American journal of perinatology
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High peak inspiratory pressure (PIP) and tidal volume (V(T)) from manual ventilation are hazardous to the neonatal lung. We investigated the influence of operator training on the extent of applied PIP and V(T) between two manual ventilation devices. We performed a prospective, crossover study of 84 medical professionals using a neonatal mannequin. ⋯ Twenty-five participants (30%) had previous experience with T-piece devices; this correlated significantly with lower PIP and lower V(T) provision ( P > 0.001 for PIP and V(T)). Operator training level and device-specific experience had a significant impact on PIP and V(T) provision when using SI-bags for manual ventilation. For operators with no specific training in manual ventilation, use of T-piece devices is advised to control for excessive PIP and V(T) application.
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The exact role of the Zavanelli maneuver for the management of shoulder dystocia still remains to be defined. None of the previously reported cases in which the Zavanelli maneuver has been employed described impaction of posterior fetal arm. At 40 weeks' gestation, a nulliparous patient with gestational diabetes, who underwent vacuum delivery, delivered an infant with shoulder dystocia. ⋯ The posterior fetal arm was noted to be persistently impacted, so the Zavanelli maneuver was used to deliver an unsuspected macrosomic (4215 g) infant. The newborn, at the age of 3 years, has a right Erb's palsy. The Zavanelli maneuver can be used to alleviate a posterior arm shoulder dystocia, though there may be concomitant neurological injury.