Favorable outcome after nine minutes of shoulder dystocia preceded by a tight nuchal cord
-
Maria Novoa
,
Jonathan Friedman
Abstract
Objectives
A case report involving a tight nuchal cord and concomitant shoulder dystocia with a review of the literature. We demonstrate that favorable outcomes may result with correct application of maneuvers and adequate management after delivery.
Case presentation
A 41 years old woman was admitted with spontaneous rupture of membranes. The first stage of labor was unremarkable. During the second stage, an intentionally-cut tight nuchal cord was followed by 9 min of shoulder dystocia that was finally relieved by delivery of the anterior shoulder. APGAR scores were 0, 3, 4, 7 at 1, 5, 10 and 20 min respectively. The neonate was placed under therapuetic hypothermia and was discharged after 13 days. At 5 months and 1.5 years of age, the infant met age appropriate developmental milestones with no neurologic sequela.
Conclusions
Shoulder dystocia can result in fatal outcomes for the neonate. Adequate management highlights the need for prompt recognition of this complication and application of appropriate maneuvers. Therapeutic hypothermia decreases mortality and improves neurological development in infants who experience hypoxic ischemic encephalopathy (HIE).
Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The research related to human use has complied with all the relevant national regulations, institutional policies and has been conducted in accordance with the tenets of the Helsinki Declaration, and it has been approved by the authors’ Institutional Review Board or equivalent committee.
References
1. Henry, E, Andres, RL, Christensen, RD. Neonatal outcomes following a tight nuchal cord. J Perinatol 2013;33:231–4. https://doi.org/10.1038/jp.2012.79.Search in Google Scholar
2. Nausea, ACOG. Vomiting of pregnancy. Obstet Gynecol 2015;126:e12–24. https://doi.org/10.1016/0002-9378(68)90445-6.Search in Google Scholar
3. Cunningham, FG, Leveno, KJ, Bloom, SL, Hauth, JC, Rouse, DJ, Spong, CY. Williams Obstetrics, 25th ed. Appleton-Century-Crofts; 2018:89–91 p.Search in Google Scholar
4. Papile, LA, Baley, JE, Benitz, W, Cummings, J, Carlo, WA, Eichenwald, E, et al. Hypothermia and neonatal encephalopathy. Pediatrics 2014;133:1146–50. https://doi.org/10.1542/peds.2014-0899.Search in Google Scholar
5. Iffy, L, Varadi, V, Papp, E. Untoward neonatal sequelae deriving from cutting of the umbilical cord before delivery. Med Law 2001;20:627–34.Search in Google Scholar
6. McFarland, M, Hod, M, Piper, JM, Xenakis, EMJ, Langer, O. Are labor abnormalities more common in shoulder dystocia? Am J Obstet Gynecol 1995;173:1211–4. https://doi.org/10.1016/0002-9378(95)91355-6.Search in Google Scholar
7. Lurie, S, Levy, R, Ben-Arie, A, Hagay, Z. Shoulder dystocia: could it be deduced from the labor partogram? Am J Perinatol 1995;12:61–2. https://doi.org/10.1055/s-2007-994403.Search in Google Scholar
8. Dall’Asta, A, Ghi, T, Pedrazzi, G, Frusca, T. Does vacuum delivery carry a higher risk of shoulder dystocia? Review and meta-analysis of the literature. Eur J Obstet Gynecol Reprod Biol 2016;204:62–8. https://doi.org/10.1016/j.ejogrb.2016.07.506.Search in Google Scholar
9. Lerner, H, Durlacher, K, Smith, S, Hamilton, E. Relationship between head-to-body delivery interval in shoulder dystocia and neonatal depression. Obstet Gynecol 2011;118:318–22. https://doi.org/10.1097/aog.0b013e31822467e9.Search in Google Scholar
10. Hope, P, Breslin, S, Lamont, L, Lucas, A, Martin, D, Moore, I, et al. Fatal shoulder dystocia: a review of 56 cases reported to the confidential enquiry into stillbirths and deaths in infancy. BJOG An Int J Obstet Gynaecol 1998;105:1256–61. https://doi.org/10.1111/j.1471-0528.1998.tb10003.x.10.1111/j.1471-0528.1998.tb10003.xSearch in Google Scholar PubMed
11. Menticoglou, S, Schneider, C. Resuscitating the baby after shoulder dystocia. Case Rep Obstet Gynecol 2016;2016:1–3. https://doi.org/10.1155/2016/8674167.Search in Google Scholar
12. Tagin, MA, Woolcott, CG, Vincer, MJ, Whyte, RK, Stinson, DA. Hypothermia for neonatal hypoxic ischemic encephalopathy: an updated systematic review and meta-analysis. Arch Pediatr Adolesc Med 2012;166:558–66. https://doi.org/10.1001/archpediatrics.2011.1772.Search in Google Scholar
13. Hoffman, MK, Bailit, JL, Branch, DW, Burkman, RT, Van Veldhusien, P, Lu, L, et al. A comparison of obstetric maneuvers for the acute management of shoulder dystocia. Obstet Gynecol 2011;117:1272–8. https://doi.org/10.1097/aog.0b013e31821a12c9.Search in Google Scholar
