Page 30 - OB Risks - Delivering the Goods (Part Two)

SVMIC Obstetrics Risks: Delivering the Goods

emergency as the infant may suffer life-threatening injuries,

and maternal injuries may occur as well. In order to deal with
a shoulder dystocia quickly, there should be a plan of action in

place to prevent complications that could lead to brachial plexus
injury, brain damage, or on rare occasion, the infant’s death.

There are considerable risks peculiar to shoulder dystocia, but
there are also strategies to augment patient safety, minimize

risk, prevent error, and successfully defend a claim. Most injuries
associated with shoulder dystocia are manifested as brachial

plexus injuries or hypoxic brain injuries.
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Since it is difficult to predict shoulder dystocia, constant
preparedness for such an occurrence is essential. This

includes patient education as to the risks of shoulder dystocia,
and informed consent discussions with the patient regarding

vaginal versus cesarean delivery; management protocols that
include tracking diagnostics; have scheduled reassessments;

and monitor periodic weights and measurements closely. An
assessment format that highlights the clinical factors indicative

of shoulder dystocia will alert the provider to the presence of
these risk factors. In addition, the physician and entire team

should participate in practice drills and continuing education
courses. Mock drills ensure that each member of the team
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understands his or her role and promotes a calm, systematic
approach to resolving the shoulder dystocia.

Antepartum factors that may increase the risk of shoulder
dystocia and should be part of the prenatal assessment include

but are not limited to:

• Fetal macrosomia

48 https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2019/02/vaginal-
birth-after-cesarean-delivery
49 Shoulder Dystocia ACOG Practice Bulletin Number 178, May 2017

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