Was Erb’s palsy caused by excessive traction?
<court>Prince William County (Va) Circuit Court</court>
After an unremarkable pregnancy, a 17-year-old woman presented to a hospital for labor induction. When oxytocin was administered, she was 80% effaced and 2 cm dilated. Approximately 10 hours later, the mother was instructed to push. Two hours later, the doctor applied a vacuum and performed an episiotomy. Shoulder dystocia was encountered.
The obstetrician performed the McRobert’s maneuver and delivered the infant without difficulty. However, it was soon noted that the newborn showed decreased movement of the right upper extremity. The infant later required brachial plexus exploration and underwent nerve-grafting surgery at 14 months.
In suing, the mother claimed that a vacuum was applied more than twice, with the obstetrician leaving the area to retrieve another vacuum. The patient argued that after 1 failed vacuum attempt, the obstetrician should have performed a cesarean.
She also argued that she was at increased risk for shoulder dystocia because she was only 5’1 and labor was induced at 40.5 weeks’ gestation with an unengaged vertex. In addition, she said that slow dilatation in the first stage of labor and a prolonged second stage should have further alerted the physician to likely shoulder dystocia.
Lastly, she alleged that the physician failed to utilize proper maneuvers to manage the shoulder dystocia, and that excessive traction to the baby’s head and neck resulted in Erb’s palsy.
The doctor maintained that the brachial plexus injury either occurred in the birth canal during descent or resulted from a turtle mechanism during the shoulder dystocia.
- The case settled for $450,000.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.