No abstract available.
Dystocia* ; Female ; Pregnancy ; Shoulder*

Shoulder dystocia refers to difficulty in delivery of fetal shoulders, and is one of the most dreaded and dramatic complications encountered in obstetrics. It is a true emergency, and when it occurs, it can result in high rate of maternal morbidity as well as neonatal morbidity and mortality. The occurrence of shoulder dystocia cannot be accurately predicted or prevented on the basis of antenatal risk factors or labor abnormalities. Therefore, the obstetrician must be prepared to recognize a shoulder dystocia immediately and proceed through an orderly sequence of steps to effect delivery in a timely manner. The goal of management is to prevent fetal asphyxia, while avoiding physical injury.
Asphyxia ; Dystocia* ; Emergencies ; Female ; Mortality ; Obstetrics ; Pregnancy ; Risk Factors ; Shoulder*

Postpartum genital tract adhesions are unusual, and their cause has not been evaluated. However, severe dystocia and numerous pelvic examinations have been suggested as possible causes. Here, we report a case of vaginal adhesions following a difficult labor that presented as dyspareunia for 5 months. Pelvic examination and ultrasonography revealed a transverse vaginal septum that obstructed the vaginal cavity, and fluid collection proximal to this septum. The patient was successfully treated with surgical resection and administration of antibiotics.
Anti-Bacterial Agents ; Dyspareunia ; Dystocia* ; Female ; Gynecological Examination ; Humans ; Postpartum Period ; Pregnancy ; Tissue Adhesions ; Ultrasonography ; Vagina

BACKGROUND: This study was done to compare vacuum delivery and cesarean section rates in a large population before and after on-demand labor epidural analgesia became available. METHODS: We retrospectively investigated the overall sets of delivery modes in patients who gave birth during a 12-month period before the introduction of on-demand labor epidural analgesia, and those giving birth after labor epidural analgesia became available. Additionally, we compared the rates of cesarean section or vacuum delivery in patients delivering before and after the availability of on-demand labor epidural. RESULTS: Included were 3905 patients who delivered before, and 4318 patients who delivered after epidural analgesia became available. Labor epidural rates were 0.3% vs 14.7% for the before and after groups. The rates of cesarean delivery for dystocia in primary cesarean operation did not change (10% vs 10.5%), and vacuum delivery rates in the total vaginal delivery patients were not changed (15.1% vs 14.7%) for the before and after group. CONCLUSIONS: Increased epidural analgesia did not change the overall cesarean delivery rates for dystocia and vacuum - assisted delivery rates.
Analgesia, Epidural* ; Cesarean Section* ; Dystocia ; Female ; Humans ; Parturition ; Pregnancy ; Retrospective Studies ; Vacuum*

The neurogenic tumor of frequent occurrence in the presacral area is a schwannoma. Giant presacral schwannoma has a risk for anterior surgical approach because of its massive size and proximity to abundant vascularity of presacral region. We report a single stage posterior approach for total resection of a giant presacral schwannoma. A 40-year-old female patient experienced left buttock pain and tingling sensation at left S1 dermatome. Magnetic resonance imaging showed that the presacral huge mass at S1–3 level with osseous extension and structural remodeling in left sacral ala. The presacral mass was ranging in maximum diameter from 8.0 to 8.6 cm. S2 foramen laminectomy was performed to expose the mass. The tumor capsule and the root were carefully dissected away. The tumor was removed while preserving the capsule by dissecting the plane between the inner wall of the capsule and the tumor. The single stage posterior approach for presacral giant schwannoma is feasible, and it can be a good surgical alternative to prevent pelvic organ or vascular damage and anterior approach related dystocia and infertility.
Adult ; Buttocks ; Dystocia ; Female ; Humans ; Infertility ; Laminectomy ; Magnetic Resonance Imaging ; Neurilemmoma* ; Pregnancy ; Sensation

Spondylolisthesis and spondylolysis is one of the major causes of the low back pain and orthopaedic surgeons frequently encounter this problems with increasing tendency. In 19th century, spondylolisthesis had been studied by the European obstetrician as the main cause of dystocia. Advancement of the radiological techniques enabled us to know more precise degree of slipping. Therefore, many surgical techniques have been used. Spondylolysis has been also studied as the precursor of the spondylolisthesis. This report is based upon the analysis of the records of 26 patients who had operated at the Department of Orthopaedic Surgery of National Medical Center from 1972 to 1981. The results were as follows. 1. Most common age group was 30–50 age group and theres no sexual difference. 2. Most common symptoms were lumbago and radiating pain and the most common sign was Lasegue sign. 3. Most common type was isthmic type and location was 5th lumbar vertebra, and degree of slipping was grade I by Meyerding's method. 4. The fusion of the grafted bone were observed in 24 cases among 26 cases: of which the duration were 3 months in 16 cases and remaining 8 cases had duration between 3 and 6 months. 5. Postoperative analysis under the basis of the functional recovery was satisfactory in 93% of cases by Gill's criteria.
Dystocia ; Female ; Humans ; Low Back Pain ; Methods ; Pregnancy ; Spine ; Spondylolisthesis ; Spondylolysis ; Surgeons ; Transplants

