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At least 19 recordsLinked to original sources
PubMed1997

Effect of dystocia on yield, fertility, and cow losses and an economic evaluation of dystocia scores for Holsteins.

Lactation records of US Holstein cows were analyzed with mixed models to determine the effect of dystocia on 305-d milk, fat, and protein yields, days open, number of services, and cow losses and to estimate the economic loss associated with dystocia. The data were 122,715 records of 71,618 cows from 1980 to 1991. The single-trait animal model included herd-year-season, sex of calf, age of dam, and dystocia score as fixed effects and animal and permanent environment as random effects. The effect of dystocia was significant (P < 0.01) on all traits within and across parities. Over multiple parities, the differences between score 5 (extreme difficulty) versus score 1 (no problem) for milk yield, fat yield, protein yield, days open, number of services, and cow deaths were 703.6 kg, 24.1 kg, 20.8 kg, 33 d, 0.2 services, and 4.1%, respectively. The losses associated with traits were priced and summed to determine the total economic loss associated with dystocia. In addition, calf mortality was considered to be a cost. Across parities, estimates of costs were $0.00, $50.45, $96.48, $159.82, and $379.61 for scores 1 to 5, respectively. Cost of dystocia was relatively higher on a per incidence basis than would be expected from the mean of the population. The total cost associated with dystocia (i. e., within-parity sum of costs associated with dystocia scores weighted by the probability of occurrence) was $28.53 for an average heifer and about $10.00 for an average cow for other parities.

Animal Husbandry↗
PubMed1987

Reporting of dystocia scores and effects of dystocia on production, days open, and days dry from dairy herd improvement data.

Dystocia and livability scores are collected through the Mid-States Dairy Records Processing Center. Thirty-four percent of the cows had dystocia scores reported. Least difficult births were scored 1 and the most difficult births scored 5. Days open in first parity were 14 d greater for births scored 5 versus 1. The differences were larger in later parities. There were 26 more d open in second parity and 19 more d open in third and greater parities for score 5 versus 1. Differences between cows scored 5 versus 1 were 465 kg milk and 20.7 kg milk fat in first lactations, 576 kg milk and 20.9 kg milk fat in second lactations, and 725 kg milk and 25 kg milk fat in third and greater lactations. Cows produced more in lactations following an easy birth. Frequency of difficult births was less in lactations other than the first.

Animals↗
PubMed1975

[Constriction ring dystocia: a special form of uterine dystocia (author's transl)].

Constriction Ring Dystocia means a rare form of uterine dystocia (0.1%--1.7%). Pathophysiologically it means a hypertonic incoordinate anomaly of labor. The paper reports two cases of constriction ring, which had been recognized first during sectio cesarean. As the measure of choose is suggested to use tocolytica, although there do not exist any experiences and there was yet no chance to utilise these medicines because of lack of early recognition.

Adult↗
PubMed2003

Dystocia in a referral hospital setting: approach and results.

REASONS FOR PERFORMING STUDY: Dystocia in the mare is an emergency in which duration has a profound effect on survival of the foal. Specific examination of the effects of dystocia duration on foal survival provides information to enable horse care personnel and veterinarians to manage these cases more effectively and maximise the chances of obtaining a live foal. HYPOTHESIS: Dystocia duration would have a negative impact on foal survival while method of dystocia resolution would not have an effect on foal survival. Additionally, we were interested in determining the effects of dystocia on subsequent fertility. METHODS AND RESULTS: In the years 1986-1999, 247 dystocias were admitted. Of these, 91 % resulted in survival and discharge of the mare, 42% in delivery of a live foal, and 29% of foals survived to discharge. Period from hospital arrival to delivery for foals alive at discharge (23.0 +/- 14.1 mins) was not significantly different than for foals not surviving (24.8 +/- 10.6 mins) (P > 0.05); and from chorioallantoic rupture to delivery for foals alive at discharge (71.7 +/- 343 mins) was significantly less than for foals not surviving (853 +/- 37.4 mins) (P < 0.05). Average predystocia live foaling rates for all mares with available records was 84%. Overall post dystocia live foaling rates over the entire period of this study were 67%. Of mares bred in the year of the dystocia, 59% had a live foal in the year following. CONCLUSIONS: Based on these results, dystocia duration has a significant effect on foal survival and resolution methods should be chosen to minimise this time, as the difference between mean dystocia duration for foals that lived and those that did not in this study was 13.6 mins. Post dystocia foaling rates reported here are higher than previously reported for both same-season and overall breedings, indicating same-season breeding may be rewarding for select dystocia cases. POTENTIAL RELEVANCE: Dystocia resolution methods that minimise delivery time may maximise foal survival. Post dystoicia breeding may be rewarding in select cases.

Animals↗
PubMed1999

The incidence and severity of shoulder dystocia correlates with a sonographic measurement of asymmetry in patients with diabetes.

