What Does Dystocia Mean & How Is It Medical Malpractice?
Dystocia refers to abnormal or difficult childbirth or labor. It occurs when there is an incoordinate uterine activity, abnormal fetal life or presentation, absolute or relative cephalopelvic disproportion, etc. Shoulder dystocia is a type of dystocia where the anterior of the infant cannot pass below the pubic symphysis or requires a significant amount of manipulation to pass. Shoulder dystocia, just like dystocia, occurs during childbirth or labor. And it is diagnosed when the shoulders of the infant fail to be delivered shortly after the fetal head. If the infant’s shoulder is unable to be freed within minutes, the infant will suffer irreversible brain damage or death.
In plain English; it’s a difficult delivery that can result in the child getting stuck and either suffering a shoulder separation or a brain injury.
Some signs to look for regarding shoulder dystocia are; the turtle sign– this is the appearance and retraction of the fetal head (much like a turtle going back into its shell) and a red puffy face indicative of facial flushing.
What Can My Physician Do About This Type of Complication?
When presented with this complication in the delivery room, there are a few procedures that can be done to try and ensure the safe delivery of the infant. It is reported that if the physician delivering the baby suspects shoulder dystocia, they are to follow the ALARMER mnemonic first before any of the listed procedures below, are followed. The ALARMER mnemonic stands for; Ask for help, Leg hyperflexion, Anterior shoulder disimpaction, Rubin maneuver, Manual delivery of posterior arm, Episiotomy, and Rollover on all fours. After the ALARMER is followed, here are some of the different types of procedures the obstetrician or physician can perform:
- McRoberts Maneuver – this involves hyper-flexing the mother’s leg tightly to her abdomen. This widens pelvis and flattens the spine in the lower back.
- Suprapubic Pressure (Rubin I) – the goal of suprapubic pressure is to decrease the fetal bisacromial diameter by adducting the anterior fetal shoulder. Pressure is applied to the suprapubic area in a downward fashion or a rocking motion from the fetal back toward the front
- Rubin II – posterior pressure on the anterior shoulder. This would bring the fetus in an oblique position with the head towards the vagina.
- Wood’s Screw – leads to turning the anterior shoulder to the posterior and vice versa.
- Jacquemier’s Maneuver – delivery of the posterior shoulder first. The forearm and hand are identified in the birth canal and gently pulled.
- Gaskin Maneuver – moving the mother to an all-fours position with the back arched, widening the pelvic outlet.
- Zavanelli’s Maneuver – pushing the fetal head back in, and performing a cesarean section or internal cephalic replacement by c-section.
- Intentional Fetal Clavicular Fracture – reduces the diameter of the shoulder girdle that requires to pass through the birth canal.
- Abdominal Rescue – hysterectomy facilitates vaginal delivery of the impacted shoulder.
- Maternal Symphysiotomy – makes an opening of the birth canal by breaking connective tissue between the two pubic bones, allowing the shoulders to pass through.
The ALARMER mnemonic goes from the least invasive to the most invasive procedures, reducing the harm to the mothers in the event that the infant is delivered with one of the earlier maneuvers. If these maneuvers are unsuccessful, then the skilled obstetrician is to begin performing the additional procedures.
The major concern regarding shoulder dystocia is the damage to the upper brachial plexus nerves. The brachial plexus nerves supply the sensory and motor components of the shoulder, arm, and hands. Moreover, excess tension may physically tear the nerve roots out of the neonatal spinal column and resulting in total dysfunction. The ventral roots (motor pathway) are the most prone to injury because they are in the plane of the greatest tension. Other concerns coming from shoulder dystocia are:
- Klumpke paralysis
- Erb’s Palsy
- Fetal hypoxia
- Fetal Death
- Cerebral Palsy
- Maternal postpartum hemorrhage
If Your Child Suffered An Injury After A Difficult Delivery, Contact Our Experienced Medical Malpractice Lawyers Today
If your child suffered from shoulder dystocia at birth in a Northern Virginia, D.C., or Maryland hospital, contact Donahoe Kearney to find out if you have a case. To pursue a medical malpractice case against the doctor or hospital involved, you should contact us today for a complimentary consultation at 202.393.3320 or reach us online at donahoekearney.com/contact-us