Erbsche Lähmung ohne Schulterdystokie: Neuere Aspekte bei der gutachterlichen Beurteilung.Vorstellungen zur vorgeburtlichen Entstehung kindlicher Plexusläsionen - Erb's Palsy without Shoulder Dystocia: More Recent Aspects for Experts' Appraisement. Concepts concerning prenatal development of plexus lesions in neonates -

Abstract

Shoulder dystocia with subsequent brachial plexus lesions in neonates is a common reason for obstetric liability litigation. Trauma during delivery is often assumed to be directly responsible for the lesion. We recently gave an expert opinion in a case involving Erb's palsy after an unremarkable delivery with no evidence of shoulder dystocia. We review the recent North American literature on plexus lesions in neonates without shoulder dystocia. The analysis of neonates with Erb's paralysis after delivery without shoulder dystocia, particularly after atraumatic cesarean delivery, have led to a new concept of prenatal (in utero) development of plexus lesions. These cases are inconsistent with the traditional concept of plexus lesions due to trauma sustained at delivery. In this group the traditional risk factors for shoulder dystocia play only a minor role. Overall, at least 50% of neonatal brachial plexus lesions result from unavoidable antepartum or intrapartum events and occur without shoulder dystocia. Antenatal brachial plexus lesions may result from stretching forces or pressure exerted on the plexus in utero by uterine anomalies (e.g., leiomyomas, intrauterine septa, bicornuate uterus) or other factors. Abnormal forces of labor may also play a role. The concept of Erb's paralysis unrelated to trauma at delivery and shoulder dystocia has medicolegal implications.