Primary prevention

Under current obstetric circumstances, prevention is not possible.[1]​​[3]​ However, some centers have begun to develop risk scores that have shown early promise.[36] Optimal management of diabetes during pregnancy reduces the risk of fetal macrosomia.[37]

​Institution of a shoulder dystocia protocol and simulation of shoulder dystocia delivery on labor and delivery units has been shown to decrease but not eliminate the incidence of brachial plexus birth injury (BPBI).[38][39][40]

Cesarean delivery may be considered for fetuses deemed at high risk for BPBI, but this should be balanced against the risks of cesarean delivery; cesarean delivery does not completely remove the risk.[1]​[3][41]​ Induction of labor in cases of suspected fetal macrosomia has been shown to reduce the risk of neonatal fracture, but not BPBI.[42]

Secondary prevention

Mothers with children affected by BPBI may choose to deliver any subsequent children via cesarean section to avoid potential shoulder dystocia. Prior shoulder dystocia is associated with a 10-fold increase in the occurrence of subsequent shoulder dystocia.[23][173] While not completely eliminated, rates of BPBI after cesarean section are considerably lower than after vaginal delivery.[15][16][41] No other preventative strategies are available.

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