Obstetric brachial palsy: Challenges of management in a developing country

Abstract

Background: Obstetric brachial palsy is not common in the presence of satisfactory Obstetric practice. The objective of this study was to highlight the challenges in the management of Obstetric brachial palsy (OBP) in Liberia. Patients and Method: The study was carried out at John F Kennedy (JFK) Memorial Hospital Monrovia Liberia, the largest tertiary institution in Liberia, between October 2018 and June 2019. Records of all patients with OBP that presented to the orthopedic outpatient clinic were used for the study. All the patients were less than 3 months old. The follow-up status at 8–12 weeks and as at June 2019 were recorded. Phone numbers provided on the charts were used to trace the parents of the patients or care givers. Results: Records of 10 patients were analyzed. There were seven males and three females. Birth weight ranged 2.6–4.5 kg, the gestational ages at birth was 36–40 weeks. Parity of the mothers were 1–3. Five patients had Erbs Palsy, three patients had Klumpkes paralysis, and two patients had global deformity. All 10 patients had right upper limb involvement. All the patients were referred for physiotherapy. At 8–12 weeks of presentation, three patients came for follow-up, seven were lost to follow-up. A follow-up phone call in June 2019 revealed improvement in four patients, some improvement in one patient, whereas five patients could not be reached. Conclusion: OBP is not uncommon in our setting and usually occurs on the right upper limb. Majority of the patients that present soon after birth would have significant improvement on physiotherapy.