Bilateral fractures in a shoulder dystocia delivery

Description

A male neonate weighing 4170 g (99th centile) was born to a non-diabetic primigravid woman by difficult vaginal delivery at 37 weeks gestation due to right shoulder dystocia. The labour was induced and Neville Barnes forceps were employed for successful delivery. Apart from maternal obesity (body mass index of 36 kg/m²), no other risk factors for fetal macrosomia or shoulder dystocia were noted. After birth, absent right shoulder movement with asymmetrical Moro reflex was noted, raising the possibility of right clavicular fracture with possible brachial plexus injury (BPI). Although left arm mobility was reduced, neurology was normal. Both elbows and wrists were flexed with symmetrical grasp reflex. A chest radiograph was performed, confirming displaced fractures of his right clavicle and left humerus (figure 1). Examination findings at 48 hours were unchanged, and there were no signs of Horner's syndrome or respiratory distress indicating phrenic nerve injury. It was difficult...

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