VAJİNAL DOĞUM SIRASINDA İSTENMEYEN DURUMLAR: OMUZ DİSTOSİSİ Uncertainted Cases During Vaginal Birth: Shoulder Dystocia

OZET Amac: Bu calismada, 2012-2018 yillari arasinda kadin dogum klinigimizde gelisen omuz distosisi vakalarinin mevcut risk faktorlerini, kurtarma manevralarini ve perinatal sonuclari degerlendirmeyi amacladik. Gerec ve Yontemler: Calisma, Kocaeli Derince Egitim ve Arastirma Hastanesi’nde ve Adana’da Ozel Hastanesinin Kadin Dogum Kliniginde dogum sirasinda omuz distosisi gelisen olgularin retrospektif taranmasi ile gerceklestirildi. Vaginal dogumlar icinde 24513 tekil dogumda belgelenmis omuz distosisi olan 133 olgu ile bilgisayardan randomizasyon ile secilen 128 saglikli olgu arasinda karsilastirildi. Hastalarin kayit altina alinmis olan maternal demografik ozellikleri, intrapartum ozellikleri ve neonatal sonuclari bilgisayar veri tabaninda analiz edildi. Istatiksel analizler Windows icin SPSS 23 (Version 23.0. IBM Corp) istatistik programi ile yapildi. Bulgular: Her iki grupta da anneye ait demografik ozellikler acisindan fark yoktu. Mekonyum mevcudiyeti, gestasyonel diabetes mellitus orani, bebegin agirligi, omuz distosisi gelisen grupta yuksek bulundu. Omuz distosisi gelisen grupta fetal abdominal cevre daha buyuk olculdu. Omuz distosili bir bebekte hem humerus hem de klavikula kirigi olustu. Apgar skorlari ve umbilikal kord pH degerleri omuz distosili yeni dogan grubunda anlamli dusuktu. Omuz distosisi gelisen 133 yeni doganin % 35,4’unde arka omuz cikarilmasi sirasinda klavikulada fraktur gelisti. Iki bebekte kalici brakial pleksusu sekeli gelisti. Sonuc: Dogum becerilerinin artirilmasi ve omuz distosisinde uygulanan manevralarda surekli teorik ve pratik egitim ve dokumantasyonla izlem, omuz distosisi ile iliskili morbidite ve mortalitenin dusurulmesinde yararli olacaktir. Anahtar Kelimeler: Obstetrik Dogum Komplikasyonlari; Omuz Distosi; Risk Faktorleri; Perinatal Sonuclar ABSTRACT Objective: In this study, the current risk factors, maneuvers and perinatal outcomes of cases with shoulder dystocia in our clinic between 2012-2018 were reviewed. Material and Methods: This study was performed in a retrospective screening of women who developed shoulder dystocia during delivery at the Obstetrics and Gynecology Clinic at Kocaeli Derince Education and Research Hospital and Private Hospital in Adana. 24513 singular deliveries of vaginal birth and 128 healthy cases selected randomly, a total of 133 of them documented shoulder dystocia (SD). Maternal demographics, intrapartum characteristics and neonatal outcomes of the patients were analyzed. Statistical analyzes were performed with SPSS 23 for Windows (Version 23.0. IBM Corp.). Results: Both examined groups, there were no differences about the comparised tasks above. The presence of meconium, the rate of gestational diabetes mellitus, higher weight baby developing much more SD. Women with large fetal abdominal circumference have more risks. A baby with a SD has a humerus, clavicle fracture. Apgar scores and umbilical cord pH values were significantly lower with SD. 35.4 % of 133 newborns developed SD and clavicle fracture during posterior shoulder removal. And in two babies, sequential persistent brachial plexus sequel were seen. Conclusion: Improved skills of delivery and follow-up with continuous both theorical and practical education about maneuvers for SD and documentation will be probably crucial to decrease morbidity and mortality caused by SD. Keywords: Obstetric Labor Complications; Shoulder Dystocia; Risk Factors; Perinatal Outcomes