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Summary In utero causation is a manufactured theory based on speculation that contradicts known anatomic and physiologic principles. Brachial plexus injury (BPI) is a very-low-velocity and very-low-impact injury. Adult BPI is a high-velocity and high-impact injury. Labor forces are compressive and expulsive, not traction or stretching. “Using a statistical model it is possible to identify...
Summary Prior shoulder dystocia is the strongest risk factor for a recurrent shoulder dystocia. Prior macrosomia, abnormal labor, and operative delivery dramatically increase the injury rate in subsequent pregnancies. Early induction of labor or cesarean section is indicated unless the infant is significantly smaller. Prediction of future outcomes is not a realistic endeavor in modern-day obstetric...
Summary This chapter contradicts the claim that more than half of all brachial plexus injuries are associated with uncomplicated deliveries. Infants are injured much more frequently with macrosomia and operative delivery. Twenty-five percent of infants suffer injury, and 5% to 22% become permanent. Shoulder dystocia was recorded in 97% of 135 cases.
Summary Using a classification for shoulder dystocia provides insight into a greater understanding of the mechanisms of injury. Failure of restitution is an ominous finding. Traction on the head injures the brachial plexus. Contractions are compressive and expulsive force, not stretching.
Summary The rate of injury can be reduced. Prediction of the complication is not the solution. Prevention does not require prediction. The foundations of the science of medicine were laid down by Hippocrates not Nostradamus!
Summary Brachial plexus traction injury can occur at the time of cesarean section delivery. This results from the operator’s failure to recognize soft tissue incisional dystocia. Avoiding traction on the infant’s head and enlarging the incision in the uterus and/or abdominal wall will prevent infant and maternal injury.
Summary The intrapartum management of the fetus with known or suspected macrosomia presents a considerable challenge to the clinician. Risks and complications are reviewed, and management is discussed.
Summary Midwives and physicians face similar challenges. Preparedness is the key to success. Midwives often practice strategies unfamiliar to physicians. The Gaskin and somersault maneuvers are two examples.
Summary The objective of this chapter is to describe and discuss the radiographic, intraoperative, and histologic findings that are present after brachial plexus birth injury. This review is based on the authors’ clinical and operative experiences and a survey of the peer-reviewed literature. Together our findings provide evidence that in the vast majority of cases of brachial plexus birth palsy are...
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