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Dystocia (antonym eutocia) is an abnormal or difficult childbirth or labour. Dystocia may arise due to incoordinate uterine activity, abnormal fetal lie or presentation, or absolute or relative cephalopelvic disproportion. Oxytocin is commonly used to treat incoordinate uterine activity. However, pregnancies complicated by dystocia often end with assisted deliveries including forceps, ventouse or, commonly, caesarian section.
Shoulder dystocia is a specific case of this complication whereby the anterior shoulder of the infant cannot pass below the pubic symphysis, or requires significant manipulation to pass below, the pubic symphysis. It is diagnosed when the shoulders fail to deliver shortly after the fetal head.
A number of obstetrical maneuvers are used to facilitate delivery at this point, including McRobert's maneuver; suprapubic pressure (or Rubin I); Rubin II or posterior pressure on the anterior shoulder; Woods' screw maneuver which leads to turning the anterior shoulder to the posterior and vice versa; and Jacquemier's maneuver (also called Barnum's maneuver), or delivery of the posterior shoulder. More drastic maneuvers include Zavanelli's maneuver or internal cephalic replacement followed by Cesarean section; intentional clavicular fracture, symphisiotomy, and abdominal rescue, described by O'Shaughnessy, where a hysterotomy facilitates vaginal delivery of the impacted shoulder.
Although the definition is imprecise, it occurs in approximately 1% of vaginal births. There are well-recognised risk factors, such as diabetes, fetal macrosomia, and maternal obesity, but it is often difficult to predict (Breeze and Lees, 2004). Despite appropriate obstetric management, fetal injury (such as brachial plexus injury) or even fetal death can be a complication of this obstetric emergency.
None of this has been proven. One renound physician Dr. Howard Herrell (Johnson City, TN) has made drastic and important studies in this controversial field, but Dystocia has not yet been recognized as an accurate diagnosis. Although this article is an interesting observation, its accuracy can not be confirmed. Many fellows would have trouble with the backing proof as well as the accuracy of the diagnosis.
Dystocia in cattle
Dystocia in cattle occurs mainly due to two main factors
- Maternal cause: Uterine inertia, Vaginal prolapse
- Fetal cause: Mainly due to abnormal fetal presentation,position and posture
See also
References
Breeze AC, Lees CC (2004). Managing shoulder dystocia. Lancet 364, 2160-1*
"Dystocia"