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The study explores the roles of routine prenatal diabetic screening and control in the occurrence of neurological birth injuries associated with shoulder dystocia. The investigation involved retrospective review of 226 medical records that contained information about the antenatal events in cases that resulted in permanent neonatal injuries following arrest of the shoulders at delivery. Close attention was paid to diabetic screening and management of mothers with evidence of glucose intolerance. Analysis of the records revealed that one-third of all women, including those with predisposing factors, received no diabetic screening during pregnancy. The majority of confirmed diabetic patients were not treated adequately. Among babies of diabetic women, birth weights exceeding 4500 g were about 30-fold more frequent than among those with normal glucose tolerance. The data suggest that universal screening and rigid diabetic control, including mothers with borderline glucose tolerance, are effective measures for the prevention of excessive fetal growth and intrapartum complications deriving from it. If ignored, impaired maternal glucose tolerance may become a major predisposing factor for neurological birth injuries. It appears therefore that with routine screening for diabetic predisposition and effective control of gestational diabetes the risk of fetal damage can be reduced substantially. [ABSTRACT FROM AUTHOR]

Despite impressive progress in perinatology, fetal injuries from arrest of the shoulders at birth have not decreased in recent decades. Based upon sporadic reports of Erb's palsy in neonates born by Cesarean section, some obstetricians embraced the theory recently that brachial plexus lesions often derive from spontaneous forces acting in utero. Having reviewed three hundred malpractice claims involving fetal injuries attributed to shoulder dystocia at birth, the authors found only two cases connected with abdominal deliveries. One followed manual replacement of the already delivered fetal head into the pelvis after sequential vacuum and forceps procedures and failed manual extraction of the body. The other was an elective repeat Cesarean section where extensive adhesions limited the available space for the lower segment transverse uterine incision. Coincidental fracture of the clavicle and absence of contractures or deformities indicated that the brachial plexus injury was acute, having resulted from forceful traction at delivery. [ABSTRACT FROM AUTHOR]