000			01735cam a2200193 4500
001			NMDX7128
008			120401t2009 xxu||||| |||| 00| 0 eng d
100			_aSteel, A.
240			_aJournal of Obstetrics and Gynaecology
245			_aManagement of complicated second stage of labour in stillbirths: a review of the literature and lessons learnt from two cases in the UK
260			_c2009
500			_aNMUH Staff Publications
500			_a29
520			_a<span style="font-size: 10pt;">The stillbirth rate for singletons in the UK is approximately 5.3/1,000 births/year. Macrosomic babies are associated with obstructed labour and shoulder dystocia. Some 3.3% of stillborns weigh over 4 kg, when such problems are likely to be encountered. In developed countries, caesarean section is regarded as being more civilised than destructive operations for obstructed labour prior to full cervical dilatation in an interuterine death. However, when the cervix is fully dilated or severe shoulder dystocia is encountered, fetal destructive operations have half the maternal mortality rate of that associated with caesarean section, with fewer long-term sequelae. A significant obstacle in performing destructive operations in developed countries is the lack of skilled practitioners. It is difficult to acquire these skills in the UK, however simulated training can be provided with manikins. We feel mothers should be informed of the alternative of a destructive operation, potentially avoiding unnecessary caesarean section.</span>
700			_aFakokunde, A.
700			_aYoong, W.
856			_uhttps://www.ncbi.nlm.nih.gov/pubmed/19697190
856			_uhttp://www.tandfonline.com/doi/full/10.1080/01443610902980860
999			_c76124 _d76124