The objective of this paper is to examine the relationship between fetal asymmetry measured sonographically and the incidence and severity of shoulder dystocia in diabetic patients. Ultrasound data were collected retrospectively from examinations of women with gestational and pregastational diabetes who delivered at University of California, Irvine Medical Center from 1993-1995. Sonographic fetal asymmetry was quantified by calculating the difference between the abdominal diameter and the biparietal diameter in centimeters (AD-BPD). The residual AD-BPD was a patient's actual AD-BPD at the time of the ultrasound minus the mean AD-BPD obtained in our population at the patient's gestational age. The correlations between fetal asymmetry and the incidence and severity of shoulder dystocia were assessed using an analysis of variance as well as a logistic regression analysis. Mild shoulder dystocia was defined as a delivery requiring McRobert's maneuver and/or suprapubic pressure, while severe shoulder dystocia was assessed when delivery of the posterior arm with Wood's corkscrew maneuver was required. One hundred twenty-three women met the inclusion criteria for the study. Dividing the cohort into three groups based on AD-BPD residual values resulted in the following AD-BPD residual ranges and incidences of shoulder dystocia: Group I, -1.80 to -0.32 cm (9.8%), Group II, -0.31 to 0.32 cm (19.5%), and Group III .33 to 2.0 cm (34.1%), (p <0.03). The residual AD-BPD difference correlated with the incidence of shoulder dystocia after controlling for maternal age, weight, parity, birth weight, and the gestational age at ultrasound (P <0.03). Similar results were found with regards to dystocia severity as the mean residual AD-BPD difference between those with no dystocia, mild dystocia, and severe shoulder dystocia was -0.09, 0.23, and 0.46 cm, respectively, (p <0.006). The residual AD-BPD correlated with the severity of shoulder dystocia after controlling for the above-mentioned confounding variables (p <0.05) in a regression analysis. There is a direct correlation in diabetic patients between the level of fetal truncal asymmetry measured sonographically and the incidence and severity of shoulder dystocia.

Abdomen↗
PubMed1987

Shoulder dystocia: a fetal-physician risk.

Trauma that occurs as a result of shoulder dystocia is an important cause of neonatal morbidity. If the occurrence of severe shoulder dystocia, resulting in fetal asphyxia and trauma, could be accurately predicted from maternal risk factors, then a cesarean section would be indicated to prevent the poor outcome. The information available in the obstetric literature, however, is contradictory regarding whether shoulder dystocia can be predicted. In the present study, the patients at greatest risk of shoulder dystocia (all 394 mothers delivering neonates with birth weights greater than or equal to 4000 gm over a 2-year period) were examined. A three-way discriminant analysis was used to determine if a model could be developed that could effectively predict those patients who would be included in each of the groups of no shoulder dystocia, shoulder dystocia without trauma (29 patients), and shoulder dystocia with trauma (20 patients). Three factors, including birth weight, prolonged deceleration phase, and length of second stage labor, were found individually to contribute significantly to the classification. However, when examined in detail, it was noted that while 94% of cases with no shoulder dystocia would be detected, only 16% of the cases of shoulder dystocia with trauma would be predicted by this model. We conclude that in the group of pregnancies delivering neonates greater than or equal to 4000 gm, the occurrence of shoulder dystocia cannot be predicted from clinical characteristics or labor abnormalities, and that the occurrence of shoulder dystocia is not evidence of medical malpractice.

Birth Injuries↗
PubMed1995

Perinatal implications of shoulder dystocia.

OBJECTIVE: To assess the antecedents of shoulder dystocia, the risk of recurrence, and the perinatal morbidity associated with the different maneuvers used for its management. METHODS: We conducted a 10-year (1980-1989) retrospective case record review of all instances of shoulder dystocia in a teaching maternity hospital. RESULTS: There were 254 cases of shoulder dystocia in 40,518 vaginal cephalic deliveries (0.6%), with 33 cases (13.0%) of brachial plexus palsy and 13 fractures (5.1%). There were no perinatal deaths attributable to shoulder dystocia. The risk of shoulder dystocia was increased with prolonged pregnancy (threefold), prolonged second stage of labor (threefold), mid-forceps deliveries (tenfold), and increasing birth weight. Of the maneuvers used to deal with shoulder dystocia, strong downward traction on the head was significantly correlated with brachial plexus palsy compared with other individual methods of delivering the shoulders. There was only one case of recurrent shoulder dystocia in 80 women having 93 cephalic vaginal deliveries after their original delivery coded with shoulder dystocia. CONCLUSION: Shoulder dystocia is not a reliably predictable event in labor. Although the risk of shoulder dystocia is increased with prolonged pregnancy, prolonged second stage of labor, increasing birth weight, and mid-forcepts delivery, the majority of cases occur without these risk factors. Strong downward traction on the head is associated with the greatest degree of neonatal trauma, whereas McRoberts maneuver has the least. The risk of recurrent shoulder dystocia is low.

Birth Injuries↗
PubMed2002

Erb's palsy without shoulder dystocia.