Ovarian cysts are common incidental findings in term infants and, if unusually large, may result in dystocia, torsion, or rupture. We report the case in which serial sonographic examination revealed changing pattern of cystic ovarian mass from hypoechogenic to well defined multiseptated echogenic during pregnancy. Postnatal T2-weighted MR images revealed a multilocular with high signal density. After delivery a laparotomy was performed, and a twisted ovary measuring 6.7x5x4.5 cm was removed. Ovarian torsion was left-sided and had been almost autoamputated. The resected specimens were nontense, thin walled cysts, filled with hemorrhage like fluid. Histological examination demonstrated the presence of lymphangioma with widespread hemorrhage and necrosis. The neonate did well after the procedure.
Dystocia ; Female ; Hemorrhage ; Humans ; Incidental Findings ; Infant ; Infant, Newborn ; Laparotomy ; Lymphangioma ; Necrosis ; Ovarian Cysts* ; Ovary ; Pregnancy ; Rupture ; Ultrasonography*

Bowel obstruction is a rare complication of pregnancy. The usual causes include previous abdominal surgery, volvulus, intussusception, colonic neoplasm, or the enlarging uterus. Bowel obstruction secondary to uncorrected Hirschsprung's disease as a complication of pregnancy is difficult to diagnosis, its occurrence can have grave implications for both mother and fetus, and anticipation of dystocia. Hirschsprung's disease is diagnosed and treated in the neonatal period. Persistence of Hirschsprung's disease into adulthood is very rare and confirmed by rectal biopsy providing the absence of the ganglion cell in Auerbach and Meissner's plexus. We experienced vaginal Delivery in Hirschsprung's disease complicating pregnancy and report our own case study with a brief literature review.
Biopsy ; Colonic Neoplasms ; Diagnosis ; Dystocia ; Female ; Fetus ; Ganglion Cysts ; Hirschsprung Disease* ; Humans ; Intestinal Volvulus ; Intussusception ; Mothers ; Pregnancy* ; Submucous Plexus ; Uterus

The following are summary of the clinical observations on 184 pregnant women underwent cesarean section under general and spinal anesthesia. 1. Ages of pregnant women ranged from 18 to 45 years The second and third decades. comprised 94% of all cases. 2. 83% of the cases were emergency and others were elective operations. 3. Surgical indications revealed dystocia in 43%, hemorrhage in 35%, and others in 22%. 4. 92 cases were performed by general anesthesia, 88 cases by spinal and the remains by local. 5. Apgar scores checked one minute after delivery were as follows. That was Poor category (0 to 4): 42% Fair category (5 to 7): 19% Good category (8 to 10): 39% Resuscitation of Apgar score 0 babies were successful in 8 cases.
Anesthesia* ; Anesthesia, General ; Anesthesia, Spinal ; Apgar Score ; Cesarean Section* ; Dystocia ; Emergencies ; Female ; Hemorrhage ; Humans ; Pregnancy ; Pregnant Women ; Resuscitation

OBJECTIVE: To determine if birth weight greater than 4000gm can be predicted by ultrasound measurement of abdominal circumference(AC) and if shoulder dystocia in macrosomic infants can be predicted by ultrasound measurement of the difference between the abdominal diameter(AD) and biparietal diameter(BPD). METHODS: A Retrospective study was performed of births occuring from March, 1998 to August, 1999 at department of Obstetrics and Gynecology, College of Medicine, Chung-Ang University. Among neonates of birth weight greater than 4000 gm, 50 cases in that ultrasound examination was done within 2 weeks before delivery were selected for macrosomic group and 50 cases were selected for control group during the same period, among neonate of birth weight from 3100gm to 3900gm. RESULTS: 1) Normal spontaneous vaginal delivery(NSVD) was 41 cases in control group and 30 cases in macrosomic group. Among NSVD, shoulder dystocia was 1 case in 41 cases of control group and was 7 cases in 30 cases of macrosomic group. 2) On ultrasound measurement, 6 cases had AC greater than 35 cm in control group and 45 cases in macrosomic group. Among 30 cases in NSVD was done in macrosomic group, difference between AD and BPD was 2.9 0.271 cm when shoulder dystocia was existed and was 2.1 0.409 cm when shoulder dystocia was not existed. Between the two groups, statistically significant difference was detected. 3) When AC(cutoff value of 35cm) was used for screening of macrosomia, sensitivity for macrosomia was 88.2% and specificity was 89.8% and when AD-BPD difference(cutoff value of 2.6cm) was used for prediction of shoulder dystocia, sensitivity for shoulder dystocia was 66.6% and specificity was 95.2%. CONCLUSIONS: In prenatal ultrasound measurement, AC measurement at third trimester of pregnancy will be a valuable indicator for macrosomia screening. The AD-BPD difference of shoulder dystocia group was greater than uncomplicated group in macrosomia and the AD-BPD difference cutoff value of 2.6cm was significant value statistically.
Birth Weight ; Dystocia* ; Female ; Gynecology ; Humans ; Infant ; Infant, Newborn ; Mass Screening ; Obstetrics ; Parturition ; Pregnancy ; Pregnancy Trimester, Third ; Retrospective Studies ; Sensitivity and Specificity ; Shoulder* ; Ultrasonography*