Risk Factors: Plexus Birth Injury

Brachial Plexus Injury From Shoulder Dystocia

This article describes what risk factors contribute to traumatic birth injuries to the brachial plexus nerves from shoulder dystocia during birth and other causes.

In recent times, there have been increasing instances of babies suffering from brachial plexus injury during birth. Although most such birth injuries get corrected with time, some may be permanent and can leave your child with a disability for life.

A brachial plexus injury is usually a consequence of a birthing emergency known as shoulder dystocia, where the baby’s shoulders get stuck behind the mother’s pelvis and cannot be delivered without intervention. In trying various maneuvers to resolve the shoulder dystocia so as to deliver the baby, the brachial plexus nerves of the fetus can get stretched and damaged.

Depending on the severity of such damage, different types of brachial plexus injuries such as Erb’s palsy, Klumpke’s palsy, and bracial palsy can occur. All the sensations in the baby’s arm; starting from the shoulder, to the arm, to the wrist and the hand, are controlled by the brachial plexus nerves. Thus, a brachial plexus injury can affect the movement of the arm and may even result in permanent paralysis of the entire arm.

All brachial plexus injuries are not necessarily seen after a shoulder dystocia. Many such injuries can occur even if no shoulder dystocia occurred while delivery. However, since a majority of these injuries do arise from shoulder dystocia; here’s a look at some risk factors that will help you to determine whether or not brachial plexus injury will occur from shoulder dystocia.

Prior births with shoulder dystocia: If there is a history of shoulder dystocia during one or more previous deliveries, then there are higher chances of shoulder dystocia during subsequent deliveries. This does increase the risk of brachial plexus injury to the fetus, even if previous dystocias were resolved successfully without injury.

Prior difficult deliveries: If a woman has had difficult vaginal deliveries in the past, which have ended up with a cesarean delivery, then there are chances that a shoulder dystocia did occur but was not diagnosed properly. In such cases too there is an increased risk of shoulder dystocia and birth injuries. However, since most deliveries after one c-section are also cesareans, the risk of brachial plexus injury is reduced greatly.

Prior births with macrosomic fetus: If there is a history of delivering macrosomic babies (large babies with fetal weight greater than 4500 grams), then the risk of shoulder dystocia and brachial plexus injury is increased significantly. And since majority of brachial plexus injuries are seen with macrosomic fetuses, it is advisable to consult your gynecologist about this increased risk if you are carrying another large baby.

Induction of labor: If labor needs to be induced, different types of labor inducing drugs are used to hasten the labor. Medical studies have shown that such drugs are associated with a higher risk of shoulder dystocia during birth. One theory is that when labor is induced, the fetus does not descend naturally into the birthing canal but does so in an awkward position, which results in shoulder dystocia. And since induction of labor increases the risk of shoulder dystocia, the baby’s risk for brachial plexus injury is also increased.

Prolonged second stage of labor: When the second stage of labor does not progress in a timely fashion but is prolonged, the chances of brachial plexus injury may increase. This is because forceps and vacuum extractors may be used to hasten the second stage of labor. The use of such tools, especially for more than 20 minutes, has shown to increase risk of shoulder dystocia, which in turn increases risk of brachial plexus injury to the fetus.

Increased glucose in urine: If there is an increased content of glucose in the urine of a pregnant woman, this could be sign that the woman has developed gestational diabetes. If such is indeed the case, then the risk for brachial plexus injury is heightened because shoulder dystocia risk is increased.All the above are simply risk factors that may increase chances of brachial plexus injury from shoulder dystocia. But, many cases of erb’s palsy and brachial palsy are seen in babies that did not exhibit any of these risk factors. Thus, all in all, it is very difficult to predict whether a shoulder dystocia will definitely result in a brachial plexus injury or not.

However, since majority of such injuries occur predominantly after a shoulder dystocia, it is best to concentrate on recognizing and minimizing the risk factors for shoulder dystocia. Some of these risk factors are:

• Maternal age
• Maternal obesity
• Diabetes
• Macrosomic fetus
• Post term pregnancy

Thus, if your doctor has studied your complete medical and birthing history, predicting a shoulder dystocia is indeed possible. Once predicted, it is possible to prevent a shoulder dystocia by opting for a cesarean, which also lowers the risk of brachial plexus injury considerably.If you have any concerns regarding shoulder dystocia and brachial plexus injury, make sure you discuss your concerns with your doctor.

If you have reason to believe that your doctor did not take your concerns seriously and if any type of brachial plexus injury was a direct result of a medical mistake, you should get in touch with an Erb’s palsy lawyer to know if you have valid grounds for an Erb’s palsy lawsuit and about compensation due to you.