Öz
Omuz distosisi vajinal doğumun öngörülemeyen bir komplikasyonudur, anne ve yenidoğanda ciddi olumsuz sonuçlara yol açabilir. Olumsuz sonuç riskini azaltmak için bu acil obstetrik duruma hızlı müdahale ve uygun yönetim esastır. Omuz distosisini hafifletmeye yönelik çeşitli avantaj ve dezavantajları olan manevralar daha önce tanımlanmıştır. Bu raporda omuz distosisini hafifletmek için kullanılabilecek, uygulaması kolay ve noninvaziv yeni bir manevra tanımladık. Bu manevra, vajinal doğum sırasında omuz distosisi yaşayan iki nullipar ve iki multipar kadında başarıyla uygulandı. Omuz distosisi tanısı konulduktan ve McRoberts ve suprapubik basınç manevrasının başarısız olmasından sonra litotomi pozisyonunda fetal baş ve boyuna hafif yukarı traksiyon uygulandı. Bu manevra ile arka omuz sakral boşlukta öne doğru kayarak introitusa yaklaştırıldı. Böylece ön ve arka omuzlar artık pelvis içinde aynı antero-posterior düzlemde değildi. Daha sonra, obstrukte ön omuz simfiz pubisin arkasından kurtulana ve perineden dışarı çıkana kadar fetal başa hafif aşağı doğru traksiyon uygulandı. Bu dört olguda doğumun tamamlanması için başka bir manevraya ihtiyaç duyulmadı ve anne veya yenidoğanda herhangi bir komplikasyon görülmedi. Sonuç olarak sunulan manevra kolay ve noninvazif bir manevradır. Simülasyon eğitimi ile kolaylıkla öğrenilebilir ve omuz distosisi yönetiminde kullanılabilir.
Anahtar Kelimeler
Kaynakça
- Committee on Practice Bulletins—Obstetrics. Practice Bulletin No 178: Shoulder Dystocia. Obstet Gynecol. 2017;129(5):e123-33. https://doi.org/10.1097/AOG.0000000000002043
- Ouzounian JG, Gherman RB. Shoulder dystocia: are historic risk factors reliable predictors? Am J Obstet Gynecol. 2005;192(6):1933-5. https://doi.org/10.1016/j.ajog.2005.02.054
- Berle P, Misselwitz B. Antepartal maternal risks for shoulder dystocia. An analysis of 224 744 births spontanous and vaginal and after the 37th week of gestation born in Hessen (2002-2008). Z Geburtshilfe Neonatol. 2009;213(5):171-5. https://doi.org/10.1055/s-0029-1241869
- Dajani NK, Magann EF. Complications of shoulder dystocia. Semin Perinatol. 2014;38(4):201-4. https://doi.org/10.1053/j.semperi.2014.04.005
- Sentilhes L, Sénat MV, Boulogne AI, et al. Shoulder dystocia: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol. 2016;203:156-61. https://doi.org/10.1016/j.ejogrb.2016.05.047
- Lok ZLZ, Cheng YKY, Leung TY. Predictive factors for the success of McRoberts' manoeuvre and suprapubic pressure in relieving shoulder dystocia: a cross-sectional study. BMC Pregnancy Childbirth. 2016;16(1):334. https://doi.org/10.1186/s12884-016-1125-3
- Spain JE, Frey HA, Tuuli MG, Colvin R, Macones GA, Cahill AG. Neonatal morbidity associated with shoulder dystocia maneuvers. Am J Obstet Gynecol. 2015;212(3):353.e1-5. https://doi.org/10.1016/j.ajog.2014.10.001
- Menticoglou S. Shoulder dystocia: incidence, mechanisms, and management strategies. Int J Womens Health. 2018;10:723-32. https://doi.org/10.2147/IJWH.S175088
- Bruner JP, Drummond SB, Meenan AL, Gaskin IM. All-fours maneuver for reducing shoulder dystocia during labor. J Reprod Med. 1998;43(5):439-43.
