Shoulder dystocia means that after the fetal head is delivered, the fetal front shoulder is incarcerated above the pubic symphysis , and the fetal shoulders cannot be delivered using conventional midwifery methods.
For the mother, it can cause postpartum hemorrhage, severe perineal laceration, vaginal laceration, cervical laceration, uterine rupture, genital tract fistula and puerperal infection.
For newborns, it can cause brachial plexus injury, fractures, asphyxia, intracranial hemorrhage, and even death.
Half an hour later, the patient arrived in the delivery room.
This is a pregnant woman who is 37 weeks pregnant. She was found to have diabetes two years ago. She took two oral hypoglycemic drugs to control her blood sugar during pregnancy. Her blood sugar control was poor. She did not seek medical treatment in time and did not adjust her medicines.
After intrauterine stillbirth, labor was induced at county-level hospital . The fetal head had been delivered outside the vagina and was embedded in the vagina and pelvis from the neck down. All methods could not be used to deliver the baby.
I thought that after traveling a lot, the incarcerated fetus would be a little loose. After the examination, I found that the situation was quite difficult. The still fetus was highly swollen, and the vagina was filled to the brim with the fetal trunk and limbs.
How can a stillborn fetus be delivered smoothly without causing severe tearing of the mother's soft birth canal?
could only come up with a "trick" - the all-fours method and the postpartum shoulder method . After many twists and turns, the fetus was finally delivered, uterine contraction drugs were injected, blood sugar was monitored, and the soft birth canal was checked. Fortunately, the patient did not have the above symptoms. complication.
The patient was hospitalized for five days. Under the guidance of an endocrinologist, he was successfully discharged after his blood sugar stabilized.
"The doctor can heal the disease before it is sick". In order to prevent similar tragedies from happening again, we have the responsibility to spread some popular science knowledge.
Maternal diabetes is divided into two types, one is diabetes that occurs before pregnancy, and the other is diabetes that occurs during pregnancy.
Blood sugar control during pregnancy is normal, and maternal and fetal outcomes are good. On the contrary, it can cause related complications.
Such as giant fetus, too small fetus, fetal miscarriage and premature birth, intrauterine hypoxia and death, fetal malformation; neonatal respiratory distress syndrome, neonatal hypoglycemia ; maternal prone to infection, postpartum hemorrhage, shoulder dystocia, Birth canal injury, diabetic ketoacidosis , etc., some even kill two people.
Most pregnant women with diabetes can eat and sleep, and the external manifestations of the disease are not obvious, so it is easy to miss diagnosis.
How can we detect diabetes? - Women of childbearing age with high-risk factors can do a 75-gram glucose tolerance test before pregnancy or early pregnancy to determine whether they have pregestational diabetes; all pregnant women who have not done the above tests should do the above tests between 24 and 28 weeks of pregnancy.
Patients with pre-pregnancy diabetes should seek medical treatment in time before pregnancy to determine the severity of diabetes.
Doctors have assessed that if a person is not suitable for pregnancy, once she becomes pregnant, the mother and baby are at greater risk and should use contraception.
Pregnant women can strictly control their blood sugar under the supervision of a physician before pregnancy. During the entire pregnancy, the pregnancy must be under the joint supervision of a physician and an obstetrician to reduce the risk to the mother and child.
Regardless of the type of diabetes, pregnant women need to follow a regular diabetes diet and engage in moderate-intensity exercise 30 minutes after each meal.
Most pregnant women with gestational diabetes can control their blood sugar within the ideal range through the above methods. Only patients with pre-gestational diabetes and a small number of patients with gestational diabetes need to inject insulin to control blood sugar.
When blood sugar is well controlled throughout pregnancy, the outcome for both mother and baby is good.
After delivery of a diabetic mother, blood sugar monitoring and hypoglycemic treatment are equally important.
Visit the obstetrics department promptly 42 days after delivery and review the 75-gram glucose tolerance test to evaluate whether the diabetes has returned to normal and whether follow-up monitoring and treatment are needed.
If this pregnant woman with pregestational diabetes had conceived under the standardized management of a multidisciplinary team, the pregnancy outcome might have been different.
Unfortunately, we don't have ifs and maybes.
Obstetric medical staff are called the patron saints of maternal and infant safety. As one of them, I hope that every pregnancy will have a good outcome—the mother and child are healthy and safe!
(Editor Rainbow. Picture source network, infringement and deletion)
Hunan Medical Chat special author: Yiyang Central Hospital Liu Jiadi
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