Shoulder dysplasia during birth

Shoulder dystocia

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Shoulder dystocia is a birth injury that happens when one or both of a baby’s shoulders get stuck inside the mother’s pelvis during labor.
In most cases of shoulder dystocia, babies are born safely. But it can cause problems for both mom and baby.
It’s often hard for health care providers to predict or prevent shoulder dystocia.
When shoulder dystocia happens, your provider tries to move your body and your baby into a better position to help get your baby out.
If your provider recommends a scheduled c-section, ask if you can wait until at least 39 weeks to give your baby time to develop before birth.

What is shoulder dystocia?

Shoulder dystocia is a birth injury (also called birth trauma) that happens when one or both of a baby’s shoulders get stuck inside the mother’s pelvis during labor and birth. In most cases of shoulder dystocia, babies are born safely. But it can cause serious problems for both mom and baby. Dystocia means a slow or difficult labor or birth.

It’s often hard for health care providers to predict or prevent shoulder dystocia. They often discover it only after labor starts. Shoulder dystocia happens in 0.2 to 3 percent of pregnancies.

Are you at risk for shoulder dystocia?

Shoulder dystocia can happen to any woman. We do know that some things may make you more likely than others to have shoulder dystocia. These are called risk factors. A risk factor is something that makes you at risk for a condition. Having a risk factor doesn’t mean for sure that you’ll have shoulder dystocia. And risk factors for shoulder dystocia don’t seem to be helpful in predicting if you’ll have it. It’s hard for providers to predict or prevent.

Risk factors for shoulder dystocia include:

Macrosomia. This is when your baby weighs more than 8 pounds, 13 ounces (4,000 grams) at birth. If your baby is this large, you may need to have a cesarean birth (also called c-section). This is surgery in which your baby is born through a cut that a doctor makes in your belly and uterus (womb). Most babies with macrosomia who are born vaginally (through the vagina) don’t have shoulder dystocia. In most cases of shoulder dystocia, the baby’s weight is normal.
Having preexisting diabetes or gestational diabetes. Diabetes is a medical condition in which your body has too much sugar (called glucose or blood sugar) in your blood. This can damage organs in your body, including blood vessels, nerves, eyes and kidneys. Preexisting diabetes is when you have diabetes before you get pregnant. Gestational diabetes is a kind of diabetes some women get during pregnancy. Diabetes is a risk factor for having a large baby.
Having shoulder dystocia in a previous pregnancy
Being pregnant twins, triples or other multiples
Being overweight or gaining too much weight during pregnancy

Conditions that are part of labor and birth also are risk factors for shoulder dystocia. These include:

Getting a medicine called oxytocin to induce your labor (make your labor start).
Getting an epidural to help with pain during labor. An epidural is pain medicine you get through a tube in your lower back that helps numb your lower body during labor. It’s the most common kind of pain relief used during labor.
Having a very short or very long second stage of labor. This is the part of labor where you push and give birth.
Having an assisted vaginal birth (also called operative vaginal birth). This means that your provider uses tools, like forceps or a vacuum, to help your baby through the birth canal. Forceps look like big tongs. Your provider places them around your baby’s head in the vagina to help guide your baby out. A vacuum is a suction cup that goes around your baby’s head in the vagina to help guide your baby out. This is the most common risk factor for shoulder dystocia.

What problems can shoulder dystocia cause?

Most moms and babies recover well from problems caused by shoulder dystocia.

Problems for the baby can include:

Fractures to the collarbone and arm
Damage to the brachial plexus nerves. These nerves go from the spinal cord in the neck down the arm. They provide feeling and movement in the shoulder, arm and hand. Damage can cause weakness or paralysis in the arm or shoulder. Paralysis is when you can’t feel or move one or more parts of your body.
Lack of oxygen to the body (also called asphyxia). In the most severe cases, this can cause brain injury or even death. This is rare.

Problems for the mother can include:

Postpartum hemorrhage (also called PPH). This is heavy bleeding after giving birth.
Serious tearing of the perineum (the area between the vagina and the rectum). Surgery may be needed to repair the tearing.
Uterine rupture. This is when the uterus tears during labor. This is rare.

How is shoulder dystocia treated?

If your provider thinks you may be at risk for shoulder dystocia, she can prepare you ahead of time for what to expect during labor and birth. And she can make sure staff and equipment are ready at the hospital.

