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Obstetric brachial plexus palsy associated with breech delivery
1Department of Surgery, King Khalid University Hospital, King Saud University, PO Box 18097, Riyadh 11415, Saudi Arabia.
Annals of Plastic Surgery
|September 11, 2003
Summary
Obstetrical brachial plexus palsy from breech delivery is rare. This study reviews 34 cases, finding C5/C6 avulsion common and suggesting nerve transfer for poor prognosis cases.
Area of Science:
- Pediatric Neurology
- Obstetrics
- Neurosurgery
Background:
- Obstetrical brachial plexus palsy (OBPP) is a known complication of childbirth.
- OBPP associated with breech delivery is infrequently studied, with limited data on its specific epidemiology and management.
Purpose of the Study:
- To review the authors' center's experience with OBPP in breech deliveries.
- To compare epidemiological and surgical findings with existing literature.
- To describe the center's management approach for this specific injury.
Main Methods:
- Retrospective review of 34 limbs affected by OBPP in breech deliveries.
- Analysis of epidemiological data, including birth weight and lesion types.
- Evaluation of surgical findings, natural history, and treatment outcomes.
Main Results:
- Erb's palsy affected 32 limbs; total palsy affected 2 limbs.
- Mean birth weight was low (2.3 kg); 6 patients had bilateral lesions, 3 had phrenic nerve palsy.
- C5/C6 avulsion or avulsion in situ was the common intraoperative finding, specific to breech deliveries.
Conclusions:
- 58% of limbs showed full spontaneous recovery, 21% partial, and 21% poor prognosis based on recovery by 4 months.
- Nerve transfer procedures, such as Oberlin's ulnar nerve to biceps nerve transfer, are valuable in managing cases with poor prognosis.
- The described management approach aims to prevent contractures at the shoulder and elbow.