PubMed · 5108891
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F Kubli, M Hinselmann, H Rüttgers, A Castaño-Almendral. 1971-06-04. [Trial forceps].. https://doi.org/10.1007/bf00682934
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OBJECTIVE: Our purpose was to determine whether clinical or ultrasonographic prediction of fetal macrosomia influences subsequent delivery route and birth outcome in a clinical setting where macrosomia is not considered an indication for cesarean delivery. STUDY DESIGN: The hospital records of 504 patients delivered of infants weighing > or = 4200 gm between October 1989 and March 1994 were reviewed. Statistical comparisons were made between patients in whom fetal macrosomia was predicted before delivery (n = 102) and those in whom it was not (n = 402). Cesarean delivery, shoulder dystocia, and birth trauma rates were the variables of interest. RESULTS: Cesarean sections were performed in 52% of the "predicted" group deliveries and in 30% of the "not predicted" group (p < 0.01). The increased cesarean delivery rate in the predicted group appeared to be related to an increased incidence of labor inductions (42.5% vs 26.6%, p = 0.005) and a greater proportion of failed inductions. The proportion of patients delivered by cesarean section without a trial of labor was similar in the predicted and not predicted groups (14.7% vs 10.2%, p = 0.21). There was no significant differences in the incidence of shoulder dystocia or the occurrence of birth trauma. CONCLUSIONS: The antenatal prediction of fetal macrosomia is associated with a marked increase in cesarean deliveries without a significant reduction in the incidence of shoulder dystocia or fetal injury. Ultrasonography and labor induction for patients at risk for fetal macrosomia should be discouraged.
An unmatched comparative study is described to determine if routine clinical indicators are useful predictors for shoulder dystocia. Parity, maternal weight gain during pregnancy, and a history of a previous large baby and increased operative vaginal delivery rate were more often associated with shoulder dystocia. No other significant associations were found. However, shoulder dystocia can not be predicted accurately antepartum using routinely available clinical factors.
The authors report on a case of fracture of the distal humeral epiphysis sustained at birth. This is extremely rare. The main problem in treatment of this kind of fracture is correct and timely diagnosis. In almost all reported cases the fracture has been confused with elbow dislocation. The reason for this mistake is difficult roentgenological orientation owing to invisible ossification nuclei. Ultrasono und examination is recommended for diagnosis. The treatment of the injury is conservative. Closed reduction and immobilization for 3 weeks in an above-the-elbow plaster cast is advised. The end-results have been very good in all published cases, as they were in the present case, in which the shape of the injured elbow corresponded absolutely to that on the healthy side, mobility was unrestricted and no growth disturbances were observed after 9 months.