Medical Mistakes
Lawsuits: Erb's Palsy Shoulder Nerve Damage Caused by Pediatric Medical Mistakes
When medical mistakes result in erb's palsy shoulder nerve damage, consider our lawyers to evaluate whether your child’s stuck shoulder during childbirth could have been prevented.
This page focuses on a medical article about stuck shoulder during childbirth and what can be done for the resulting nerve damage.
Shoulder dystocia or stuck should is defined as the inability to deliver the fetal shoulders after delivery of the head, without the aid of specific maneuvers. If the baby's shoulders have not yet entered the pelvis, they can easily become entrapped above the pelvic inlet if they are in the antero-posterior diameter.
Turning the mom to hands and knees would encourage the baby's back to roll towards the floor, thus moving the shoulders to the transverse diameter and allowing them to enter the pelvis and then rotate back to the antero-posterior diameter for movement through the pelvic outlet. The all-fours maneuver appears to be a rapid, safe, and effective technique for reducing shoulder dystocia in laboring women.
The all fours maneuver has been known to cause uproar when suggested to doctors and midwives.
In a John Hopkins study, of 78 cases, 39 babies had permanent brachial plexus injury but in 82 cases primarily treated with the Gaskin maneuver (putting the mom on all fours), zero infants had a brachial plexus injury, one infant had a broken arm, and three infants had low 1-minute Apgar (activity, pulse, grimace, appearance, and respiration) score.
Shoulder dystocia is one of the most anxiety-provoking emergencies encountered by obstetricians and midwives. Although many factors have been associated with shoulder dystocia, most cases occur with no warning.
Calm and effective management is possible by instituting specified maneuvers, such as the McRoberts maneuver (using X-ray pelvimetry), suprapubic (lower abdominal) pressure, internal rotation of the head within the pelvic floor, or removal of the posterior arm, to relieve the impacted shoulder and allow for spontaneous delivery of the infant. In rare cases in which these interventions are unsuccessful, additional management options, such as intentional clavicle fracture, symphysiotomy (vacuum extraction), and the Zavanelli maneuver may be prescribed.
The Zavanelli maneuver which is also the most dangerous involves pushing the baby's head back inside the vagina and doing a cesarean. A delivery requiring the Zavanelli maneuver can be difficult to perform and may be worsened by insufficient personnel and inexact reversal of all the cardinal movements of labor.
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Complications resulting from shoulder dystocia during delivery can affect the mother and infant. Postpartum hemorrhage and fourth-degree lacerations are the most common maternal complications. Their incidence remains unchanged by rotation maneuvers or other manipulation. Among the most common fetal complications are brachial plexus palsies, occurring in 4 to 15 percent of infants. These rates remain constant, independent of doctor or midwife experience. Nearly all palsies resolve within six to 12 months, with fewer than 10 percent resulting in permanent injury.
Anapol Schwartz can help you. A pediatric medical mistake is heart-wrenching. Contact us for a free consultation so we may learn the facts about your complications from shoulder dystocia
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