A review of the literature on shoulder dystocia reveals the following:

1. Despite the use of ultrasound to attempt to estimate fetal weights, there is currently no way for obstetricians to determine with any degree of accuracy which babies will be macrosomic or will experience shoulder dystocia at delivery. New work on shoulder dystocia prediction algorithms may change this existing limitation in obstetric practice.

2. The various strategies proposed to attempt to reduce the number of shoulder dystocia deliveries and brachial plexus injuries would result in:

a. The performance of hundreds or thousands of cesarean sections to prevent a single case of permanent brachial plexus injury

b. The potential medical complications from such interventions

c. The economic costs of such interventions

3. Although there are various techniques for resolving shoulder dystocias, these will not totally eliminate the incidence of brachial plexus palsies and other birth injuries.

4. Brachial plexus injuries may be caused by multiple factors related to the physiology of labor and delivery.

5. No published clinical or experimental data exist to support the contention that the presence of persistent neonatal brachial plexus palsy could only be caused by the application of excessive force by the birth attendant.

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Copyright © 2017 Henry Lerner