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Klumpke's PalsyTreatment: There is no specific treatment. However, early immobilization is followed by passive movements with a view of preventing contractures (fibrosis of connective tissue and skin, fascia, muscle, or joint capsule that prevents normal mobility of the related tissue or joint). A regimen of physical therapy and/or occupational therapy may be prescribed. Surgery is an option in severe cases and especially if a nerve has been severed. Risks: The bigger the baby, the higher the risks for Erb's Palsy type injuries. The doctor must assess some of the following information which may lead to potential higher probability for an Erb's Palsy or Brachial Plexus injury: Prior large birth weight babies; Gestational diabetes; Prior C-sections; Mother is very small physically, especially small pelvis; Small mother with large baby; Genetic or constitutional causes: Large women tend to give birth to large babies; Neural diabetics or pre-diabetes; Overdue pregnancies; Excessive maternal weight gain during pregnancy; Advance maternal age.
Pre-Delivery Prevention
Management for Shoulder Dystocia at delivery:1) Rotation of the anterior shoulder: If unrotated by fingers, transvaginally to bring it in the anterio-posterior diameter. 2) Generous episiotomy and gentle downward traction with suprapubic pressure by an assistant obliquely to flex the anterior shoulder against the fetal chest. 3) McRoberts' Maneuver: A sharp flexion of the maternal thighs against her abdomen. 4) Woods Screw Maneuver: Dr. Woods in 1943 described this as the rotating of the fetus as a screw by inserting two fingers of the right hand and rotating anteriorly to dislodge the shoulder. 5) Extraction of the posterior arm inserting two fingers to grab the posterior arm when extracting same. 6) Zavanelli's Maneuver: Inserting two fingers and the hand to rotate the baby's head manually to the anterioposterior position whereby an immediate Caesarean section is performed. |
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