If your provider thinks your baby is large or if you have diabetes, your provider may recommend scheduling a c-section. If so, ask about waiting until at least 39 weeks of pregnancy to have your baby. This gives your baby the time she needs to grow and develop before birth. Scheduling a c-section should be for medical reasons only. Your provider may want to schedule a c-section if:

She thinks your baby weighs at least 5,000 grams (about 11 pounds).
You have diabetes and she thinks your baby weighs at least 4,500 grams (9 pounds, 15 ounces).

If you have shoulder dystocia, your provider can try several methods to move you and your baby into better positions to open your pelvis wider and move your baby’s shoulders. Your provider may:

Press your thighs up against your belly. This is called the McRoberts maneuver.
Press on your lower belly just above your pubic bone. This is called suprapubic pressure.
Help your baby’s arm out of the birth canal
Reach up into the vagina to try to turn your baby. Or turn you over so you’re on all fours (on your hands and knees).
Give you an episiotomy. This is not done routinely but only in cases in which a larger opening to the vagina is helpful and the incision won’t affect the baby.
Do a c-section, other surgical procedures or break your baby’s collarbone to release his shoulders. These are done only in severe cases of shoulder dystocia that aren’t resolved by other methods.

Last reviewed June, 2019

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Shoulder dystocia | Pregnancy Birth and Baby

What is shoulder dystocia?

Shoulder dystocia happens when one of the baby’s shoulders gets stuck behind the mother’s pubic bone (the bone behind the pubic hair) or sacrum (the bone at the back of the pelvis, above the tailbone) during birth.

During the second stage of labour, there is normally a pause after the baby’s head has been born but before the body comes out. When shoulder dystocia occurs, this delay is longer delay than normal. The baby will need emergency help to be born.

Shoulder dystocia happens in about 1 in every 200 births. It is more common during a vaginal birth, but a baby’s shoulder can also get stuck during a caesarean.

Shoulder dystocia is a medical emergency. While the baby is stuck, they cannot breathe and the umbilical cord may be squeezed. They will need help to be born quickly so they can get enough oxygen. It can also cause a fracture of the baby’s collarbone or upper arm, nerve damage affecting the shoulders, arms, hands or fingers, brain damage or speech disability. Sadly, there is a risk that lack of oxygen during birth can lead to brain damage or even death.

Sometimes shoulder dystocia can lead to complications for the mother, including tears, a haemorrhage, infection, or damage to the nerves causing incontinence.

These complications are very rare, and doctors and midwives are highly trained to deal with shoulder dystocia if it happens.

Why does shoulder dystocia happen?

Shoulder dystocia can happen during any vaginal birth. It is usually because the baby is too big, because it is in the wrong position, or because the mother is in a position that restricts the room in the pelvis.

It is impossible to predict whether shoulder dystocia will happen, but there are some things that make it more likely, including when you:

experienced shoulder dystocia during a previous labour
are having a large baby (called ‘fetal macrosomia’)
are having twins or multiple babies
are very overweight
have diabetes
have had labour induced, or other interventions are used during labour

Shoulder dystocia can also happen if the labour goes very quickly or very slowly.

What to expect if shoulder dystocia happens

If your doctor or midwife suspects shoulder dystocia, they will first tell you to stop pushing. They will immediately call for help, since you may need other specialist doctors to care for you or the baby.

Sometimes, simply changing your position can free the shoulder. You might be asked to lie flat on your back with your knees pulled back as far as they can go. The midwife or doctor will gently press on your tummy to help free the baby’s shoulder. This is called the 'McRoberts manoeuvre'.

Another position that can work for you to get onto all fours. Sometimes, the midwife or doctor will need to put their hand inside your vagina to free the baby’s body. You will need an episiotomy first.

In very rare cases, the doctor will need to break the baby’s collarbone to get them out. It will heal quickly afterwards. The other option is for you to have a caesarean under general anaesthetic. Once the anaesthetic has taken effect, the baby will be pushed back into your uterus and delivered through your tummy. Both of these options are a last resort.

After the birth

Most babies recover from shoulder dystocia very well. But because they may have been injured or deprived of oxygen, they may need to be watched more closely or spend time in the neonatal intensive care unit. Some babies will need physiotherapy, and you may need help with breastfeeding if your baby has been injured.

If you had a tear or haemorrhage, it will take some time for you to recover. It can also be hard emotionally if you have had a difficult birth. You might feel shocked, guilty or worried about your baby. Midwives, your doctor or a maternal child health nurse can help you deal with these feelings.

Your doctor will talk to you about why the shoulder dystocia might have happened. As you are at greater risk of it happening again, they may suggest you consider a planned caesarean next time around.

Preventing shoulder dystocia

Shoulder dystocia is unpredictable so there is very little you can do to prevent it. Managing conditions like diabetes and watching your weight during pregnancy can help. If your baby is big, it may be a good idea to give birth lying on your side or on all fours.

