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    Neonatal brachial plexus palsy: Is prevention possible?

     

    Dr. Lockwood, Editor-in-Chief, is Dean of the Morsani College of Medicine and Senior Vice President of USF Health, University of South Florida, Tampa. He can be reached at [email protected]

     

    My very first delivery as an ob/gyn intern was complicated by a severe shoulder dystocia. Fortunately for me, my attending was highly experienced. He methodically employed recently popularized maneuvers such as McRoberts and Wood’s before attempting to deliver the posterior arm—all to no avail. As my pulse quickened, he ultimately intentionally fractured the clavicle to effect delivery. Much to my surprise, there was no evidence of a neonatal brachial plexus palsy (NBPP).

    In the thousands of deliveries that I have either performed or supervised since, while I have had some tough shoulder dystocia cases and a couple of transient NBPP episodes, I have miraculously been spared a case of persistent NBPP and the attendant lawsuit it would likely entail. My good fortune notwithstanding, I retain a healthy degree of post-traumatic stress at the thought of a shoulder dystocia and a nearly pathological fear of NBPP—and I suspect I am not alone.

    While it is unlikely that the new American College of Obstetricians and Gynecologists (ACOG) NBPP task force report will eliminate this fear, the report is packed with useful information on the pathophysiology of the injury and certainly reinforces the argument that most cases of NBPP can be neither anticipated nor prevented, the claims of plaintiff attorney TV ads notwithstanding.1

     

    Charles J. Lockwood, MD, MHCM
    Dr. Lockwood, Editor-in-Chief, is Dean of the Morsani College of Medicine and Senior Vice President of USF Health, University of South ...

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    • Dr. kenny stall
      How will the 39 week rule play on the incidence of shoulder dystocia? With a patient who had experienced 2 prior shoulder dystocias (both with fractured clavicles), the hospital would not allow induction at a smaller weight (38w4d) using the argument that shoulder dystocia is not predictable and not an accepted ACOG reason for early delivery. MFM judged the patient to be at risk and therefore to comply with hospital requirements recommended performing a cesarean at 39 weeks anticipating the child to be growing at a similar rate as her previous pregnacies. The patient did not want surgery. But the hospital held to the premis that the desire of the mother has no imput in the direction of care the woman was to receive in today's medical insurance protocols.

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