oxytocin and Brachial-Plexus-Neuropathies

Most allegations in obstetric lawsuits against obstetrician-gynecologists relate in some manner to the management of labor and delivery; few solely involve perceived flaws in prenatal or postpartum care. Although many of these cases accuse the defendant of not having properly monitored the fetus during labor for signs of oxygen deprivation, there is in most cases an underlying allegation regarding proper decision making about the timing and route of delivery. A perspective on accusations relating to the failure to identify or to act on intrapartum asphyxia has been presented elsewhere in this issue. This article focuses on legal allegations that arise from the conduct of labor and the timing of delivery, independent of those related to fetal monitoring.

Topics: Algorithms; Birth Injuries; Brachial Plexus Neuropathies; Cesarean Section; Documentation; Female; Humans; Malpractice; Medical Records; Obstetric Labor Complications; Oxytocics; Oxytocin; Pregnancy; Vaginal Birth after Cesarean

Management of extremely large birthweight infants presents challenges during the period of labour and delivery. We sought to examine outcomes in infants with extreme macrosomia (birthweight > 5000 g), at an institution where the management of labour is standardised.. This is a retrospective analysis of prospectively gathered data on all infants with a birthweight >5000 g delivered at a tertiary level institution from 2008 to 2012. Details of labour characteristics and outcomes were examined; these were compared according to parity.. During the study period, there were 46 128 deliveries at the hospital and 182 infants with a birthweight >5000 g, giving an incidence of 0.4%. The majority of women (133/182) were multiparous. Among nulliparas, 47% (23/49) had a vaginal delivery, while 53% (26/49) had a caesarean delivery. 86% (97/113) of multiparas had a vaginal delivery, and 14% (16/113) had a caesarean delivery. 43% (69/162) required induction of labour. This was more common in nulliparous compared with multiparous women (58% [29/49] vs 30% [40/133], P = 0.005, OR = 3.4, 95% CI = 1.7-6.6). A total of 30% (49/162) of women had their labour accelerated with oxytocin. There were higher rates of oxytocin use in nulliparas than in multiparas (55% [27/49] vs 16.5% [22/133], P < 0.0001, OR = 6.2, 95% CI = 3-12.8). Seventeen of the 120 infants delivered vaginally had a shoulder dystocia (14.2%), with three suffering an Erbs palsy, all of which had resolved before 6 months of age. One baby had a clavicular fracture.. Extreme macrosomia affects 0.4% of pregnancies in contemporary practice. Multiparas have a low rate of caesarean section. Infants delivered vaginally are at increased risk of shoulder dystocia and associated complications.

Topics: Birth Injuries; Birth Weight; Brachial Plexus Neuropathies; Cesarean Section; Dystocia; Female; Fetal Macrosomia; Humans; Incidence; Ireland; Labor, Induced; Oxytocics; Oxytocin; Parity; Pregnancy; Retrospective Studies

To determine the effect of extreme macrosomia on perinatal outcome.. We conducted a retrospective review of all deliveries with birth weight > or = 5000 g in a tertiary centre from 1986 to 2000 and analyzed the method of delivery and perinatal outcome.. Extreme macrosomia (birth weight > or = 5000 g) was coded in 111 deliveries. There were 62 deliveries by Caesarean section (CS) (25 in labour and 37 elective). The 49 vaginal deliveries were complicated by 10 (20%) cases of shoulder dystocia and 3 (6%) of Erb's palsy. Permanent Erb's palsy was noted in only 1 of these 3 cases. Shoulder dystocia was associated with use of oxytocin and instrumental deliveries.. Implementing the 2002 guidelines from the American College of Obstetricians and Gynecologists (that is, recommending Caesarean delivery of fetuses with an estimated weight of at least 5000 g) would have a negligible effect on the CS rate while eliminating 10 cases of shoulder dystocia in 49 births. A policy eliminating the use of oxytocin and instrumental deliveries would have prevented most birth traumas in this group. Unfortunately, this high-risk group is difficult to identify in the antepartum period, complicating the implementation of these guidelines and probably leading to higher rates of CS. In addition, the effect of endorsing such a policy on overall neonatal and maternal morbidity is minimal, because most morbidity occurs in newborns weighing less than 4000 g.

Topics: Birth Injuries; Brachial Plexus Neuropathies; Cesarean Section; Delivery, Obstetric; Dystocia; Elective Surgical Procedures; Extraction, Obstetrical; Female; Fetal Macrosomia; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor Stage, First; Labor Stage, Second; Length of Stay; Ontario; Oxytocics; Oxytocin; Pregnancy; Retrospective Studies