Obstetric Brachial Plexus Palsy

Abstract

Objectives: to describe my research into and conclusions about obstetric brachial plexus palsy with special emphasis on aspects that would be of interest to obstetricians.Materials and Methods: based on an extensive literature review as well as on the research I was involved in concerning birth palsy, the following points are investigated: classification of the types of traumatic birth palsy, risk factors, congenital and intra-uterine palsies, evaluation, prognostic factors for spontaneous recovery and surgery for obstetric paralysis.Results: infants with birth palsy should be assessed by a multidisciplinary team. Traumatic brachial plexus injury is classified into four types: Erb’s, total, Klumpke’s and intermediate palsies. Each type is associated with a specific intrapartum force and each has a specific clinical presentation. Risk factors for birth palsy include fetal macrosomia, shoulder dystocia, maternal short stature, gestational diabetes, vaginal breech delivery, instrumental delivery and a previous history of giving birth to a baby with birth palsy. The hand surgeon is frequently involved in the medico-legal assessment of birth palsy cases and, hence, it is important to realize that paralysis of the limb in the newborn is not always due to traumatic delivery. Other causes of paralysis include: congenital aplasia of the roots of the brachial plexus, congenital varicella, cerebral palsy, intra-uterine nerve compression by the umbilical cord or amniotic bands, “Deformation Syndrome“ and “intra-uterine mal-adaptation palsy”. Infants with birth palsy should be evaluated at regular intervals by the hand surgeon and have continuous physiotherapy exercises. The most important factor that indicates good spontaneous recovery is early clinical improvement of limb function. Infants with poor spontaneous recovery will benefit from surgical exploration and reconstruction of the brachial plexus.Conclusion: obstetric brachial plexus palsy has become a subject of interest in the surgical literature because of advances in microsurgery and nerve reconstruction. This has led to several published papers on the topic dealing with the re-classification of the types of palsy, its risk factors, aetiology, evaluation, prognosis and new concepts of surgical intervention.