Shoulder Dystocia

Shoulder dystocia is an obstetrical complication that occurs in approximately 30,000 deliveries in the US every year. In this medical emergency, the child’s head is able to clear the cervix, but the shoulders become impacted behind the mother’s pelvis. This impaction may prevent a vaginal delivery. In such cases, the baby’s face will exhibit what is known as a turtle sign, where the head appears to be pulled back tightly against the vulva. This is generally the first sign that there is a problem. The fear is that if the shoulder is not quickly dislodged, the baby is not able to breathe because the vaginal canal is compressing against the baby’s chest. Additional maneuvers are then required to properly deliver the baby.

When this occurs, most physicians initially perform a variety of conservative procedures to free the baby’s shoulders. These procedures are part of the standard of care in deliveries where shoulder dystocia occurs, and may include:

· the McRobert’s maneuver, where the mother’s thighs are hyperflexed to widen the pelvic outlet· Gaskin maneuver where the mother is placed into an all fours position on her hands and knees. This may not be possible in cases involving epidural anesthesia. · Rubin I, where suprapubic pressure is applied to the mother’s pubic bone, to rotate and dislodge the shoulder under the pubis symphysis.· Rubin II, where posterior pressure is placed on the anterior shoulder· Woods maneuver, where the physician inserts a hand to rotate the fetus either way to facilitate delivery· Jacquemier’s (or Barnum’s) maneuver, where the posterior shoulder is delivered up and over the chest, then the shoulder and the rest of the baby, and · Zavanelli’s maneuver, which is the most dangerous and used as a last resort. This involves pushing the baby’s head back into the vagina and performing a caesarean section.

The incidence of shoulder dystocia may lead to more serious injury, and may include:

· fractures of the clavicle (sometimes intentional to clear the cervix)· fractures of the humerus (sometimes intentional to clear the cervix)· temporary or permanent injury involving the brachial plexus nerves (brachial plexus injury or Erb’s Palsy) that attach to the spine in the upper, middle and lower trunk, and run through the shoulder and down to the arms and hands.· hypoxia leading to brain damage or· death

Deliveries with shoulder dystocia occur in both diabetic and non-diabetic mothers. The incidence is greater in diabetic mothers who deliver larger babies. If you are at high risk for delivering a baby with shoulder dystocia, your health care provider should perform an ultrasound to determine if the baby’s size will be a problem. Your physician should also discuss if a large episiotomy will be necessary or if a planned caesarean section will be the best way to safeguard the health of the child. Caesarean sections are not always the practical solution for all cases, but if the birth weight of the infant is high (macrosomia), maternal obesity exists, the mother has gestational diabetes, and/or there is a previous history of shoulder dystocia, then a caesarean section may be indicated.

If your child suffered a brachial plexus injury during delivery, he or she might be entitled to compensation if the physician’s negligence was responsible for the injury. To learn more about shoulder dystocia or other birth injuries, click here.

Article Source: http://EzineArticles.com/?expert=Tara_Pingle

Erb's Palsy Cases - The Defense Rests

In obstetrics negligence cases, a frequent claim is that an obstetrician negligently delivered an infant causing brachial plexus injury or Erb’s Palsy. During a vaginal delivery after the infant’s head delivers, the anterior shoulder can get stuck behind the mother’s pelvic bone. This stuck shoulder syndrome is called shoulder dystocia.

There are numerous maneuvers to free the shoulder; none of these maneuvers involve touching the baby’s head. When an obstetrician applies excessive force to the neck—Erb’s palsy usually occurs.

Counsel may encounter the following defenses:Even if the doctor applied undue force – this was after all – an emergency. Attempts at lateral traction are never acceptable for two reasons. 1--the procedure cannot free the anterior shoulder and 2--lateral traction is the only known cause for Erb’s palsy.

The obstetrician didn’t know the baby weighed 8 pounds 14 oz or more. This is bad practice as there are numerous tools to determine the baby’s fetal weight.

Shoulder dystocia was not predicted because the infant was not about average weight. Should dystocia is still predictable if there’s disproportion between the size of the fetus and size of the pelvis.

Delivery was normal and easy; Erb’s palsy must’ve happened in utero. Excessive lateral traction is the only known cause for Erb’s palsy in a head first vaginal delivery.

The obstetrician applied gentle lateral traction. Once shoulder dystocia happens, no lateral traction should be administered.

By understanding the birth injury mechanisms, counsel can effectively respond to the defense’s contentions and demonstrate that the injury was both predictable and preventable.

Source: Based on an article written by Stephen H. Mackauf for the Association Trial Lawyers of America, Cross-Examination Of An Expert Medical Malpractice Witness In An Erbs Palsy Case, and The Problems With Shoulder Dystocia by Anapol Schwartz Philadelphia Lawyers.

Michael Monheit, Esq. is a "Philadelphia Attorney" licensed to practice in Pennsylvania and New Jersey. A graduate of the University of Pennsylvania Wharton School of Business and Temple University Law School, he is the founder of Pennsylvania Law Firm - Monheit Law and a member of PA and NJ Law Firm - Anapol Schwartz Weiss Cohan Feldman & Smalley. Mr. Monheit's practice areas focus on mass tort pharmaceutical cases and medical malpractice and medical device injuries, including: Fosamax, Zelnorm Lawsuits, Trasylol, Ketek, Erb's Palsy, ReNu, Kugel Mesh, Permax and many others. He can be reached at michael@monheit.com or toll free 866-761-1385 or from the firm's web site at monheit.com.

Article Source: http://EzineArticles.com/?expert=Michael_Monheit