Shoulder Dystocia, Erb's Palsy and Brachial Plexus Injuries; Fetal Complications
Powers & Santola · Albany and Syracuse Birth Injury Malpractice Attorneys
"Dystocia" is a word which means "abnormal labor." Shoulder dystocia is an abnormal labor which occurs when spontaneous delivery of the fetus suddenly stops because the baby is too big to fit through the birth canal and his or her shoulder gets wedged behind the mother's pubic bone.
The risk that shoulder dystocia will occur during delivery is increased if:
- The mother has previously delivered a large infant (over 8 pounds and 13 ounces) or has experienced shoulder dystocia during prior deliveries;
- The mother has maternal diabetes;
- The gestational age of the fetus is more than 41 weeks;
- The estimated fetal weight is greater than 8 pounds and 13 ounces (this condition is known as "macrosomia").
All patients who are at risk for "macrosomia" should be scanned with an ultrasound during the third trimester of their pregnancy to better estimate fetal weight. The estimate of fetal weight based upon the ultrasound can then be used to approximate the estimated fetal weight at delivery. This is done by adding 1.06 ounces per day from the day that the ultrasound scan was performed to the date of delivery.
Based upon the estimated fetal weight at delivery (using both clinical findings and ultrasound evaluation) and knowledge of maternal diabetes, it is generally recommended that a Caesarean delivery be performed if the mother is not diabetic and the estimated fetal weight at delivery is more than 8 pounds and 13 ounces or if the mother is diabetic and the estimated fetal weight at delivery is greater than 9 pounds and 15 ounces.
Proper management of shoulder dystocia is essential to prevent complications that can lead to brain damage, Erb's palsy, or death.
When shoulder dystocia occurs, the infant's head often has been delivered when the shoulder gets stuck. Because the umbilical artery pH falls at a rate of 0.04 per minute following delivery of the head, acute total asphyxia of the baby can result, with consequential permanent brain damage, if the delivery cannot be completed within a short period of time after delivery of the head.
Fetal Complications - Brachial Plexus Injuries
The nerves that emerge from the cervical spinal cord and that enervate the arm can be stretched by excessive downward traction on the baby's head (i.e. pulling on the baby's head) as the baby is being delivered. This is known as an injury to the brachial plexus of the baby and can result in an arm that is permanently paralyzed. The specific nature of the injury is dependant upon which nerve roots are damaged.
Erb's palsy, for example, results from an injury to the nerve roots at C5-6 (that is, the nerve roots that are located at the 5th or 6th cervical vertebrae) of the baby's neck. This injury leads to paralysis of the deltoid, supraspinatus, infraspinatus, biceps and brachioradialis muscles. As a result, the Moro (or startle) reflex and the biceps reflex (that is, the contraction of the biceps muscle when the tendon is struck) are reduced or abolished. Approximately one-third of these injuries become permanent.
The "phrenic nerve," which arises from nerve roots C3, C4 and C5, innervates the diaphragm, enabling breathing. If the phrenic nerve is damaged, the resulting injury is known as hemidiaphragm paralysis. A paralyzed diaphragm results in breathing difficulty, asymmetric chest movement during breathing and frequent lung infections.
An injury at the level of C8, T1 (8th cervical vertebrae and 1st thoracic vertebrae) can result in "Klumpke's paralysis," which is a weakness of intrinsic muscles of the hand leading to the absence of the ability to grasp objects with the effected hand.
Approximately sixty percent of these injuries become permanent.
Fetal Complications - Skeletal Injury
The clavicle (collarbone) is the most frequently damaged bone during birth and may be fractured in about fifteen percent of cases of shoulder dystocia. In addition, the baby may suffer from a broken arm or a dislocated shoulder during the delivery process. These injuries are customarily diagnosed with a simple x-ray. In many cases when such skeletal injuries occur, a brachial plexus injury also occurs.
Injury to patients at risk for shoulder dystocia can be avoided by prophylactic cesarean surgery. Brachial plexus injury or Erb's Palsy can also be avoided by using several different obstetrical maneuvers to disengage the anterior fetal shoulder before continuing with a vaginal delivery.
Contact Powers & Santola if your child suffered lasting injury or died as a result of fetal complications. Our lawyers offer sound legal advice and honest answers in a free consultation.
