Non-CTG Obstetric Problems .


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The AVMA Medical and Legal Journal Incorporating Healthcare & Law Digest. CLINICAL. RISK. AVMA Conference July 12th 2002. BRACHIAL PLEXUS INJURY AT BIRTH. A TRACTION INJURY. Roger V Clements Editor:Clinical Risk. The Brachial Plexus. CLINICAL. RISK. AVMA Conference July 12th 2002.
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The AVMA Medical and Legal Journal Incorporating Healthcare & Law Digest

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY AT BIRTH A TRACTION INJURY Roger V Clements Editor:Clinical Risk

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The Brachial Plexus

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY AT BIRTH A TRACTION INJURY dependably ? Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY AT BIRTH A TRACTION INJURY quite often Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY AT BIRTH Vaginal conveyance: cephalic presentation confounded by shoulder dystocia breech conveyance utilizing the Mauriceau-Smellie-Veit move Roger V Clements Editor:Clinical Risk

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The Mauriceau-Smellie-Veit Maneuver

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY AT BIRTH Cesarean conveyance: cephalic presentation - a vast infant and a deficient entry point breech conveyance - a small preterm infant through a rash \'lower fragment\' cut Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 SHOULDER DYSTOCIA Incidence 1.02% (territory 0.1% - 2%) (underourished Chinese - overweight Americans) Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 SHOULDER DYSTOCIA Definition "when the standard conveyance methodology of delicate descending footing of the fetal head and direct fundal weight neglect to finish conveyance" (O\'Leary) Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 SHOULDER DYSTOCIA Classification O\'Leary:According to treatment utilized Gibb: 3 degrees of trouble 1. A tiny bit of trouble with the shoulders 2. One-sided 3. Reciprocal Roger V Clements Editor:Clinical Risk

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Bilateral Unilateral

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CLINICAL RISK AVMA Conference July twelfth 2002 SHOULDER DYSTOCIA Unilateral: typically deliverable with sufficient method Bilateral: undeliverable vaginally Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 SHOULDER DYSTOCIA What if not assuaged? Asphyxia mind harm passing Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 SHOULDER DYSTOCIA Management at Delivery McRoberts position/all fours Suprapubic Pressure Woods/Rubin Screw Deliver Posterior Arm Zavanelli Manoevre Roger V Clements Editor:Clinical Risk

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McRoberts Position

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Suprapubic Pressure - Single-gave

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The Woods Screw Maneuver altogether Fours