14. Vollebergh, JHA, Van Dongen, PWJ. The Zavanelli manoeuvre in shoulder dystocia: case report and review of published cases. Eur J Obstet Gynecol Reprod Biol 2000;89:81–4. https://doi.org/10.1016/s0301-2115(99)00163-3.Search in Google Scholar
15. Wykes, CB, Johnston, TA, Paterson-Brown, S, Johanson, RB. Symphysiotomy: a lifesaving procedure. BJOG An Int J Obstet Gynaecol 2003;110:219–21. https://doi.org/10.1046/j.1471-0528.2003.02001.x.Search in Google Scholar
16. Hoek, J, Verkouteren, B, Van Hamont, D. Posterior axilla sling traction: a new technique for severe shoulder dystocia. BMJ Case Rep 2019;12. https://doi.org/10.1136/bcr-2018-226882.Search in Google Scholar
17. Coppus, SFPJ, Langenveld, J, Oei, SG. An underestimated technique for the management of shoulder dystocia: the all-fours manoeuvre. Ned Tijdschr Geneeskd 2007;151:1493–7.Search in Google Scholar
18. Mercer, J, Erickson-Owens, D, Skovgaard, R. Cardiac asystole at birth: is hypovolemic shock the cause?. Med Hypotheses 2009;72:458–63. https://doi.org/10.1016/j.mehy.2008.11.019.Search in Google Scholar
© 2020 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Case Reports – Obstetrics
- Fetal pulmonary choristoma: report of first case and literature review
- Ultrasound prenatal diagnosis of a de novo 14q distal duplication associated with foetal anomalies: a case report
- Prenatal diagnosis of Kleefstra syndrome
- Cardiac implant and the risk of infective endocarditis in pregnancy
- Iatrogenic fetal goiter. Conservative management and spontaneous resolution
- Management in cases of large uterine myomas in pregnancy
- Significantly enlarged varix in the free-loop of the umbilical cord during the second trimester
- A case report of co-infection with rhinovirus and SARS-CoV-2 in pregnancy
- Monoamniotic twins pregnancy complicated by a fetal congenital heart defect – a challenge for perinatal decisions
- Favorable outcome after nine minutes of shoulder dystocia preceded by a tight nuchal cord
- Circumvallate placenta and abnormal cord insertion as risk factors for intrauterine growth restriction and preterm birth: a case report
- A rare case of intra-uterine blood transfusion for fetal anemia caused by a giant placental chorioangioma
- Septated fetal bladder in a case of 2q13 deletion
- A case of prenatal diagnosis of single umbilical artery due to thrombosis diagnosed by the ultrasound finding of “wink-sign”
- Ultrasound diagnosis of myelomeningocele: the role of 3D ultrasonography in determining surficial status of the pathological lesion
- Pragmatic approach and variations in the management of pregnant women with type 1 diabetes mellitus on insulin pump: a case series
- A great pre-eclampsia masquerader. Hemophagocytic lymphohistiocytosis (HLH) presenting in pregnancy
- Survival of both twins in a pregnancy complicated by pre-viable cord prolapse at 21 weeks of gestation
- A case report of a pregnant woman diagnosed with intrahepatic cholangiocarcinoma (ICC) complicated by opioid tolerance
- Prenatal and postnatal imaging of an intrapericardial teratoma
- Case report of a ruptured uterine sacculation in the 19th week of pregnancy
- Is thromboelastography reliable in postpartum coagulopathies? Two case reports and a literature review
- Prenatal diagnosis of megacystis-microcolon-intestinal hypoperistalsis syndrome
- Fetal head entrapment within the lower uterine segment
- Case Reports – Fetus
- A case of diprosopus: a rare form of twinning radiology-pathology correlation
- Case Reports – Newborn
- Transmission of SARS-CoV-2 to premature twins from an asymptomatic mother
- Spinal dysraphism, club feet, and dextrocardia with situs inversus totalis in a neonate: a rare association and review
- Giant congenital vascular malformation: diagnostic approach and clinical course
- Transient neonatal myasthenia gravis following maternal myasthenia gravis presenting in pregnancy after treatment with Alemtuzumab
- Congenital pulmonary lymphangiectasia in an extremely low birth weight: a case report
- Congenital kaposiform hemangioendothelioma: don’t let the appearances fool you
- Agnathia-otocephaly complex: a case report and a literature review on recurrence risk
- Perinatal severe hypophosphatasia: a case report
- Recurrent neonatal group B streptococcus cellulitis and adenitis syndrome with late-onset sepsis
- Neonatal hypertension caused by left-to-right shunt flow through a patent ductus arteriosus in a premature infant
