How can Should Dystocia Be Prevented and What Does the ACOG Recommend?

If not handled properly, a shoulder dystocia emergency that occurs during live birth can have serious consequences for the baby. As the head of the baby is already delivered, but the shoulders are stopped by the pelvis of the mother, a strong possibility of the the baby dying form suffocation arises if too much time is allowed to elapse and the shoulder dystocia is not addressed.

In truth, sometimes even if doctors are able to resolve the dystocia using one of the many maneuvers for handling shoulder dystocia, far too frequently brachial plexus injuries are sustained by the baby. Such injuries affect the movement of the arm and hands and may even leave the baby’s arm paralyzed for life. Though some statistics suggest that this occurs in only two to five babies per every 1000 live births, as far as we are concerned that is two to five babies too many. Fortunately, ACOG (American College of Obstetricians and Gynecologists) has recognized the seriousness of this birthing emergency and is taking many steps to ensure that brachial plexus injuries from shoulder dystocia can be reduced. Here’s a look at what ACOG is doing about shoulder dystocia. Training For Doctors For Prevention Of Brachial Plexus Injuries

ACOG has many different training and educational programs for doctors and health care practitioners to help prevent brachial plexus injuries. They routinely conduct clinical seminars on the subject of ‘Managing Shoulder Dystocia’, which help to educate doctors on the following topics:

– Is shoulder dystocia predictable?

– Is shoulder dystocia preventable?

– When the emergency does occur, is it possible to resolve shoulder dystocia without causing any fetal injury or brachial plexus injuries?

– Is excess traction, applied by the doctor, the reason for all brachial plexus injuries?

By taking part in such seminars and completing the training courses, obstetricians and other health care givers are then able to:

– Identify the various risk factors for shoulder dystocia and take measures to prevent it if there is an increased risk of dystocia.

– Resolve shoulder dystocia (if it occurs) in the best possible manner using the various maneuvers for handling dystocia.

– Understand why brachial plexus injuries occur, especially due to the application of excessive traction. With better understanding of these reasons there is higher chance of resolving shoulder dystocia without brachial plexus injuries.

ACOG also has videos on shoulder dystocia that show doctors how to recognize the emergency in the labor room and how they can help reposition mothers so as to widen their birth canal to the maximum and help the baby to be delivered without brachial plexus injuries such as Erb’s palsy.

Therefore, ACOG is doing all in its power to further educate doctors about all aspects of shoulder dystocia, including new ways to predict and prevent its occurrence. But since shoulder dystocia and resultant brachial plexus injuries are very difficult to predict, ACOG training for doctors also aims to teach doctors how best to resolve shoulder dystocia and prevent fetal injuries.

In addition to the above, ACOG seminars also aim to make doctors aware about the many medico-legal aspects regarding shoulder dystocia and brachial plexus injuries. Shoulder dystocia lawsuits are discussed as well as the various claims that can be made against doctors if fetal injuries do occur. Since doctors are made aware of the huge potential for expensive litigation in the form of brachial plexus injury lawsuit, it does make them try that much harder to prevent shoulder dystocia and conditions such as Erb’s palsy.

Information For Parents For Prevention Of Brachial Plexus Injuries

Apart from training doctors and conducting clinical seminars, ACOG is also involved in educating parents about everything related to shoulder dystocia and brachial plexus injuries. By providing relevant information to parents, ACOG is trying to make them more aware of such birthing emergencies and what parents can do to prevent fetal or birth injuries to their babies.

The ACOG regularly releases for parents practice bulletins that contain the most updated should dystocia information. These bulletins contain information that can help mothers to understand whether they may be at an increased risk for shoulder dystocia. If the risk of dystocia and brachial plexus injuries is high, parents are advised as to the best way to reduce such risk and ensure the birth of a healthy baby.

Two main risk factors for shoulder dystocia are maternal diabetes and fetal macrosomia. ACOG has issued practice bulletins on these two topics so that parents can manage gestational diabetes properly and also perhaps opt for a cesarean delivery if the fetus is macrosomic (excessively large). Here are the ACOG guidelines on these two topics:

1. ACOG Guidelines For Fetal Macrosomia: The recommendations are:

– Cesarean delivery is indicated when the weight of the fetus is more than 4500 grams.

– Women who are not diabetic should consider cesarean deliveries if the weight of their fetus is more than 5000 grams. For diabetic women the fetal weight for cesarean consideration is 4500 grams.

2. ACOG Guidelines For Management Of Gestational Diabetes: The recommendations are:

– Mothers should take the laboratory-screening test for gestational diabetes between 24 and 28 weeks of pregnancy.

– If gestational diabetes is present, ask the obstetrician about the best manner in which to manage this condition during pregnancy.

ACOG also recommends that women who have gestational diabetes and whose fetus weighs more than 4500 grams should seriously consider a cesarean delivery as this reduces the risk of brachial plexus injuries greatly.

The clinical seminars, practice bulletins and training programs issued by the ACOG for doctors and parents therefore greatly assist in lessening the number of brachial plexus injuries from shoulder dystocia.