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Prevention of Erbs Palsy

Shoulder Dystocia

Prevention of brachial plexus injury continues to be the goal of an obstetrician because most cases of Erbs palsy that occur during childbirth are preventable. The problem is identification of whether the injury was preventable. If identifiable risk factors are present then there is a greater possibility that the baby will be born with a brachial plexus injury. Therefore, the key to preventing such an injury is identification and optimal management of risk factors.

Studies show that most brachial plexus injuries are a result of shoulder dystocia during childbirth. This is a known obstetricalemergency and a rapid response by a skilled obstetrician can manage the event successfully. If the childbirth is managed by proper manual maneuvers, then nearly all cases of shoulder dystocia can be resolved with no brachial plexus injury. Although most cases of brachial plexus injury are related to excessive traction during delivery and shoulder dystocia, there are cases of brachial plexus injuries not related to shoulder dystocia that continue to present a challenge.

An elective cesarean delivery might prevent brachial plexus injury, but routine use of cesarean delivery is unwarranted. In one study, 92 percent of patients in the highest risk category, i.e. diabetic women who underwent assisted vaginal delivery and whose infants weighed more than 4,500g at birth did not present with brachial plexus injuries and a cesarean delivery would have been unnecessary.

Strategies for prevention

Some basic strategies for preventing Erbs Palsy include induction of labor; assigning qualified personnel to the delivery room; offering cesarean section if there are multiple identified risk factors; proper use of instruments like forceps; proper use of vacuum extractors; management of diabetes during pregnancy; and managing maternal weight during pregnancy.

Other strategies and insights include:

Cesarean delivery is an alternative to normal vaginal delivery in high-risk cases because the fetus is allowed to bypass the mothers pelvis and is protected from the excessive force of labor that may cause brachial plexus injury. Some studies have shown a reduction of brachial plexus injuries by cesarean delivery.

Birth weight of the infant is a high-risk factor for brachial plexus injury and can be managed by tight control of blood sugar in patients who have complications due to diabetes mellitus during pregnancy.

Extreme caution should be taken during breech deliveries, especially in the case of premature babies who are at a higher risk of sustaining brachial plexus injuries or erbs palsy.

Although shoulder dystocia cannot be anticipated with certainty but is a possibility based on risk factors, then preparatory tasks can be accomplished prior to delivery. The key personnel can be alerted about the risk factors, the patient and family can be educated about the steps necessary in the event of a difficult delivery.

Preliminary intervention for shoulder dystocia in a patient with known risk factors involves implementing the head and shoulder maneuver to deliver through until the anterior shoulder becomes visible. This can be achieved by continuing the momentum of the fetal head delivery until the shoulder comes in view. Once controlled delivery of the head is achieved, the obstetrician proceeds with immediate delivery of the anterior shoulder.

 

Erb's Palsy Infographic: An Overview and Prevention Guide

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