OBJECTIVES: The purpose of this commentary is to review certain articles which have provided evidence that Erb's palsy can occur without associated shoulder dystocia. The mechanism of the specific cause of the injury will be described. METHODS: Prior to the last 10-12 years it was assumed that Erb's palsy occurred exclusively with and was the result of shoulder dystocia. Gonik et al. [Am J Perinat 1991;8:31-34], reported on a research study based on the premise that when Erb's palsies occurred there must have been shoulder dystocia present but it went undetected by the delivering physician. Subsequently Gherman [Am J Obstet Gynecol 1998;178:423-427], published a detailed study which carefully looked at multiple aspects of shoulder dystocia including those similar injuries occurring with and without associated shoulder dystocia. RESULTS: Both Gonik's and Gherman's research revealed distinct maternal and newborn differences when comparing Erb's palsy occurring with and without associated shoulder dystocia. These differences, which have nothing to do with the ability to recognize shoulder dystocia, provide conclusive evidence that Erb's palsy does occur without associated shoulder dystocia. CONCLUSIONS: Therefore, Gonik's original premise, that shoulder dystocia must have been present if Erb's palsy occurred, is not supported. This brings into question the cause of Erb's palsy in those cases without shoulder dystocia. The maternal forces are the most likely cause both with and without shoulder dystocia.

Birth Injuries↗
PubMed1998

A six-year retrospective analysis of shoulder dystocia and delivery of the shoulders.

OBJECTIVE: To investigate the diagnosis, incidence and management of shoulder dystocia. DESIGN: Retrospective review of all the deliveries between 1988 and 1993 which were coded on the computer data base as 'moderate difficulty with the shoulders' or 'shoulder dystocia'. SETTING: A teaching hospital in the south of England. PARTICIPANTS: The study population consisted of 15,658 women who had cephalic vaginal deliveries of babies weighing > 2.5 kg. The sample consisted of the 257 women reported to have moderate difficulty with the shoulders or shoulder dystocia at delivery. FINDINGS: There was a significant fall in the reported incidence of shoulder dystocia during the period under investigation. Eighty-six (1.1%) of the deliveries between 1988 and 1990 were reported to have been complicated by shoulder dystocia. In 1991 a second option was introduced to allow both shoulder dystocia or moderate difficulties with the shoulders to be coded after delivery. Following this change in categorisation, the incidence of shoulder dystocia was reduced to 30 (0.6%) reported cases in 1992-1993. Over the same period the reported incidence of moderate difficulty rose significantly from 29 (1.1%) in 1992 to 60 (2.4%) in 1993 (P < 0.001). Disparity was noted between the experience of practitioners and contemporary definitions of shoulder dystocia and this was highlighted by the number of reported cases of moderate difficulty. In this study practitioners used the term shoulder dystocia in a general sense to describe a range of difficulties encountered with the delivery of the shoulders and they identified many varied manifestations. In comparison, contemporary literature describes shoulder dystocia as a discrete entity. KEY CONCLUSIONS: Shoulder dystocia is a complex clinical scenario and perceptions of the incidence may be influenced by alterations in the delivery technique and changes in the diagnosis and documentation. IMPLICATIONS FOR PRACTICE: The application of traction may interfere with the normal mechanisms of labour and the spontaneous birth of the shoulders, whilst increasing the risk of trauma to the baby. It may be unnecessary to use such interventions routinely in the care of normal labouring women.

Birth Weight↗
PubMed1993

Shoulder dystocia: an analysis of risks and obstetric maneuvers.

OBJECTIVE: The purpose of this study was to determine whether there is a risk profile for predicting or preventing shoulder dystocia and whether any of the obstetric maneuvers to disimpact a shoulder reduce the likelihood of permanent injury. STUDY DESIGN: A retrospective analysis of 14,297 parturients with 12,532 vaginal deliveries and 1765 cesarean sections (12.4%) from January 1986 through June 1990 was performed. A total of 204 maternal and infant charts, related to shoulder dystocia or neonatal injury, were reviewed in depth for age, parity, episiotomy, type of delivery, hemorrhage, maternal obesity, diabetes, weight gain, fetal weight, sex, and Apgar scores. In addition, the type of maneuver or combination thereof used to relieve the dystocia, type of injury to the infant, and follow-up of the injury were reviewed. RESULTS: The 185 coded episodes of shoulder dystocia represent 1.4% of all vaginal deliveries (12,532). There were 42 injuries recorded: 14 fractured clavicles and 28 brachial plexus injuries. An additional 19 patients, not coded for shoulder dystocia, sustained 14 fractured clavicles and five brachial plexus injuries. All but one of the brachial plexus injuries resolved by 6 months. The occurrence of shoulder dystocia increased in direct relationship to the birth weight and becomes significant in newborns over 4000 gm (p < 0.01). The occurrence of a previous large infant was also a significant risk factor (p < 0.01). Diabetes and midforceps delivery become significant factors only in the presence of a large fetus. Obesity, multiparity, postdate pregnancy, use of oxytocin, low forceps delivery, episiotomy, and type of anesthesia were unrelated to shoulder dystocia. No delivery method was without injury. CONCLUSIONS: This study clearly indicates that most of the traditional risk factors for shoulder dystocia have no predictive value, shoulder dystocia itself is an unpredictable event, and infants at risk for permanent injury are virtually impossible to predict. In addition, no delivery method in shoulder dystocia was superior to another with respect to injury. Thus no protocol should serve to substitute for clinical judgment.

Delivery, Obstetric↗