Deviation in the Standard of Obstetrical Care During Labor & Delivery for Failure to Recognize Shoulder Dystocia Resulting in Erb's Palsy

Evaluate breaches in the standard of care when determining whether or not there has been a Deviation in the Standard of Obstetrical Care During Labor & Delivery for Failure to Recognize Shoulder Dystocia Resulting in Erb's Palsy

Answer the following questions to find out if the standard of care was followed for your case.

  • Did the clinician elicit and document a thorough medical history?

    Yes
    No
    Answer unknown

    Why is this important?
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests. The deep understanding of the patient that can be obtained only through the immediacy of the history and physical examination also plays a pivotal role in treatment decisions that must be addressed at various points throughout the pregnancy.
    Click here for additional information at ClinicalKey.com


  • Did the clinician elicit a positive history of shoulder dystocia in a prior pregnancy?
    Why is this important?
    Answer this question
    A clinician who treats an obstetric patient for the first time needs to specifically attempt to elicit a history of shoulder dystocia in a prior pregnancy.
    (2007) 31 ESMPER 3 185-195

  • Was an ultrasound performed to assess fetal weight during labor? Why is this important?
    Answer this question
    The primary fetal factor for shoulder dystocia is macrosomia, defined as weight greater than 4500 g by the American college of obstetricians and gynecologists. There are multiple formulas that try to predict fetal weight based on ultrasonography during the third trimester.
    (2012) 39 EPCCOP 1 135-144

  • Was the estimated fetal weight documented by the clinician? Why is this important?
    Answer this question
    It is necessary that the estimated fetal weight be measured and documented as it can help both the patient and provider be prepared for maneuvers that may be needed at the time of delivery.
    (2012) 39 EPCCOP 1 135-144

  • Did the clinician perform interventions to manage shoulder dystocia? Why is this important?
    Answer this question
    Because shoulder dystocia cannot be predicted, it must be anticipated in every delivery, particularly in patients with one or more risk factors. It is important to recognize shoulder dystocia when it occurs-this is often described as the turtle sign, whereby the head delivers but does not undergo external rotation and the neonatal cheeks and chin recoil tightly against the perineum.
    (2012) 39 EPCCOP 1 135-144

  • Did the clinician call for additional support from specialists? Why is this important?
    Answer this question
    Once priorities and goals have been agreed upon, referral to the appropriate professionals must be made in a timely manner. To deliver care requires a coordinated approach that allows sharing of skills and expertise. The skills of members from all professional disciplines must be utilized to enable all patients to achieve their maximum potential. Click here for additional information at ClinicalKey.com

  • Which of the following did the baby experience? (Choose all that apply) Why is this important?
    Answer this question
    Obstetrical brachial plexus injury is generally considered to be caused by excessive traction applied to nerves. This injury may result from shoulder dystocia, use of excessive or misdirected traction, or hyperextension of the arms in breech extraction during the birthing process.
    (2008) 38 EPEDNU 4 235-242

  • Which of the following interventions were taken? (Choose all that apply) Why is this important?
    Answer this question
    There are several maneuvers that may be attempted to reduce a dystocia. In general, there has not been strong evidence that any one maneuver is superior to another in releasing an impacted shoulder or reducing the risk of injury to the fetus. The American Academy of Family Physicians (through ALSO [the Advanced Life Support in Obstetrics program]), the ACOG, and the Royal College of Obstetricians and Gynecologists (RCOG) support following a systematic sequence of maneuvers starting with the simplest and least invasive. The McRobert’s maneuver is a time-honored and proven technique that is ideal for the initial management. It involves the flexion of the maternal thighs onto the abdomen. This maneuver is often performed in addition to applying suprapubic pressure to dislodge the offending shoulder from behind the maternal pubic symphysis.
    (2012) 39 EPCCOP 1 135-144

  • Did the clinician document the time interval between delivery of the infant’s head and its body? Why is this important?
    Answer this question
    The rapid resolution of shoulder dystocia is needed to avoid fetal asphyxia and resultant central nervous system injury. A head-to-body time interval over 6 to 8 minutes is considered critical in the development of these sequelae.
    (2012) 39 EPCCOP 1 135-144

  • Did the clinician document the time spent performing each maneuver? Why is this important?
    Answer this question
    Most interventions are intended to dis-impact the anterior shoulder from behind the symphysis pubis by rotating the fetal trunk or delivering the posterior arm and shoulder. The documentation needs to include the time spent on each maneuver.
    (2012) 39 EPCCOP 1 135-144

  • Did the clinician document the presence of all specialists? Why is this important?
    Answer this question
    It is imperative that the documentation be accurate and comprehensive.
    (2012) 39 EPCCOP 1 135-144

  • Did the clinician obtain and document umbilical cord gases (arterial and venous)? Why is this important?
    Answer this question
    Umbilical cord gases (arterial and venous) need to be obtained at birth in all shoulder dystocia cases, even if the infant does not appear to be depressed.
    (2012) 39 EPCCOP 1 135-144

  • Did the clinician document the condition of the infant after delivery? Why is this important?
    Answer this question
    It is imperative that documentation be accurate and comprehensive.
    (2012) 39 EPCCOP 1 135-144

  • Did the infant show signs of brachial plexus injury? Why is this important?
    Answer this question
    Obstetrical brachial plexus palsy is defined as a flaccid paresis of an upper extremity due to traumatic stretching of the brachial plexus received at birth, with the passive range of motion greater than the active.
    (2008) 38 EPEDNU 4 235-242

  • Did the clinician counsel the patient regarding the risk of shoulder dystocia in future pregnancies? Why is this important?
    Answer this question
    Because there are so many unknowns about exact pathogeneses, risk factors, prognostic indicators, and future management plans, it is critically important to educate the woman whose delivery was complicated by shoulder dystocia, and to ensure her understanding that it is a significant issue as far as future childbearing is concerned.
    (2007) 31 ESMPER 3 185-195

  • Which of the following were advised by the clinician? (Choose all that apply) Why is this important?
    Answer this question
    A specific discussion of nutrition and monitored weight gain is warranted, especially if the previous infant was large-for-gestational age.
    (2007) 31 ESMPER 3 185-195

  • Was an x-ray obtained to evaluate the brachial plexus injury? Why is this important?
    Answer this question
    X-rays of the chest, spine, and upper limbs are of utmost importance because they reveal associated injuries, such as, rib, transverse process, clavicle, or humeral fractures. Moreover, a chest X-ray is necessary to rule out phrenic nerve injury.
    (2008) 38 EPEDNU 4 235-242

  • Was the baby referred for physical therapy? Why is this important?
    Answer this question
    No matter the cause, care of the newborn with brachial plexus injury must involve a multidisciplinary approach including pediatrics, pediatric neurology, physical therapy, and possible referral to a brachial plexus injury center. The care plan must be clearly communicated with the parents.
    (2007) 34 EOGCNA 3 501-531

  • Did the clinician follow up on the infant’s condition after discharge from the new born nursery? Why is this important?
    Answer this question
    Routine follow-up evaluations are necessary to offset any complications that may arise. Regular check-ups ensure that changes in health are quickly assessed and remedied. Click here for additional information at ClinicalKey.com