Shoulder Dystocia
Shoulder dystocia is a well
documented complication of childbirth. It occurs when a baby’s anterior
shoulder becomes stuck behind the mother’s pubic bone following delivery of the
head. If the treating obstetrician or midwife is unable to free the baby’s shoulder
within a few minutes the infant will suffer irreversible brain damage or
death. Prompt and effective action
through the use of various manoeuvres and procedures is therefore essential.
Brachial Plexus Injury
The brachial plexus is a network of nerves, arising
from the spinal cord that supplies the hand, arm, and part of the shoulder with
movement and feeling. It consists of the nerve roots of spinal
cord segments C5, C6, C7, C8 and T1.
Brachial plexus injury is one of
the fetal complications which can arise in cases of shoulder dystocia. Injury
can occur when the baby’s brachial plexus, is temporarily, or
permanently damaged.
One cause of brachial plexus
injury is believed to be the stretching of the nerves in the baby’s neck during
the manoeuvres used to release the baby’s shoulder. Some schools of thought
argue that brachial plexus injury results solely or primarily from excessive
traction by the healthcare professional whilst others suggest that maternal propulsive force can contribute to
the injury.
Fortunately fewer than 10% of
incidents of brachial plexus injury result in a permanent neurological
dysfunction.
Brachial plexus injuries are not
always associated with injuries to the spinal cord, however, in particularly
severe cases, such as avulsion, when the nerve is pulled out from the spinal
cord, people can suffer from paralysis of the muscles in the shoulder and upper
limb.
The two main types of brachial
plexus injury are: Erbs Palsy and Klumpke palsy.
Erbs palsy is the more commonly
occurring injury and involves the upper trunk of the brachial plexus, nerve
roots C5 through to C7. Injuries in cases of Erbs Palsy are variable but
generally affect the shoulder, upper arm and chest wall as well as the thumb,
index and middle fingers of the hand.
Klumpke palsy is less common and
involves injuries to the lower nerve roots, C7, C8 and T1, which tend to affect
elbow, forearm, wrist and hand function.
In some injuries, nerve fibres
transversing T1 may be damaged leading to Horner’s syndrome, a condition with
symptoms which include drooping of the mouth and eyelid.
These conditions can cause
complex, life altering injuries, often involving impaired arm and hand function,
which in many ways are comparable to the injuries sustained by people with incomplete
spinal injuries.
Mismanagement of Shoulder Dystocia
The management of shoulder
dystocia is an area fraught with difficulty and characterised by a need for
quick thinking and appropriate action. Healthcare professionals are faced with
unenviable time pressures to release the baby, whilst at the same time, they
will be conscious of the importance of trying to preserve the integrity of the
brachial plexus. In some circumstances, negligent mismanagement of this
stressful situation will be responsible for a brachial plexus injury.
Claudia Hillemand is a solicitor at Bolt Burdon Kemp and specialises in
clinical negligence claims. Claudia has years of experience of acting for
seriously injured clients.
If you or a loved one are concerned about treatment you have received
contact us free of charge and in confidence on 020 7288 4800 for specialist
legal advice.
Solicitor
DDI +4420 7288 4843
Mobile: +447881 312496
Bolt Burdon Kemp
Providence House, Providence Place, Islington, London N1 0NT
www.boltburdonkemp.co.uk
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