ROBERT B GHERMAN

OBJECTIVE: Much of our understanding and knowledge of shoulder dystocia has been blurred by inconsistent and scientific studies that are of limited scientific quality. In an evidence-based format, we sought to answer the following questions: (1) Is shoulder dystocia predictable? (2) Can shoulder dystocia be prevented? (3) When shoulder dystocia does occur, what maneuvers should be performed? and (4) What are the sequelae of shoulder dystocia?

STUDY DESIGN: Electronic databases, including ...

OBJECTIVE: Our goal was to evaluate the effectiveness of therapy with a specific pulmonary vasodilator, nitric oxide, in a woman with Eisenmenger syndrome during pregnancy.

STUDY DESIGN: Eisenmenger syndrome consists of a congenital communication between the systemic and pulmonary circulation with secondary pulmonary hypertension causing reversal of flow through the shunt. Maternal morbidity is approximately 50% with the greatest risk of death being in the peripartum period. ...

OBJECTIVE: We sought to determine the fetal injury rate associated with shoulder dystocia and to determine whether there is a higher rate of brachial plexus injury or bone fracture when fetal manipulation techniques are required for delivery.

STUDY DESIGN: A retrospective review of 285 cases of shoulder dystocia that occurred between January 1991 and December 1995 was performed. The type, sequence, and combination of obstetric maneuvers used to relieve the shoulder dystocia were noted. ...

OBJECTIVE: To determine whether a simulation training scenario improves resident competency in the management of shoulder dystocia.

METHODS: Residents from 2 training programs participated in this study. The residents were block-randomized by year-group to a training session on shoulder dystocia management that used an obstetric birthing simulator or to a control group with no specific training. Trained residents and control subjects were subsequently tested on a standardized shoulder ...

OBJECTIVE: Our purpose was to determine the rate of success of the McRoberts' maneuver as the initial treatment for shoulder dystocia and to compare the rate of maternal and neonatal morbidity with those cases of shoulder dystocia requiring additional obstetric maneuvers. A secondary goal was to assess those factors associated with successful McRoberts' maneuvers.

STUDY DESIGN: A retrospective review of shoulder dystocia cases occurring between 1991 and 1994 was performed. The identified ...

OBJECTIVE: The purpose of this study was to determine whether medical treatment of early pregnancy failure represents a reasonable alternative to surgical therapy.

STUDY DESIGN: Patients who were diagnosed with pregnancy failure before 12 weeks of gestation were randomly assigned to receive either medical (intravaginal misoprostol) or surgical therapy (dilatation and curettage). In the medical arm of the study, 800 microg of misoprostol was placed within the posterior vaginal fornix. ...

OBJECTIVE: To estimate the incidence, timing, and associated clinical characteristics of objectively diagnosed pregnancy-associated venous thromboembolism.

METHODS: We retrospectively reviewed venous thromboembolism cases (deep venous thrombosis and pulmonary embolism) that occurred between 1978 and 1996. Study inclusion criteria required the objective diagnosis with either Doppler ultrasound, venography, impedance plethysmography, pulmonary angiography, ventilation-perfusion scanning, ...

OBJECTIVE: The purpose of this study was to analyze the data on brachial plexus injury and its relationship with shoulder dystocia from a tertiary center for a 23-year period.

STUDY DESIGN: A review of the logbooks on labor and delivery and the nursery and the International Classification of Diseases codes identified all newborn infants with brachial plexus injury who were delivered at our center.

RESULTS: During the 23 years (1980-2002), there were 89,978 deliveries, of which there were ...

OBJECTIVE: To determine if outpatient cervical ripening using misoprostol can initiate labor within 48 hours of medication administration and to determine if time from medication administration to time of delivery is decreased using outpatient cervical ripening.

METHODS: Uncomplicated singleton, vertex pregnancies at 41 weeks' gestation or later with Bishop score of 4 or less were eligible for enrollment. Other inclusion criteria included intact membranes, less than eight uterine ...

Simulations have been used by the military, airline industry, and our colleagues in other medical specialties to educate, evaluate, and prepare for rare but life-threatening scenarios. Work hour limits for residents in obstetrics and gynecology and decreased patient availability for teaching of students and residents require us to think creatively and practically on how to optimize their education. Medical simulations may address scenarios in clinical practice that are considered ...

OBJECTIVE: To delineate factors that differentiate shoulder dystocia with and without brachial plexus injury (BPI).

STUDY DESIGN: A case-control study culled from an established shoulder dystocia database. Cases of shoulder dystocia-related BPI were identified and matched (1:1) with a control group of shoulder dystocia in which BPI did not result. Odds ratios (OR) and 95% confidence intervals (CI) were calculated.

RESULTS: From 1980 to 2002, there were 89 978 deliveries with 46 cases of ...

OBJECTIVE: Our purpose was to determine the rate of associated risk factors for shoulder dystocia from a large cohort of patients delivered within our Southern California perinatal program.

STUDY DESIGN: A retrospective analysis was performed of patients delivered from January 1991 to June 2001. Patients with and without shoulder dystocia were identified from our computer-stored perinatal database and compared. Statistical methods used included: chi 2 test, t test, calculation of odds ...

OBJECTIVE: Brachial plexus injury may be unrelated to manipulations performed at the time of delivery, occurring in the absence of shoulder dystocia and in the posterior arm of infants with anterior shoulder dystocia. To further support the hypothesis that some of these nerve injuries appear to be of intrauterine origin, we present a series of brachial plexus palsies associated with atraumatic cesarean delivery among fetuses presenting in the vertex position.

STUDY DESIGN: We performed a ...

OBJECTIVE: To estimate differences between shoulder dystocia-associated transient and permanent brachial plexus palsies.

METHODS: We performed a retrospective case-control analysis from national birth injury and shoulder dystocia databases. Study patients had permanent brachial plexus palsy and had been entered into a national birth injury registry. Cases of Erb or Klumpke palsy with documented neonatal neuromuscular deficits persisting beyond at least 1 year of life were classified as ...