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Better Training Yields Fewer Brachial Plexus Injuries

baby incubatorShoulder dystocia is generally considered an obstetric emergency, and must be handled promptly and effectively to prevent undue harm to the baby. As the name implies, this complication occurs when the baby’s shoulders become trapped in the birth canal under the pubic bone at the time of delivery. Every year, thousands of infants suffer brachial plexus injuries as doctors attempt to dislodge or disimpact the fetal shoulders using incorrect maneuvers.

In worst case scenarios, severe injury to the brachial plexus nerves can render the affected arms and hands partially or entirely paralyzed.

In an attempt to prevent unnecessary brachial plexus injury, U.K. researchers began introducing a special obstetric emergencies training program, and followed the outcomes of births complicated by shoulder dystocia over a period of 12 years. The study took place in the U.K.’s Southmead Hospital in Bristol.

Training for emergencies yields fewer brachial plexus injuries

The study authors evaluated the effects of a mandatory annual training on management of shoulder dystocia across 1,148 pregnancies and births.  Researchers looked at incidence of brachial plexus injury, fractured clavicles or humeri and Apgar scores at 5 minutes.

The results of the study showed that after 9-12 years of implementing yearly OB emergency training, the number of shoulder dystocia cases in which no suggested maneuvers were performed decreased from 53.7% to 0.2%. In addition, the use of excessive traction also declined as did rates of brachial plexus injury, which dropped from 1.51 to 0.41 per 1,000 births.

Though shoulder dystocia cannot always be accurately predicted, there are some risk factors that indicate a higher likelihood.

Risk factors for shoulder dystocia include:

  • High birth weight
  • Maternal obesity
  • Gestational diabetes
  • Prolonged gestation

One of the most widely used methods to address shoulder dystocia is the McRobert’s maneuver, which hyperflexes the mother’s hips and legs toward her stomach in attempt to dislodge the baby’s shoulders. Studies suggest that this method is only successful in less than 50 percent of cases. Other procedures include the Rubin’s and the Wood’s Screw maneuvers.  Since shoulder dystocia often happens unexpectedly, OBGYN and delivery room personnel must be aptly trained and ready to respond with correct maneuvers.

However, in experienced or negligent hands, shoulder dystocia can result in either maternal or fetal injury, giving rise to a medical malpractice lawsuit.

Shoulder dystocia and traumatic birth

Births complicated by shoulder dystocia have long been associated with fetal injuries, with an estimated 20 percent of infants incurring some sort of temporary or permanent damage. Besides harm to the brachial plexus nerves, the most common injuries include contusions, fractured clavicles, fractured humeri and asphyxia (oxygen loss).

Birth asphyxia, especially when sustained over several minutes, frequently leads to fetal brain damage and a later diagnosis of cerebral palsy. Though there are many causes of cerebral palsy, including abnormal brain development in utero and maternal infection, some unfortunate instances may be traced back to doctor negligence and malpractice. In unfortunate cases like these, parents and their children may be entitled to significant compensation through the courts, if attending health care professionals have been found to deviate from accepted standards of care.

  1., Improved shoulder dystocia management and outcomes after training,

  2., Causes of Cerebral Palsy

  3., Fetal injuries following shoulder dystocia,