A template for reviewing the strength of evidence for obstetric brachial plexus injury in clinical negligence claims

Clin Risk 2008;14:96-100
doi:10.1258/cr.2008.080020
© 2008 Royal Society of Medicine Press

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A template for reviewing the strength of evidence for obstetric brachial plexus injury in clinical negligence claims

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A template for reviewing the strength of evidence for obstetric brachial plexus injury in clinical negligence claims
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A template for reviewing the strength of evidence for obstetric brachial plexus injury in clinical negligence claims
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A template for reviewing the strength of evidence for obstetric brachial plexus injury in clinical negligence claims

Articles by Draycott, T.

Articles by Lloyd, J.
A template for reviewing the strength of evidence for obstetric brachial plexus injury in clinical negligence claims
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A template for reviewing the strength of evidence for obstetric brachial plexus injury in clinical negligence claims
A template for reviewing the strength of evidence for obstetric brachial plexus injury in clinical negligence claims

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Clinical Negligence


Tim Draycott,
Dr Carolyn Sanders,
Dr Joanna Crofts and
Joanna Lloyd

Email: tdraycott{at}gmail.com

Obstetric brachial plexus injury (OBPI) is uncommon but accountsfor a significant proportion of obstetric clinical negligenceclaims. There is debate in the medical literature and in legalproceedings regarding the causation of OBPI, particularly whetherOBPI is caused by the accoucheur applying excessive tractionor simply through the forces of labour itself.

This paper reviews the medical literature and legal case lawsurrounding OBPI and presents a template for reviewing the strengthof evidence for OBPI in clinical negligence claims. The templatecontains factors more likely to be present if the OBPI was causedby the maternal forces of labour ‘propulsion injury’(injury to the posterior arm, no documented evidence of shoulderdystocia, up-to-date training, appropriate shoulder dystociamanagement, no evidence of excessive traction, correct numberof birth attendants, precipitous second stage, temporary injury)and factors more likely if the injury is iatrogenic (injuryto the anterior arm, shoulder dystocia, no recent training,incorrect shoulder dystocia resolution manoeuvres used, evidenceof excessive traction, insufficient birth attendants, fundalpressure, permanent injury). Each factor does not, in itself,establish causation, but the template may provide a useful aidto legal teams reviewing medical notes.

A template for reviewing the strength of evidence for obstetric brachial plexus injury in clinical negligence claims
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