Another issue covered in the report is how long a clinician has to resolve a shoulder dystocia before central neurologic damage occurs. Studies have shown that permanent neurologic injury can occur as soon as 2 minutes after shoulder impaction, although the risk of acidosis or severe hypoxic-ischemic encephalopathy remains low until impaction has lasted at least 5 minutes.
The last chapters of the ACOG report focus on orthopedic aspects of brachial plexus injury, including diagnosis, treatment, and prognosis.
The report concludes with a glossary and three appendices:
- Royal College of Obstetricians and Gynecologists Green Top Guidebook #42 on shoulder dystocia
- ACOG Practice Bulletin #40 on shoulder dystocia
- ACOG Patient Safety Checklist #6 on the documentation of shoulder dystocia.
The ACOG report on NBPP is an important and much-needed document. It includes a comprehensive review of the literature on brachial plexus injury and shoulder dystocia, written by nationally recognized experts in the field. Most important, it makes definitive statements that counteract false and dubious claims often made by the plaintiff bar in brachial plexus injury cases and provides evidence to back those statements.
The report:
- disproves the claim that “excessive” physician traction is the only etiology of brachial plexus injuries
- demonstrates that no differentiation can be made between the etiology of permanent versus temporary brachial plexus injuries
- describes how brachial plexus injuries can occur in the absence of physician traction or even of shoulder dystocia
- provides a summary of scientific information about brachial plexus injuries that will benefit obstetric clinicians
- provides a wealth of literature documentation that will enable physician defendants to counteract many of the claims plaintiffs and their expert witnesses make in brachial plexus injury cases.
The report is—and will remain—a foundational document in obstetrics for many years to come.
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