Shoulder Dystocia Leads to Nerve Palsy


This case involves the complicated vaginal delivery of a male born prematurely at 34 weeks gestation. The mother was diagnosed with maternal diabetes and pregnancy induced hypertension and during a prenatal visit her doctor told her that the baby may be too large and need to be delivered via a C-section to prevent any complication. Upon admission on the day of delivery, a bedside sonogram revealed that the fetus was in a cephalic presentation and that there was normal fetal movement, but no reports of shoulder dystocia were mentioned. The parents mentioned the previous claims by doctors that shoulder dystocia may be a problem but the physician on call told them not to worry and was quoted as saying “you will be surprised how small the baby really is.” The on-call physician  elected to proceed with a natural delivery and unfortunately ran into several complications with a delivery lasting several hours. As a result of the difficult delivery, the infant suffered from neurological injuries including the inability to use his right arm and a brain injury due to hypoxia with severe cognitive and developmental delays.

Question(s) For Expert Witness

  • 1. Was it a departure from accepted standards of medical care for the doctor to not to have diagnosed the shoulder dystocia before electing for a vaginal delivery?
  • 2. If the doctor did know that there was shoulder dystocia, was it a departure from accepted stands of care for the physician to have opted for a vaginal delivery?
  • 3. Since both parents informed the doctor that they have been told that a Cesarean Section would be required, was it a departure from accepted standards of medical care for him to opt for a vaginal delivery under the circumstances?

Expert Witness Response E-000170

This is a complicated case, but I believe there could be negligence on behalf of the OB/GYN here. It depends on how they determined that the baby was too big for a normal birth and if they indeed needed to do the C section. Furthermore, once the shoulder dystocia did occur, the doctors need to make sure they take all the right safety precautions in order to deliver the baby as safely as possible. I would be interested in reviewing this case further.

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