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Erb’s Palsy, also known as Erb-Duchenne palsy, is the lack of arm mobility as a result of brachial plexus injury. The brachial plexus are a portion of the nerves around the shoulder. They control the movements of the shoulder, arm, and hand on the coordinating side of the body. The severity of Erb’s palsy depends on which nerves experience temporary or permanent damages.

Increased Risk of Erb’s Palsy

Brachial plexus injuries that cause Erb’s palsy may occur during child birth. They can be a result of dystocia, or an exceptionally difficult birth and labor. Shoulder dystocia is the common form of dystocia relating to Erb’s palsy. During child birth, the newborn’s shoulder may catch on the mother’s hip bone. This makes vaginal birth extremely difficult. It is risky for both the infant and the mother.

Signs of increased risk for shoulder dystocia and resulting Erb’s palsy include:

  • Maternal obesity or excessive weight gain of over 35 pounds
  • Platypelloid or flat pelvis
  • Petite maternal stature
  • Gestational diabetes
  • Abnormally long labor or delivery
  • An infant that is overdue, more than 40 weeks gestational age
  • Large infant weight, of 8 pounds 14 ounces or more

Preventing Erb’s Palsy and Further Injury

If a doctor notices any risk factors for Erb’s palsy, the doctor should discuss the implications with the mother. Problems with shoulder dystocia can be difficult to predict, but there are several methods that may help minimize the chances of Erb’s palsy. If a doctor fails to abide by preexisting guidelines, medical malpractice may occur.

Important steps for managing risk of Erb’s Palsy:

Identification and analysis of the increased risks

For proper management of dystocia, it is critical to define the exact risk involved and to clarify the severity of that risk with the mother. This includes an explanation of potential birth injuries and their resulting conditions, such as Erb’s palsy. The safety of the mother and the genetics of the parents should be taken into account as well.

Close fetal monitoring

The fetus and mother should be carefully monitored once an increase of risk for Erb’s palsy has been identified. Minor changes in fetal growth may influence medical and maternal decisions.

Discussion of delivery

Depending on the risks involved, there are several methods the mother may choose from to prevent Erb’s palsy. Options may vary between medical facilities and the doctors’ expertise. The important part is that the medical provider conveys all birth options, their benefits, and their safety concerns with the mother.

Determining a Safer Delivery

Options for handling an increased risk of dystocia and Erb’s palsy include:

Elective Cesarean Delivery

Elective Cesarean delivery to prevent Erb’s palsy may be planned before the onset of labor if the mother knows she would prefer a C-section. With the risk of Erb’s palsy and additional safety concerns, this may be the safest choice for the infant. It almost negates the possibility of a brachial plexus injury. However, the mother has a higher risk of fatality during a cesarean delivery than during vaginal birth.

Cesarean Delivery

After labor naturally begins, a cesarean delivery is another option to avoid Erb’s palsy. Due to the availability of capable surgeons, it is still better to make this decision in advance. In hospitals with adequate resources, cesarean delivery allows for emergency decisions when necessary.

External Cephalic Version

External Cephalix Version may be performed prior to labor to prevent Erb’s palsy. This allows for the doctor to turn the fetus from a transverse, or side, position to a vertex, or head-first position. It may cause the mother severe pain, but it will also allow for the possibility of a vaginal birth that is safer for mother and child.

Erb’s Palsy Treatment

If a brachial plexus injury does occur, the medical provider can take quick action to alleviate the development ofErb’s palsy. Prompt surgery can help repair the damaged nerves. It is important that this surgery is performed shortly after birth. A delayed surgery may allow enough time for the child’s circulatory system within the affected arm to deteriorate. This will prevent adequate recovery and lead to the progression of Erb’s palsy.

Surgery for Erb’s palsy is most effective when combined with physical therapy. After the surgery, the child should attend pediatric therapy appointments for several years. These appointments will involve exercising the arm afflicted with Erb’s palsy by teaching the child to raise and lower their arm. The child will also practice bending their arm and grasping toys, such as a small ball. Through the combination of effective and timely treatment for Erb’s palsy, the child may regain almost all arm mobility.

 

Sources:

Collins, Dawn. “Erb’s palsy.(Malpractice).”Contemporary OB/GYN Jan. 2002: 106. Academic OneFile.Web. 19 June 2012.
Gimovsky, Alexis C., and Martin L. Gimovsky. “More strategies to avoid malpractice hazards on labor and delivery: 4 problematic L & D cases: occasions for the authors to talk about keeping clear of charges that you are the cause of injury during birth.” OBG Management Jan. 2011: 44+. Academic OneFile.Web. 19 June 2012.
Skolbekken, J A. “Shoulder Dystocia – Malpractice Or Acceptable Risk?.” Act ObstetriciaEtGynecologicaScandinavica 79.9 (2000): 750-756. MEDLINE with Full Text.Web. 19 June 2012.