1 |
Revision |
86 |
Medicolegal |
The large number of OP without dystocia does not allow us to state that OP is caused by the obstetrician. |
2 |
Revision |
22 |
Historic |
OP occurs in deliveries without dystocia3636 Zaki MSI, el Sabbagh MH, Aglan MS. Familial congenital brachial palsy: a report of two affected Egyptian families. Genet Couns 2004;15(01):27-36 ; the experience of the surgeon is indifferent to the incidence of OP3737 Mollica F, Li Volti S, Grasso A, De Simone D. Familial congenital brachial palsy. Am J Med Genet 1991;41(03):322-324 ; indirect evidence establishes that maternal driving forces are the most likely cause of Erb's palsy. |
3 |
Revision |
17 |
Shoulder Dystocia |
The most likely cause of paralysis with and without SD is maternal exertion due to expulsive forces at birth. |
4 |
Revision |
86 |
Medicolegal |
A clear cause-effect relationship between SD and brachial plexus injuries does not exist in all cases, although SD is usually associated with obstetric medicolegal opinions. |
5 |
Revision |
121 |
Shoulder Dystocia |
There is a significantly increased risk of SD during birth related to weight, and this increases linearly; prenatal and prelabor care have no statistically significant risk factors for predicting shoulder dystocia; prophylactic cesarean delivery or drug induction of labor in nondiabetic patients due to suspected fetal macrosomia has not been shown to alter the incidence of SD. |
6 |
Revision |
43 |
Cesarean Section |
Cesarean section performed in all women at 39 weeks of gestation would substantially reduce both transient and permanent brachial plexus injury, neonatal encephalopathy, intrapartum and intrauterine death. |
7 |
Revision |
74 |
Prevention |
Fetal manipulation seems to be the best method for atraumatic resolution of complicated vaginal delivery, because it requires less traction to complete it. |
8 |
Revision |
69 |
Etiopathogenesis |
Doctors need to be trained to slow and calibrate traction, because the natural tendency is to increase it when faced with a difficult delivery. Axial traction should be used, but lateral head flexion should be limited. |
9 |
Revision |
27 |
Prevention |
SD is not predictable; perinatal nurses are useful in the prenatal period to avoid excessive weight gain and assist in glycemic control and during childbirth as a timekeeper once SD is diagnosed. |
10 |
Revision |
99 |
Etiopathogenesis |
Most children with brachial plexus injuries do not have known risk factors; endogenous forces are 4- to 9-fold greater than those applied by the obstetrician during SD, according to mathematical models. |
11 |
Revision |
95 |
Shoulder Dystocia |
Pregnant women with previous cesarean section, what is the best delivery option? There are no randomized studies available that directly relate to the choice of delivery method. |
12 |
Revision |
51 |
Prevention |
SD is a risk factor for brachial plexus injury (increases by 100x the risk of OP) but is unpredictable; a significant proportion of plexus injury is secondary to injuries in the uterus. |
13 |
Revision |
44 |
Shoulder Dystocia |
Maternal, fetal and childbirth RFs have low predictive value; SD most commonly occurs in patients without identified RFs. |
14 |
Revision |
46 |
Shoulder Dystocia |
Neonatal brachial plexus paralysis can result in lifelong permanent deficits and remains common despite advances in obstetric care. The long-term results of current treatment recommendations remain unknown. |
15 |
Revision |
28 |
Shoulder Dystocia |
Some maneuvers and algorithms can be used to manage shoulder dystocia. From studies among women whose delivery is complicated by SD, there is considerable scientific evidence that the all-fours maneuver is effective for releasing the fetal shoulders. |
16 |
Revision |
80 |
Shoulder Dystocia |
Epidemiological knowledge of the incidence, prevalence and temporal changes of NBPP should assist the clinician, avoid unnecessary interventions, and help formulate evidence-based health policies. The extremely infrequent nature of permanent NBPP requires a multicenter study to improve our understanding of antecedent factors and reduce long-term sequelae. |
17 |
Revision |
26 |
Shoulder Dystocia |
Historical risk factors for neonatal brachial plexus paralysis (NBPP), whether studied alone or in combination, have not been shown as reliable predictors. Most NBPP cases occur in women with children < 4,500g who are not diabetic and have no other identifiable RFs. In addition, caesarean section reduces but does not eliminate the risk of NBPP. |
18 |
Revision |
23 |
Shoulder Dystocia |
Regarding the prevention of shoulder dystocia complications, hands-on training using dummies is associated with more improvements in SD administration than training using the video tutorial. Simulation teaching for the treatment of shoulder dystocia is encouraged for the initial and ongoing training of the various actors in the birth room (professional arrangement). |
19 |
Revision |
55 |
Prevention |
To avoid SD and its complications, two measures are proposed. Induction of labor is recommended in case of imminent macrosomia, if the cervix is favorable and gestational age > 39 weeks (professional consensus). Cesarean section administration is recommended before labor in case of (I) fetus > 4,500 g if associated with maternal diabetes, (II) fetus > 5,000 g in the absence of maternal diabetes and, (III) during labor in case of fetal macrosomia and failure to progress in the second stage, when the fetal head is above a +2 position. Caesarean section should be discussed when history of shoulder dystocia has been associated with severe neonatal or maternal complications (professional consensus). |
20 |
Revision |
94 |
Shoulder Dystocia |
SD can be prevented by performing preventive caesarean section in high-risk cases, but our ability to identify such cases is still limited. Rapid diagnosis and management of SD when it occurs is key to preventing permanent neurological sequelae. Management requires the coordinated efforts of a team with the necessary skills. The team leader must direct management and institute a series of maneuvers to release the fetus with minimal risk to him and the mother. A complete understanding of the relevant pelvic and fetal anatomy is needed, as well as the mechanisms by which dystocia can be resolved. |
21 |
Revision |
11 |
Shoulder Dystocia |
No study has proven that correcting risk factors (except gestational diabetes) would reduce the risk of SD. Physical activity is recommended before and during pregnancy to reduce some RFs. The implementation of practical training simulation for all care providers in the delivery room is associated with a significant reduction in neonatal injury, but not in the maternal. SD remains an unpredictable obstetric emergency. All doctors and midwives should know and perform obstetric maneuvers, if necessary, quickly but calmly. |