- Hoffman MK, Bailit JL, Branch DW, et al. A comparison of obstetric maneuvers for the acute management of shoulder dystocia. Obstet Gynecol. 2011;117(6):1272-8. https://doi.org/10.1097/AOG.0b013e31821a12c9
Öz
Shoulder dystocia is an unpredictable complication of vaginal delivery and it could lead serious adverse maternal and neonatal outcomes. Prompt intervention and appropriate management of this obstetric emergency is essential to reduce the risk of adverse outcome. The maneuvers that had various advantages and disadvantages to alleviate shoulder dystocia have been described previously. In this report, we defined a new, easy to perform and noninvasive maneuver which could be used to relieve shoulder dystocia. This maneuver was successfully implemented in two nulliparous and two multiparous women who had experienced shoulder dystocia during vaginal delivery. After the diagnosis of shoulder dystocia and unsuccessful McRoberts and suprapubic pressure maneuver, the gentle upward traction on the fetal head and neck was performed in the lithotomy position. The posterior shoulder slipped forward in the sacral hollow and brought closer to the introitus with this maneuver. Thus, the anterior and posterior shoulders were no longer in the same antero-posterior plane of the pelvis. Then the gentle downward traction on the fetal head was applied until the anterior shoulder protruded through the perineum and the impacted anterior shoulder dislodged from behind the symphysis pubis. No other maneuver was needed for the completion of the delivery in these four cases, and no maternal or neonatal complication was observed. In conclusion, the presented maneuver is an easy and noninvasive maneuver. It could be easily learned with simulation training and used in the management of shoulder dystocia.
Anahtar Kelimeler
Kaynakça
- Committee on Practice Bulletins—Obstetrics. Practice Bulletin No 178: Shoulder Dystocia. Obstet Gynecol. 2017;129(5):e123-33. https://doi.org/10.1097/AOG.0000000000002043
- Ouzounian JG, Gherman RB. Shoulder dystocia: are historic risk factors reliable predictors? Am J Obstet Gynecol. 2005;192(6):1933-5. https://doi.org/10.1016/j.ajog.2005.02.054
- Berle P, Misselwitz B. Antepartal maternal risks for shoulder dystocia. An analysis of 224 744 births spontanous and vaginal and after the 37th week of gestation born in Hessen (2002-2008). Z Geburtshilfe Neonatol. 2009;213(5):171-5. https://doi.org/10.1055/s-0029-1241869
- Dajani NK, Magann EF. Complications of shoulder dystocia. Semin Perinatol. 2014;38(4):201-4. https://doi.org/10.1053/j.semperi.2014.04.005
- Sentilhes L, Sénat MV, Boulogne AI, et al. Shoulder dystocia: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol. 2016;203:156-61. https://doi.org/10.1016/j.ejogrb.2016.05.047
- Lok ZLZ, Cheng YKY, Leung TY. Predictive factors for the success of McRoberts' manoeuvre and suprapubic pressure in relieving shoulder dystocia: a cross-sectional study. BMC Pregnancy Childbirth. 2016;16(1):334. https://doi.org/10.1186/s12884-016-1125-3
- Spain JE, Frey HA, Tuuli MG, Colvin R, Macones GA, Cahill AG. Neonatal morbidity associated with shoulder dystocia maneuvers. Am J Obstet Gynecol. 2015;212(3):353.e1-5. https://doi.org/10.1016/j.ajog.2014.10.001
- Menticoglou S. Shoulder dystocia: incidence, mechanisms, and management strategies. Int J Womens Health. 2018;10:723-32. https://doi.org/10.2147/IJWH.S175088
- Bruner JP, Drummond SB, Meenan AL, Gaskin IM. All-fours maneuver for reducing shoulder dystocia during labor. J Reprod Med. 1998;43(5):439-43.
- Hoffman MK, Bailit JL, Branch DW, et al. A comparison of obstetric maneuvers for the acute management of shoulder dystocia. Obstet Gynecol. 2011;117(6):1272-8. https://doi.org/10.1097/AOG.0b013e31821a12c9
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Kadın Hastalıkları ve Doğum |
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 25 Mart 2024 |
| Gönderilme Tarihi | 7 Ocak 2024 |
| Kabul Tarihi | 6 Şubat 2024 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 6 Sayı: 1 |
