Antepartum Risks of Shoulder Dystocia and Brachial Plexus Injury for Infants Weighing 4,200 g or More

1998 ◽  
Vol 45 (2) ◽  
pp. 77-80 ◽  
Author(s):  
Isaac Blickstein ◽  
Alon Ben-Arie ◽  
Zion J. Hagay
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Shoulder Dystocia

scholarly journals Obstetrical brachial plexus injury: burden in a publicly funded, universal healthcare system

2016 ◽  
Vol 17 (2) ◽  
pp. 222-229 ◽  
Author(s):  
Christopher J. Coroneos ◽  
Sophocles H. Voineskos ◽  
Marie K. Coroneos ◽  
Noor Alolabi ◽  
Serge R. Goekjian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Brachial Plexus ◽  
Healthcare System ◽  
Quality Indicators ◽  
Brachial Plexus Injury ◽  
Shoulder Dystocia ◽  
Publicly Funded ◽  
Universal Healthcare ◽  
Universal Healthcare System

OBJECT The aim of this study was to determine the volume and timing of referrals for obstetrical brachial plexus injury (OBPI) to multidisciplinary centers in a national demographic sample. Secondarily, we aimed to measure the incidence and risk factors for OBPI in the sample. The burden of OBPI has not been investigated in a publicly funded system, and the timing and volume of referrals to multidisciplinary centers are unknown. The incidence and risk factors for OBPI have not been established in Canada. METHODS This is a retrospective cohort study. The authors used a demographic sample of all infants born in Canada, capturing all children born in a publicly funded, universal healthcare system. OBPI diagnoses and corresponding risk factors from 2004 to 2012 were identified and correlated with referrals to Canada’s 10 multidisciplinary OBPI centers. Quality indicators were approved by the Canadian OBPI Working Group’s guideline consensus group. The primary outcome was the timing of initial assessment at a multidisciplinary center, “good” if assessed by the time the patient was 1 month of age, “satisfactory” if by 3 months of age, and “poor” if thereafter. Joinpoint regression analysis was used to determine the OBPI incidence over the study period. Odds ratios were calculated to determine the strength of association for risk factors. RESULTS OBPI incidence was 1.24 per 1000 live births, and was consistent from 2004 to 2012. Potential biases underestimate the level of injury identification. The factors associated with a very strong risk for OBPI were humerus fracture, shoulder dystocia, and clavicle fracture. The majority (55%–60%) of OBPI patients identified at birth were not referred. Among those who were referred, the timing of assessment was “good” in 28%, “satisfactory” in 66%, and “poor” in 34%. CONCLUSIONS Shoulder dystocia was the strongest modifiable risk factor for OBPI. Most children with OBPI were not referred to multidisciplinary care. Of those who were referred, 72% were assessed later than the target quality indicator of 1 month that was established by the national guideline consensus group. A referral gap has been identified using quality indicators at clinically relevant time points; this gap should be addressed with the use of knowledge tools (e.g., a clinical practice guideline) to target variations in referral rates and clinical practice. Interventions should guide the referral process.

IS SHOULDER DYSTOCIA WITH BRACHIAL PLEXUS INJURY PREVENTABLE?

2008 ◽  
Vol 19 (4) ◽  
pp. 293-310 ◽  
Author(s):  
EMILY F HAMILTON ◽  
ANTONIO CIAMPI ◽  
ALINA DYACHENKO ◽  
HENRY M LERNER ◽  
LOUISE MINER ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Medical Profession ◽  
Shoulder Dystocia ◽  
Social Consequences ◽  
Obstetrical Complications ◽  
The Family ◽  
Poor Care

The sequelae of shoulder dystocia with persistent brachial plexus injury (BPI) are among the most serious of obstetrical complications. Shoulder dystocia with BPI generally places second or third in the list of the top causes of permanent birth-related neonatal injuries. Apart from the devastating medical and social consequences of lifelong impairment for the family, ensuing litigation with its allegations regarding poor care exacts a heavy toll on the medical profession.

Improving Shoulder Dystocia Management and Outcomes with a Targeted Quality Assurance Program

2017 ◽  
Vol 34 (11) ◽  
pp. 1088-1096 ◽  
Author(s):  
Susan Will ◽  
Robert Allen ◽  
Andrew Satin ◽  
Edith Gurewitsch Allen
Keyword(s):  
Quality Assurance ◽  
Quality Improvement ◽  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Clinical Impact ◽  
Shoulder Dystocia ◽  
Improvement Program ◽  
Instructional Content ◽  
Vaginal Deliveries ◽  
Systematic Program

Background Several investigators have achieved remarkable success in transferring shoulder dystocia management skills mastered with simulation training to clinical practice. However, other investigators have not demonstrated similar benefits, raising questions about the comparative effectiveness of specific simulation schemes, instructional content, and additional quality assurance measures between successful and unsuccessful interventions. After our initial review revealed gaps in following shoulder dystocia management algorithms, documentation and timely follow-up of injured neonates, we developed and implemented five interventions, three educational and two systems-level, aimed at improving shoulder dystocia management. Objective To describe the clinical impact of a systematic program of quality improvement on outcomes of vaginal births complicated by shoulder dystocia. Setting An urban tertiary academic medical center that trains 36 obstetrics/gynecology residents (9 per year) and provides comprehensive obstetrical services for approximately 2,000 deliveries annually. Study Design We use SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) to (1) describe our core instructional content and simulation-based practice, emphasizing specific proscriptive and prescriptive recommendations and their evidence basis, and (2) to report an interrupted time series assessment of the clinical impact of our systematic quality improvement program targeting shoulder dystocia-associated brachial plexus injury. Results Compared with baseline (June 1993 to December 2004), the incidence of shoulder dystocia among vaginally delivered infants with birth weight ≥ 2,500 g at Johns Hopkins Hospital (January 2014 to December 2015) increased from 2.6 to 4.6% (X 2 = 29.8; df = 1; p < 0.0001); in addition, documentation improved, direct fetal manipulation increased, while use of episiotomy for the management of shoulder dystocia decreased. While preintervention only 65% of brachial plexus injury were associated with shoulder dystocia, 100% of neonatal brachial plexus injuries were associated with shoulder dystocia postintervention (80/122 [65%] vs. 7/7 [100%], X 2 = 3.66; df = 1; p = 0.055), a trend reflecting simultaneous increased recognition of impacted shoulders and improved overall management of shoulder dystocia. Most importantly, the incidence of brachial plexus injury among shoulder-dystocia-complicated vaginal deliveries has decreased from a baseline of 31.6 to 6.3% (X 2 = 27.9; df = 1; p < 0.0001), and the absolute brachial plexus injury rate declined from 8.2 to 2.9 per 1,000 vaginal births ≥ 2,500 g, a reduction of 64.5% (X 2 = 7.3; df = 1; p = 0.007). Conclusion A systematic program of quality assurance with specific proscriptive and prescriptive instructional content and management recommendations is associated with improved recognition, management, and clinical outcomes of shoulder dystocia.

Effects of shoulder dystocia training on the incidence of brachial plexus injury

2011 ◽  
Vol 204 (4) ◽  
pp. 322.e1-322.e6 ◽  
Author(s):  
Steven R. Inglis ◽  
Nikolaus Feier ◽  
Jyothi B. Chetiyaar ◽  
Margaret H. Naylor ◽  
Melanie Sumersille ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Shoulder Dystocia
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