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 language | English |
|---|---|
| Pages (from-to) | 139-141 |
| Number of pages | 3 |
| Journal | Medical Hypotheses |
| Volume | 118 |
| DOIs | |
| Publication status | Published - Sep 1 2018 |
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ASJC Scopus subject areas
- Medicine(all)
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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 journal › Article
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TY - JOUR
T1 - Clinical features of a fatal shoulder dystocia
T2 - The hypovolemic shock hypothesis
AU - Cesari, E.
AU - Ghirardello, S.
AU - Brembilla, G.
AU - Svelato, A.
AU - Ragusa, A.
PY - 2018/9/1
Y1 - 2018/9/1
N2 - 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.
AB - 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.
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UR - http://www.scopus.com/inward/citedby.url?scp=85049431266&partnerID=8YFLogxK
U2 - 10.1016/j.mehy.2018.07.006
DO - 10.1016/j.mehy.2018.07.006
M3 - Article
VL - 118
SP - 139
EP - 141
JO - Medical Hypotheses
JF - Medical Hypotheses
SN - 0306-9877
ER -