For more information

If you are worried about shoulder dystocia or if you have experienced a difficult birth, call Pregnancy, Birth and Baby on 1800 882 436 to talk to a maternal child health nurse.

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Fibrous dysplasia: Causes, Symptoms, Treatment | doc.ua

Fibrous dysplasia is a disorder in the formation of tissues, the development of internal organs or the formation of body parts. Most often, the disease is congenital in nature, but it can also manifest itself at a more mature age, from 10 to 30 years. There are several varieties of dysplasia, such as leonine face, cherubism, and Albright's syndrome.

Attention!

Here you can choose a doctor who treats Fibrous Dysplasia If you are not sure about the diagnosis, make an appointment with a general practitioner or general practitioner to clarify the diagnosis.

Causes

The causes of the development of this disease remain a mystery even today. There is an opinion that fibrous bone dysplasia develops due to a mutation in the genes. There are no facts that would prove that the disease is inherited. Basically, the disease shows itself while the patient is in childhood, although there are rare cases when the first manifestations were diagnosed in mature patients. There are also congenital precedents when children had a number of abnormalities at birth or were in the womb.

Symptoms

Fibrous dysplasia often has no obvious symptoms. The patient may not be aware of the disease for a long time, since painful sensations and inconveniences do not occur until a certain level of growth of the disease. The disease can affect one bone or affect the entire skeletal system. The features of the damage caused by fibrous dysplasia are determined by the amount of cellular fibrous tissue dotted with blood vessels, and scattered bone formations, around which there is bone-like tissue, in turn, surrounded by cells. There are two types of growths in the bones: focal and diffuse. With the first, focal lesion, the transformed part is isolated from the surrounding tissues and easily moves away from the adjacent bone. The tissue that has undergone transformation becomes dense, but does not lose its elasticity, turns pale, and bone inclusions are clearly visible in it. With the second, diffuse bone lesion, it is impossible to determine the size of the damaged tissues, due to the fact that the adjacent bone becomes porous and soft, the cortical layer becomes thinner. The porous bone matter is replaced by a dense pale yellow substance. With both types, it is possible to detect single cysts.

Clinical manifestations of a single bone lesion are subtle, do not have clearly expressed symptoms. The infected area gradually becomes thicker, while no pain occurs. The disease becomes noticeable approximately 2 years after the onset of the inflammatory process. Often there is asymmetry. When the disease manifests itself on several bones at the same time, the symptoms remain the same, but the affected area increases significantly. Frequent fractures are one of the most common signs, and skin pigmentation is also possible.

Diagnosis

Fibrous dysplasia can be diagnosed using X-ray and histological analysis. During histological examination, the continuity of transformations in the tissues during puberty is noted, which in infected people often occurs prematurely. When examining with an X-ray machine, lesions filled with bone tissue of different density are revealed. In some cases, pigmentation of the skin over the affected area becomes noticeable.

Treatment

In the vast majority of cases, if the abnormalities are not pronounced, and the diagnosis is made at an early stage in the disease of fibrous dysplasia, the treatment gives positive results. For some patients, standard therapy will be sufficient, while for others, curettage and graft repair will be used. Failures are due to graft resorption and recurrence of initially diagnosed symptoms.

Fibrous dysplasia of the femur in a neglected state leads to a change called "shepherd's stick". With such a violation, it is necessary to perform a local operation to remove the deformed area and replace it with a suitable graft. In the absence of pathologies and relapses, the treatment is successful.

Fibrous dysplasia of the skull in a neglected state turns into a variety called "leonine face". With this localization of the disease, the bones seem to swell. If such fibrous dysplasia is found in children, then facilitated surgical intervention is indicated to eliminate further deformation of the facial bones, while taking into account their subsequent growth and development as the patient grows.

Fibrous dysplasia of the tibia is externally manifested by lameness and gait disturbances, shortening of the limb in which the affected bone tissue is located is rarely noticed. Treatment also requires surgery, plasty and follow-up. After the operation, patients are forced to use crutches and orthopedic devices until full or partial recovery.

The degree, duration and intensity of therapy can only be determined by a doctor who specializes in the treatment of this disease. The method of treatment is selected for each patient exclusively individually. For children, due to the fragility and underdevelopment of the skeletal system of the child's body, first of all, therapy is used, and only if it is ineffective, an operation is prescribed. In an adult patient, the severity of the course and the neglect of the development of the disease are diagnosed. In most known examples, the operation is carried out immediately. If one bone is damaged, it is removed and replaced with a graft.