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Delivery of the back arm 1

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Delivery of the back arm 2

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Delivery of the back arm 3

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Delivery of the back arm 4

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CLINICAL RISK AVMA Conference July twelfth 2002 SHOULDER DYSTOCIA Management at Delivery What not to do:- firm footing rehashed footing fundal weight Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY AT BIRTH A TRACTION INJURY quite often Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY AT BIRTH A TRACTION INJURY however not exactly dependably Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY WITHOUT SHOULDER DYSTOCIA Anecdotal reports from 5 US focuses of OBPI without recorded shoulder dystocia Phoenix, Arizona Green Bay, Wisconsin Salt Lake City, Utah Iowa City, Iowa Los Angeles, California Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY WITHOUT SHOULDER DYSTOCIA Phoenix, Arizona Intra-uterine maladaptation "indisputable confirmation" intrauterine weights uterine peculiarities Jennett R J, Tarby T J & Kreinick M A Brachial Plexus Palsy: An old issue returned to. Am J Obst Gynecol 1992; 166:16733-7 Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY WITHOUT SHOULDER DYSTOCIA Green Bay, Wisconsin Propulsive hypothesis "solid withdrawal powers of the fetal head between… compressions in the wake of pushing… extending of the nerves happens due to the unbalanced drop of the head… before total conveyance" Sandmire H F & DeMott RK Erbs\' paralysis: Concepts of Causation. Obstetrics and Gynecology 2000;95:941-942 Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY WITHOUT SHOULDER DYSTOCIA Salt Lake City, Utah Propulsive hypothesis Observation of OBPI to the back shoulder Hankins G D V & Clark S L Brachial Plexus Palsy including the back shoulder at unconstrained vaginal conveyance American J Perinatolgy 1995;12:44-45 Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY WITHOUT SHOULDER DYSTOCIA Los Angeles, California Propulsive hypothesis Four cases that happened without shoulder dystocia… ...and four cases … .. in the back arm of newborn children with foremost shoulder dystocia Ouzounian J G, Korst LM and Phelan J P Permanent Erb\'s paralysis: a footing related damage? Obstetrics and Gynecology 1997; 89:139-141 Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY WITHOUT SHOULDER DYSTOCIA Iowa City, Iowa Completely idiopathic "The strengths of work, maternal pelvic life structures, and fetal position interface so as to make certain embryos more powerless.." Peleg D, Hasnin J & Shalev E Fractured clavicle and Erb\'s paralysis random to birth injury Am J Obstet Gynecol 1997;177:1038-40 Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY AT BIRTH A survey of the writing prompts to the accompanying conclusions:- 1. Descending and horizontal footing trying to free the front shoulder within the sight of shoulder dystocia is the in all likelihood reason for harm to the foremost brachial plexus Stirrat GM & Taylor R Mechanisms of Obstetric Brachial Plexus Palsy - A Critical Analysis Clinical Risk November 2002 (in Press) Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY AT BIRTH An audit of the writing prompts to the accompanying conclusions:- 2. There is at present no great proof for affirming that, when there has obviously been shoulder dystocia and the foremost brachial plexus has been harmed,… … .. Stirrat GM & Taylor R Mechanisms of Obstetric Brachial Plexus Palsy - A Critical Analysis Clinical Risk November 2002 (in Press) Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY AT BIRTH An audit of the writing prompts to the accompanying conclusions:- 2. … the harm was because of something besides sidelong and descending footing against resistance. Stirrat GM & Taylor R Mechanisms of Obstetric Brachial Plexus Palsy - A Critical Analysis Clinical Risk November 2002 (in Press) Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY AT BIRTH An audit of the writing prompts to the accompanying conclusions:- 3. There, is by and large, no archived record of shoulder dystocia when there is brachial plexus harm. Notwithstanding when under-detailing is contemplated there may stay a few cases in which bear dystocia has not happened. Stirrat GM & Taylor R Mechanisms of Obstetric Brachial Plexus Palsy - A Critical Analysis Clinical Risk November 2002 (in Press) Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY WITHOUT SHOULDER DYSTOCIA a. a helpless hypotonic baby b. weight from the sacral projection c. weight from fetal or uterine tumor/anomaly Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY AT BIRTH An audit of the writing prompts to the accompanying conclusions:- 4. The system by which propulsive strengths can create footing on nerves that are beneath the time when the drive works is not clear. The way that the foremost part of the neck is flexed when the head is conceived… … .. Stirrat GM & Taylor R Mechanisms of Obstetric Brachial Plexus Palsy - A Critical Analysis Clinical Risk November 2002 (in Press) Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY AT BIRTH An audit of the writing prompts to the accompanying conclusions:- 4. … ..and the front shoulder is settled over the pelvic overflow must be an additional defend against extending of the foremost plexus. Stirrat GM & Taylor R Mechanisms of Obstetric Brachial Plexus Palsy - A Critical Analysis Clinical Risk November 2002 (in Press) Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY AT BIRTH An audit of the writing prompts to the accompanying conclusions:- 5. Unanswered inquiries stay about both shoulder dystocia and brachial plexus damage and these require precisely arranged, expansive, forthcoming reviews… … . Stirrat GM & Taylor R Mechanisms of Obstetric Brachial Plexus Palsy - A Critical Analysis Clinical Risk November 2002 (in Press) Roger V Clements Editor:Clinical Risk

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CLINICAL RISK AVMA Conference July twelfth 2002 BRACHIAL PLEXUS INJURY AT BIR

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