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Prevention Unintentional Mechanical Birth Injuries

预防意外机械性分娩伤害

基本信息

批准号：
7119467
负责人：
EDITH DIAMENT GUREWITSCH ALLEN
金额：
$ 29.19万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2004
资助国家：
美国
起止时间：
2004-09-01 至 2008-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7119467
关键词：
behavioral /social science research tag biomechanics birth injury clinical research clinical trials computer simulation head movements health care personnel education health care personnel performance human pregnant subject human subject injury prevention limb injury musculoskeletal injury obstetrics shoulder

项目摘要

The objective of this proposal is to elucidate mechanisms involved in mechanical birth injuries that occur following an obstetric emergency known as shoulder dystocia and to develop practical interventions to control or prevent such injuries, some of which can lead to lifelong disability. Affecting up to 15% of vaginal deliveries, shoulder dystocia is a naturally-occurring mechanical obstruction in which, after the head delivers, the fetal shoulders become impacted behind the mother's pubic bone and the trunk cannot deliver without specific intervention by the clinician who must act expediently to prevent asphyxia while simultaneously avoiding undue stretch on the fetal neck. The latter can result in skeletal fractures and/or brachial plexus nerve injury -- unintended outcomes of up to nearly 30% of shoulder dystocias. Standard obstetric maneuvers used to resolve shoulder dystocia involve manipulation of either the mother or the fetus. The superiority of one maneuver over another has not been proven; yet biomechanical considerations support the hypothesis that fetal manipulation requires 20% to 30% less force to deliver the infant than maternal manipulation and, if prioritized, could reduce the incidence of injury. However, most clinicians are less familiar with fetal maneuvers and defer their use in favor of repeating maternal ones. The goals of this research proposal are to demonstrate the mechanical advantage of fetal over maternal manipulation in accomplishing atraumatic resolution of shoulder dystocia and to familiarize clinicians with fetal maneuvers as a public health measure to reduce and prevent neonatal injury. To achieve these objectives, biomedical engineering will be integrated with clinical obstetrics through 5 specific aims: 1. to measure clinician-applied traction on the fetal head using a custom-designed shoulder dystocia birthing simulator and correlate direction, magnitude and rate of this force with fetal neck extension, flexion and rotation, brachial plexus stretch and skeletal fracture; 2. to objectively assess, in a laboratory setting, the effect of uterine and maternal expulsive forces and of different shoulder dystocia maneuvers on clinician-applied force, fetal neck motion parameters and brachial plexus stretch; 3. to conduct an educational program for clinicians on the performance of shoulder dystocia maneuvers, employing the laboratory simulator and force-measuring systems, and assess its effect on clinicians' ability to estimate the amount of traction they apply during delivery; 4. to measure clinician-applied traction in vivo and compare this with laboratory-derived force parameters; 5. to conduct a small, randomized clinical trial comparing clinician-applied forces following McRoberts' maneuver (a maternal manipulation) and following Rubin's maneuver (a fetal manipulation).

本提案的目的是阐明在被称为肩部难产的产科急诊后发生的机械性分娩损伤的机制，并制定实际干预措施来控制或预防这种损伤，其中一些可能导致终身残疾。肩难产是一种自然发生的机械阻塞，影响了多达15%的阴道分娩，在头部分娩后，胎儿的肩膀被压在母亲的耻骨后面，如果没有临床医生的具体干预，胎儿的躯干无法分娩，医生必须采取措施防止窒息，同时避免对胎儿颈部的过度拉伸。后者可导致骨骼骨折和/或臂丛神经损伤——高达30%的肩部难产的意外结果。

项目成果

期刊论文数量（14）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Improving Shoulder Dystocia Management and Outcomes with a Targeted Quality Assurance Program.

通过有针对性的质量保证计划改善肩难产的管理和结果。

DOI：
10.1055/s-0037-1603819
发表时间：
2017
期刊：
American journal of perinatology
影响因子：
2
作者：
GurewitschAllen,EdithD;Will,SusanEBrown;Allen,RobertH;Satin,AndrewJ
通讯作者：
Satin,AndrewJ

Management of shoulder dystocia.

肩难产的治疗。

DOI：
10.1016/s0140-6736(05)74807-8
发表时间：
2005
期刊：
Lancet (London, England)
影响因子：
0
作者：
Gurewitsch,EdithD;Allen,RobertH
通讯作者：
Allen,RobertH

A biofidelic birthing simulator. Models for research and training in complicated human births.

逼真的分娩模拟器。

DOI：
10.1109/memb.2005.1549728
发表时间：
2005
期刊：
IEEE engineering in medicine and biology magazine : the quarterly magazine of the Engineering in Medicine & Biology Society
影响因子：
0
作者：
Kim,EstherJ;Theprungsirikul,Parnduangjai;McDonald,MaryK;Gurewitsch,EdithD;Allen,RobertH
通讯作者：
Allen,RobertH

Simulating complicated human birth for research and training.

模拟复杂的人类出生以进行研究和培训。