Brachial Palsy Prediction Prevention

Brachial Palsy: Prediction & Prevention. Raphi Pollack, MDCM, FRCSC. Bikur Cholim Hospital, Jerusalem.

Outline ,[object Object],[object Object],[object Object],[object Object],[object Object]

History ,[object Object],[object Object]

Significance of Brachial Palsy ,[object Object],[object Object],[object Object],[object Object]

Clinical Syndromes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Clinical Syndromes ,[object Object],[object Object],[object Object],[object Object],[object Object]

Electrodiagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Electrodiagnosis: Timing of Injury ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Incidence of Brachial Palsy ,[object Object],[object Object],[object Object],[object Object]

Natural History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pathogenesis ,[object Object],[object Object],[object Object]

In- utero insult ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

In-utero insult : The Evidence ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

In-utero insult : Natural History ,[object Object],[object Object],[object Object],[object Object]

Brachial Palsy: Risk Factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Brachial Palsy & Instrumental Delivery

Highest Risk of Brachial Palsy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pts. At Highest Risk for OBP 100 pts 92 pts normal 8 pts OBP

Birth Trauma: Recurrence Risk ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

OBP: Negative associations ,[object Object],[object Object],[object Object],[object Object]

Prevention Strategies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Murphy’s Law: First Corollary ,[object Object]

Fetal Macrosomia: Diagnosis ,[object Object],[object Object],[object Object],[object Object]

Fetal Macrosomia: Induction of Labor ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Fetal Macrosomia: Induction of Labor 2 0 Brachial Palsy 6 5 Shoulder Dystocia 18 19 C/S for CPD 4132 * 4062 BW (Gms.) 3.2 - Time to delivery (d) Expectancy Induction

Fetal Macrosomia: Elective Cesarean Delivery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Fetal Macrosomia: Elective Cesarean Delivery $8,700,000 3,695 C/S for EFW > 4500 Gms. $4,900,000 2,345 C/S for EFW > 4000 Gms. Cost / OBP prevented # C/S performed / OBP prevented Intervention

Fetal Macrosomia: Elective Cesarean Delivery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object]

Practical Advice ,[object Object],[object Object],[object Object],[object Object]

Brachial Palsy Prediction Prevention

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Brachial Palsy Prediction Prevention