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What can we do about large babies and Erb’s palsy?


    A new study is asking whether it is safer to have babies early in order to reduce complications for mothers and babies. This is especially important to reduce the risk of Erb’s palsy.

    By Paul Rumley

There is currently a clinical trial taking place, led by a partnership between University of Warwick, University Hospitals Coventry and Warwickshire NHS Trust and the Perinatal Institute and sponsored by the Erb’s Palsy Group (the only nationwide charity providing support to families affected by this condition).

The study is designed to look at:

  • Whether it is safer to deliver bigger babies early;
  • Whether by doing so it can reduce complications for mothers and babies.

The basic principle of the study is that a large baby can cause major problems including difficulty delivering the shoulders after the head has come out.

It may therefore be the case that, if large babies are delivered slightly earlier, and before they become so big that it is difficult to give birth to them naturally, the incidence of babies becoming stuck and therefore suffering injury (including Erb’s palsy) might be reduced.

What constitutes a ‘big baby’?

Views differ, but it is now accepted by the Royal College of Obstetricians and Gynaecologists’ Guidelines for Shoulder Dystocia (the shoulders becoming stuck whilst giving birth) that the risks of problems are increased where a baby is estimated to weigh between 4.5-5kg (9.9-11 pounds).

What will the clinical trial look at?

The size of a baby can be estimated by ultrasound scan and therefore during pregnancy it is possible to begin to identify those mothers who might be most at risk of having a particularly large baby.

Mothers who are likely to be carrying large babies and who take part in the trial will then be either delivered at around 38 weeks of pregnancy, or allowed to progress to full term. A review will then take place as to whether or not there were fewer complications with the babies born earlier, such as difficulty with delivery of the shoulders and therefore Erb’s palsy.

The study will therefore help decide what is the safest method of care in pregnancies where there may be complications because of the large size of the baby.

Might problems occur as a result of babies being born earlier?

In general terms, if a baby is born early it potentially has greater health risks, on the basis that it has not yet fully developed. However this normally applies to babies born prematurely, which is much earlier than 38 weeks of pregnancy as planned for in this clinical trial. Plus of course, the babies are already large and therefore fairly well developed in any event.

There are clearly always risks of a baby being born before “nature” decides it is ready, and certainly the clinical trial will need to look at whether the benefits of delivering large babies early, and therefore avoiding the complications of birth including Erb’s palsy, are outweighed by any other risks to the health of the baby (or mother) by being born a couple of weeks before full term.

The results of this clinical trial, which is to run over three and a half years including a two year recruitment period of 4000 pregnancies with large babies, are eagerly awaited. Its findings could transform the treatment approach to large babies, and therefore ultimately reduce the complications of those births and the injuries to children including Erb’s palsy.

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