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JRM was one of twins, delivered by forceps at 29 weeks and suffered serious injury to his spinal cord around the time of his birth. The forceps caused traumatic injury and tearing of the lining of the spinal artery (arterial dissection), and subsequent clot formation within the vessel resulting in vascular injury to the spinal cord due to occlusion of a branch of the anterior spinal artery. It was alleged that this was due to the negligent use of forceps with the claimant in the occipito-lateral (OL) position at birth.
Shoulder dystocia is defined as a vaginal cephalic delivery that requires additional obstetric maneuvers to deliver the fetus after gentle traction has failed. It occurs when either the anterior shoulder impacts behind the maternal symphysis or, less commonly, the posterior shoulder impacts over the sacral promontory. Evidence-based algorithms for the management of shoulder dystocia recommend resolution maneuvers designed to improve the relative dimensions of the maternal pelvis (McRoberts’ position and all-fours position), reduce the diameter of the fetal shoulders (suprapubic pressure and delivery of the posterior arm) and/or move the fetal shoulders into a wider pelvic diameter (suprapubic pressure and internal rotational maneuvers).