From the Editor
Tackle the challenging shoulder dystocia emergency by practicing delivery of the posterior arm
Successful delivery of the posterior arm may require finding and firmly grasping the fetal hand, wrist, and/or distal forearm
Second pregnancy ends in injury after shoulder dystocia
A mother told her new ObGyn that, during the birth of her first child a few years earlier, shoulder dystocia had been encountered. Although the baby was born unharmed, her prior ObGyn had recommended that she undergo cesarean delivery for future pregnancies. During the second pregnancy, the mother and new ObGyn discussed the possibility of a trial of labor and vaginal delivery.
When the mother went into labor at 37 weeks’ gestation, the ObGyn believed the child was of normal weight and proceeded with a vaginal delivery. When shoulder dystocia was encountered, various maneuvers were performed. Birth occurred 5 minutes later using moderate traction.
The child showed no signs of life at birth; Apgar scores were 0 for more than 14 minutes. The newborn was sent to the neonatal intensive care unit and later airlifted to another hospital. He had hypoxic ischemic encephalopathy and a C5–C6 brachial plexus injury.
Additional testing revealed that he has neurocognitive deficits including attention deficit hyperactivity disorder and executive function disabilities.
Parents’ claim The ObGyn was negligent in failing to fully explain the risks of vaginal delivery, failing to recommend cesarean delivery based on the patient’s history and prior physician’s recommendation. The ObGyn failed to perform ultrasonography when the mother was admitted to the hospital; such imaging would have revealed that the fetus was larger than her first baby, mandating cesarean delivery. The ObGyn failed to perform an episiotomy after dystocia was encountered, and he applied excessive traction during dystocial maneuvers.
PHYSICIAN’S DEFENSE The mother was extensively counseled on the risks of vaginal delivery, but the ObGyn admitted that he did not recommend a cesarean delivery. Ultrasonography would have had no benefit. The use of moderate traction was necessary to prevent severe brain damage or death. The child’s current deficits are not related to his birth.
VERDICT The hospital settled for $85,000 before the trial began. An Illinois defense verdict was returned for the ObGyn.
These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska (www.verdictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.
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