Re: Shoulder dystocia - Again!
From: Anna Meenan, MD (annam@uic.edu)
Sat Sep 18 22:31:42 2004
BTW, I re-visited http://www.birthinjury.com, which used to be James O'Leary's
son's website with his name all over it, and it is now a fairly generic
lawyer website where his name does not appear. Interesting.
--
Anna Meenan, MD
At Sat, 18 Sep 2004, Anna Meenan, MD wrote:
>
>Interesting. Most of the recommendations for prediction and prevention
>are not supported by evidence-based medicine, and following them would
>result in thousands of unnecessary c-sections, likely leading to some
>maternal deats to prevent Erb's Palsies. The only author I have seen
>seriously try to convince anyone that shoulder dystocias can be safely
>predicted and prevented is James O'Leary, whose son is a personal injury
>lawyer who specializes in damaged babies. I believe that the ACOG
>technical bulletin on Shoulder Dystocia recommends that elective
>c-section be CONSIDERED in diabetic moms with EFW greater than 4500g
>(NOT 4000), and does not recommend elective c-section at any EFW in
>non-diabetic moms. (My technical bulletins are at the office and I am
>at home). And of course, EFW's are not even accurate to begin with, the
>most accurate being those estimated by multiparous moms on the babies
>they are carrying.
>
>I find it fascinating that we are now being recommended to subject
>newborns to a week of daily EMG's just to make the lawyers happy.
>
>I DO agree with the recommendation to write a delivery note that
>carefully documents the use of an orderly series of recommended
>maneuvers in delivery of the shoulders, and I do agree with involving
>pediatric specialists IMMEDIATELY in any case of brachial plexus palsy.
>
>No, we don't do shoulder dystocia drills in our hospital. In cases
>where there are risk factors, I review the HELPERR mnemonic with the
>resident before the delivery and make sure the nurse marks delivery of
>the head on the monitor strip. Of course many shoulder dystocias occur
>in normal-weight babies with no risk factors, so there you are.
>
>--
> Anna Meenan, MD
>
>At Sat, 18 Sep 2004, RModugno@aol.com wrote:
>>
>>This month's OBG management had interesting recommendations on shoulder dystocia:
>>
>>http://www.obgmanagement.com/content/2004/09/tables/078/sidebar_03.pdf
>>
>>Does anyone do shoulder dystocia drills or have a "shoulder dystocia" team, like a "code blue" team at their hospital?
>>
>>Robert Modugno MD MBA FACOG
>>Marietta, GA
>>http://www.novaobgyn.yourmd.com
>
