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Brachial plexus paresis associated with fetal neck compression from forceps.
Alfredo F Gei1, Russell A Smith, Gary D V Hankins
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas 77555-0587, USA.
American Journal of Perinatology
|October 7, 2003
Summary
Instrumental vaginal deliveries can cause brachial plexus injuries. Direct forceps compression during rotation, not just shoulder dystocia, may injure the fetal neck and nerves.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Neurology
- Pediatric Surgery
Background:
- Instrumental vaginal deliveries are linked to increased risks of brachial plexus injuries.
- Existing theories suggest nerve stretch injuries from shoulder dystocia or excessive fetal rotation are primary mechanisms.
Observation:
- A case of brachial plexus paresis in a term infant following a low Kielland forceps rotation is presented.
- The infant exhibited Erb's palsy and a neck bruise, with no shoulder dystocia observed.
Findings:
- Direct compression by forceps blades during fetal neck rotation can cause brachial plexus injuries.
- This mechanism is distinct from indirect injury associated with shoulder dystocia.
Implications:
- Highlights a direct injury mechanism for brachial plexus paresis during instrumental delivery.
- Suggests careful technique during forceps rotation to minimize direct fetal neck compression.
- Informs obstetricians about potential iatrogenic neonatal nerve injuries during assisted vaginal birth.