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Shoulder Dystocia: Is Your OB Ready for this Medical Emergency?

Posted By Regan Zambri & Long || 12-Oct-2007

Was your obstetrician prepared for this potential emergency?  Some Hospitals are now requiring that obstetricians practice for this type of emergency on a regular basis, just like they practice CPR or Advanced Life Support techniques so that they are well prepared should they encounter this situation.   If a shoulder dystocia is not handled properly it could result in permanent damage to your child’s brachial plexus muscles and this could mean the child will have limited or no use of the arm.  In many situations, this tragic outcome can be avoided by identification of mothers who are at high risk for this situation and by making sure that hospitals require obstetricians to regularly practice the accepted maneuvers.

Shoulder dystocia is when the baby’s shoulder gets trapped in the pelvis and the baby cannot move down the birth canal safety.  If the doctor pulls too hard it can cause permanent injury to the child and is often called Erbs Palsy or a brachial plexus condition.  Shoulder dystocia occurs between 5-19% in cases where the baby weighs more than 8.5 pounds.  Also, women with diabetes have a greater risk of having this condition.

Calm and effective management of this emergency is critical for the baby.   The key is that the physician must be trained and ready to employ specific proven maneuvers in order to allow the baby’s shoulder to be delivered without injury to the child’s brachial plexus.   Prompt recognition of the condition followed by institution of specified maneuvers, such as the McRoberts maneuver, suprapubic pressure, internal rotation, or removal of the posterior arm  relieve the impacted shoulder and allow for safe delivery of the baby.

The "HELPERR" mnemonic from the Advanced Life Support in Obstetrics course can be a useful tool for addressing this emergency. All maneuvers in the HELPERR mnemonic aid physicians in completing one of three actions: enlarging the maternal pelvis through cephalad rotation of the symphysis and flattening of the sacrum; collapsing the fetal shoulder width; or altering the orientation of the longitudinal axis of the fetus to the plane of the obstruction.

If you believe your infant suffered erbs palsy or a brachial plexus injury due to management during child birth, you can contact us for additional information about your rights.  Please click here or call Regan Zambri & Long, PLLC at 202-759-6699.

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