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The shoulder dystocia SD is a major cause of obstetric trauma with implications in clinical maternal, perinatal, and medico legal. It occurs by the detention of internal rotation of the shoulders usually associated with a retention shoulder under the symphysis pubis, which prevents the release of the fetal body.

Maternal endogenous forces like contractions and maternal pushing, produce more pressure and therefore more chance of damage that forces applied by the operator exogenous force to solve the problem so that should be made the maneuvers tending to mobilize the shoulder on the pubis, to continue with uterine contractions and maternal pushing. The position of MR does not increase the size of the maternal pelvis, only modifies the morphology, and the combination with suprapubic compression correspond to the initial management of shoulder dystocia whole.

Unlike lithotomy been shown to reduce twice the compression force on the shoulder over the maternal pubis, promoting the displacement of the shoulder through the pubis and the subsequent detachment of the fetal head, thus explain the potential of the MR for preventing possible SD. In the prevention of the SD, the use of MR position during the release of the fetus, presents biomechanical plausibility and might even reduce other injuries not associated to SD, as clavicle fracture and brachial paralysis.

In consideration to clinical implications, ethical and medico-legal, we recommend the informed consent to define the final position in the maternal childbirth assistance. Pelvis materna e historia de la distocia de hombros.

El problema de la distocia de hombro se ha reconocido desde hace mucho tiempo. El cuero cabelludo se desliza hacia fuera con reticencia.

Maniobra de gaskin pdf viewer

Cuando la frente ha aparecido es necesario presionar el perineo para la salida de la cara. Finalmente las mejillas, que se ven voluminosas.

Maniobra de gaskin pdf viewer

La alarma aumenta. Finalizaron dicho estudio 55 del grupo experimental y 73 del grupo control, con tiempos para desprendimiento cabeza y cuerpo fetal no significativos.

No hubo diferencias para las tasas de ingreso a cuidados intensivos entre ambos grupos. A randomized controlled trial of prophylactic maneuvers to reduce head-to-body delivery time in patients at risk for shoulder dystocia.

Obstet Gynecol ; 1 : Randomized trial of McRoberts versus lithotomy positioning to decrease the force that is applied to the fetus during delivery. Am J Obstet Gynecol ; 3 : Lattus J. El parto en obstetricia.

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Leigh B. What are the lessons of recent obstetric legal cases? Obstetrical brachial palsy: pathogenesis, risk factors, and prevention.

Clin Obstet Gynecol ; 43 2 : Sandoval J. Distocia de hombro. Urgencias y Complicaciones en Obstetricia. Aedo S.

Am J Perinatol Jul Obstet Gynecol ; 86 3 : Objective definition of shoulder dystocia: a prospective evaluation. Am J Obstet Gynecol ; 4 : Gherman RB.

Distocia de hombros Gn

Shoulder dystocia: an evidence-based evaluation of the obstetric nightmare. Clin Obstet Gynecol ; 45 2 : Shoulder dystocia: an update. Obstet Gynecol Clin North Am ; 34 3 : , xii.

Maniobra de gaskin pdf viewer

Controversies surrounding the causes of brachial plexus injury. Int J Gynaecol Obstet ; 1 : Clavicular fracture: its incidence and predisposing factors in term uncomplicated pregnancy.

Eur Rev Med Pharmacol Sci ; 17 9 : Defining forces that are associated with shoulder dystocia: the use of a mathematic dynamic computer model.

Objective evaluation of the shoulder dystocia phenomenon: effect of maternal pelvic orientation on force reduction. Obstet Gynecol ; 74 1 : Prediction of brachial plexus stretching during shoulder dystocia using a computer simulation model. Goldstein S.

Parteria Espiritual_ Ina May Gaskin

Shoulder dystocia: Clarifying the care of an old problem. Journal [serial on the Internet]. Mathematic modeling of forces associated with shoulder dystocia: a comparison of endogenous and exogenous sources.

An alternate maneuver for management of shoulder dystocia.

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Am J Obstet Gynecol ; 7 : Obstet Gynecol ; 95 1 : Allen RH. On the mechanical aspects of shoulder dystocia and birth injury. Clin Obstet Gynecol ; 50 3 : Lancet ; : Intrapartum interventions for preventing shoulder dystocia. Peripartum pubic symphysis separation: a case series and review of the literature. Obstet Gynecol Surv ; 52 7 : Senechal PK. Symphysis pubis separation during childbirth.

J Am Board Fam Pract ; 7 2 : Figura 1. Figura 2.

Maniobra de gaskin pdf viewer

Santiago Oriente Dr. Summary The shoulder dystocia SD is a major cause of obstetric trauma with implications in clinical maternal, perinatal, and medico legal.