, shape, and joint mobility of the pelvis and the stretch and resilience of the vaginal canal)
• The passenger (size and shape of fetal head, fetal presentation and position)
• The pain (and the woman ’ s ability to cope with it)
• The psyche (anxiety, emotional state of the woman).

Others are extrinsic:
• Environment (the feelings of physical and emotional safety generated by the setting and the people surrounding the woman)
• Ethnocultural factors (the degree of sensitivity and respect for the woman ’ s culture - based needs and preferences)
• Hospital or caregiver policies (how fl exible, family - or woman centered, how evidence based)
• Psychoemotional care (the priority given to nonmedical aspects of the childbirth experience)”

—  The Labor Progress Handbook, Penny Simpkin
Medical Malpractice and Birth Injury: An Overview of Shoulder Dystocia

It is always a sad and tragic event when a newborn infant is injured during childbirth. Unfortunately, birth injuries caused by health care professionals who commit errors in judgment that can lead to the injury or even death to the infant or the mother or both. When this occurs, the injured party typically consults a medical malpractice attorney to learn whether a complaint can be filed against the health care professional.

A specific birth injury sometimes sustained by babies over 9 lbs in weight, being delivered vaginally by a mother who has extreme weight gain is called “Shoulder Dystocia”. Dystocia is a combination of the prefix “dys-” meaning “bad” and “-tocia” referring to the conditions of childbirth or labor. Shoulder Dystocia happens when the baby’s head is delivered normally, but the baby’s shoulders become stuck and cannot pass through the lowest part of the mother’s pelvis.

When this condition presents itself, action must be taken immediately to free the child from the birth canal and ensure that the umbilical cord is not compressed. However, safely removing the large or macrosomic baby is challenging and complications can occur even with the best-trained medical personnel. Obstetricians are schooled in the use of several maneuvers that either reposition the infant or mother in order to free the baby’s shoulder and hopefully lead to a happy outcome. Unfortunately, sometimes the maneuvers are not done, or are not able to be done correctly, and the infant sustains damage.

The brachial plexus is a set of nerves originating from the spinal cord. It branches down either side of the neck, then travels under the armpit and down into each arm. The brachial plexus controls the muscle and skin sensations in each of the arms. When a brachial plexus birth injury happens, the location and the severity of the damage to the nerve system will determine how disabled the child will be in the near and far future.

If the nerve is stretched (neuropraxia), the injury is generally mild to moderate and may resolve without treatment within four to six months. Symptoms of neuropraxia may include sensations of numbness, burning, and trouble with coordination. Moderate to severe neuropraxia may require physical therapy. In the case of a torn or avulsed nerve, surgery will be required and total paralysis of the affected arm may still be the final unfortunate outcome.

In addition to large maternal weight gain and high birth weights, additional risk factors for shoulder dystocia occurring during childbirth include: maternal diabetes, breech births and multiple births. Obstetricians should closely monitor the predicted birth weight and due date of the baby, the mother’s weight gain, and mother’s glucose levels throughout the pregnancy in order to prepare for a possible C-Section to avoid the complications of Shoulder Dystocia.

Medical malpractice cases concerning birth injury can be extremely complicated and difficult to prove. A medical malpractice attorney (also called a “birth injury attorney”) can answer any questions you may have, including questions about the statute of limitations (the time limit you have after the event to initiate legal proceedings) for the state in which you live.

R. Klettke is a freelance writer. He writes about personal injury and medical malpractice law and other matters of jurisprudence.

Note: This article is not intended to provide legal advice upon which you should rely in making any decisions regarding the instituting or prosecuting of a legal claim. Laws and rules relating to the bringing of a claim vary widely from state to state. You should always contact a personal injury attorney to obtain information as to the rules and the laws pertaining to any claim you might have.

Poem time

if shoulder dystocia is your grief
suprapubic pressure brings relief

extended episiotomy is your boon
if you wanna gain more vaginal room

if corkscrewing makes you colder
try delivering the posterior shoulder

if you still think you can’t make it
take the clavicle and gently break it

peertechz.com
Prevention of Brachial Plexus Injuries at Birth
Journal of Gynecological Research and Obstetrics is an open access, international, a peer reviewed distinguished journal which covers the outstanding and most update research works/peak quality papers in all areas of allergy. Journal of Gynecological Research and Obstetrics provides consistent information to update online viewers with the adapted methods and latest advancements in the field of related to allergy and its treatment.

Medicine is a fast evolving even if inexact science. Built in ancient times upon insightful observations of Egyptian, Greek and Arabic physicians [11. Lyons AS, Petrucelli RJ II (1978) Medicine. An Illustrated History. Harry N. Abrams, Inc., New York.], its progress was spearheaded by European (mainly British, French, German and Austrian) scientists after the middle ages. If the assignment of Nobel prizes is a guideline is this regard, in the last century the leadership was taken over by the United States. Both physicians and lay persons may be inclined to assume therefore, that the achievements of medical research are utilized in America in everyday practice and that progress runs parallel in all branches of medicine. As far as obstetrics is concerned these assumptions have limited validity at best. During the last century maternal and perinatal mortality rates (recognized indices of the quality of clinical care) were markedly less favorable in the USA than in Scandinavia [22. Iffy L, Apuzzio JJ, Mitra S, Evans H, Ganesh V, et al. (1994) Rates of cesarean section and perinatal outcome. Acta Obstet Gynecol Scand 73: 225 - 230.] and some other developed countries. They still lag behind many others at the time of this writing. 

http://www.peertechz.com/Gynecological-Research-Obstetrics/JGRO-1-101.php