- Maternal Babesia infection associated with neonatal extramedullary hematopoiesis and acute myeloid leukemia in late infancy
- Congenital high airway obstruction syndrome complicated with foregut malformation and high airway fistula to the alimentary tract – a case series with four distinct types
- Aplasia cutis congenita as a consequence of fetal reduction in a triplet pregnancy
- Anhydramnios, but prenatally normal kidneys: renal tubular dysgenesis – patient with mutations in the renin-angiotensin system gene AGTR1
- Symptomatic and lethal congenital primary cardiac rhabdomyoma
Articles in the same Issue
- Case Reports – Obstetrics
- Fetal pulmonary choristoma: report of first case and literature review
- Ultrasound prenatal diagnosis of a de novo 14q distal duplication associated with foetal anomalies: a case report
- Prenatal diagnosis of Kleefstra syndrome
- Cardiac implant and the risk of infective endocarditis in pregnancy
- Iatrogenic fetal goiter. Conservative management and spontaneous resolution
- Management in cases of large uterine myomas in pregnancy
- Significantly enlarged varix in the free-loop of the umbilical cord during the second trimester
- A case report of co-infection with rhinovirus and SARS-CoV-2 in pregnancy
- Monoamniotic twins pregnancy complicated by a fetal congenital heart defect – a challenge for perinatal decisions
- Favorable outcome after nine minutes of shoulder dystocia preceded by a tight nuchal cord
- Circumvallate placenta and abnormal cord insertion as risk factors for intrauterine growth restriction and preterm birth: a case report
- A rare case of intra-uterine blood transfusion for fetal anemia caused by a giant placental chorioangioma
- Septated fetal bladder in a case of 2q13 deletion
- A case of prenatal diagnosis of single umbilical artery due to thrombosis diagnosed by the ultrasound finding of “wink-sign”
- Ultrasound diagnosis of myelomeningocele: the role of 3D ultrasonography in determining surficial status of the pathological lesion
- Pragmatic approach and variations in the management of pregnant women with type 1 diabetes mellitus on insulin pump: a case series
- A great pre-eclampsia masquerader. Hemophagocytic lymphohistiocytosis (HLH) presenting in pregnancy
- Survival of both twins in a pregnancy complicated by pre-viable cord prolapse at 21 weeks of gestation
- A case report of a pregnant woman diagnosed with intrahepatic cholangiocarcinoma (ICC) complicated by opioid tolerance
- Prenatal and postnatal imaging of an intrapericardial teratoma
- Case report of a ruptured uterine sacculation in the 19th week of pregnancy
- Is thromboelastography reliable in postpartum coagulopathies? Two case reports and a literature review
- Prenatal diagnosis of megacystis-microcolon-intestinal hypoperistalsis syndrome
- Fetal head entrapment within the lower uterine segment
- Case Reports – Fetus
- A case of diprosopus: a rare form of twinning radiology-pathology correlation
- Case Reports – Newborn
- Transmission of SARS-CoV-2 to premature twins from an asymptomatic mother
- Spinal dysraphism, club feet, and dextrocardia with situs inversus totalis in a neonate: a rare association and review
- Giant congenital vascular malformation: diagnostic approach and clinical course
- Transient neonatal myasthenia gravis following maternal myasthenia gravis presenting in pregnancy after treatment with Alemtuzumab
- Congenital pulmonary lymphangiectasia in an extremely low birth weight: a case report
- Congenital kaposiform hemangioendothelioma: don’t let the appearances fool you
- Agnathia-otocephaly complex: a case report and a literature review on recurrence risk
- Perinatal severe hypophosphatasia: a case report
- Recurrent neonatal group B streptococcus cellulitis and adenitis syndrome with late-onset sepsis
- Neonatal hypertension caused by left-to-right shunt flow through a patent ductus arteriosus in a premature infant
- Maternal Babesia infection associated with neonatal extramedullary hematopoiesis and acute myeloid leukemia in late infancy
- Congenital high airway obstruction syndrome complicated with foregut malformation and high airway fistula to the alimentary tract – a case series with four distinct types
- Aplasia cutis congenita as a consequence of fetal reduction in a triplet pregnancy
- Anhydramnios, but prenatally normal kidneys: renal tubular dysgenesis – patient with mutations in the renin-angiotensin system gene AGTR1
- Symptomatic and lethal congenital primary cardiac rhabdomyoma
