Clinical features of a fatal shoulder dystocia

The hypovolemic shock hypothesis

E. Cesari, S. Ghirardello, G. Brembilla, A. Svelato, A. Ragusa

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Shoulder dystocia is a rare but severe obstetric complication associated with an increased risk of brachial plexus palsies, fractures of the clavicle and humerus, hypoxic-ischemic encephalopathy and, rarely, neonatal death. Here we describe a fatal case of shoulder dystocia in a term newborn, although labor was uneventful, fetal heart rate tracing was normal until the delivery of the head and the head-to-body delivery interval (HBDI) occurred within 5 min. Full resuscitation was performed for 35 min without success. Hemoglobin concentration evaluated on the umbilical cord still attached to the placenta was within normal range, while neonatal venous hemoglobin concentration blood gases at 9 min of life showed severe metabolic acidosis and anemia. As previously described by others, our case supports the hypothesis of a hypovolemic shock as the cause of neonatal death, probably due to acute placental retention of fetal blood. The death of the newborn following shoulder dystocia is an event that still presents numerous gaps in knowledge. Further research should focus on: • Performing neonatal resuscitation with an intact umbilical cord.• Milking the umbilical cord before clamping.• Clamp the umbilical cord leaving a long portion attached to the newborn and squeeze its content simultaneously with the first resuscitation maneuvers.• Consider postdelivery volume replacement therapy sooner than expected from resuscitation algorithm.

Original languageEnglish
Pages (from-to)139-141
Number of pages3
JournalMedical Hypotheses
Volume118
DOIs
Publication statusPublished - Sep 1 2018

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Dystocia
Umbilical Cord
Resuscitation
Shock
Hemoglobins
Head
Brain Hypoxia-Ischemia
Clavicle
Fetal Heart Rate
Brachial Plexus
Humerus
Acidosis
Fetal Blood
Constriction
Paralysis
Placenta
Obstetrics
Anemia
Cause of Death
Reference Values

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Clinical features of a fatal shoulder dystocia : The hypovolemic shock hypothesis. / Cesari, E.; Ghirardello, S.; Brembilla, G.; Svelato, A.; Ragusa, A.

In: Medical Hypotheses, Vol. 118, 01.09.2018, p. 139-141.

Research output: Contribution to journalArticle

Cesari, E. ; Ghirardello, S. ; Brembilla, G. ; Svelato, A. ; Ragusa, A. / Clinical features of a fatal shoulder dystocia : The hypovolemic shock hypothesis. In: Medical Hypotheses. 2018 ; Vol. 118. pp. 139-141.
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