Obstetric brachial plexus injury in subsequent deliveries

It is well known that multiparas who had previously been delivered of newborns with obstetric brachial plexus palsy are at risk of having the same complication in subsequent deliveries. However, none of the studies in the literature have actually attempted to estimate how high is that risk. The aims of the current paper were to investigate obstetric brachial plexus injury in subsequent deliveries and to study other factors associated with birth palsy, perinatal morbidity, mortality, and motor recovery of the brachial plexus. We reviewed retrospectively the records of 28 consecutive multiparas who presented with their children to our brachial plexus clinic from 1994 to 1995. Eight of the 28 multiparas gave birth to one or more children after having a newborn with brachial plexus birth palsy. These 8 mothers were delivered of a total of 16 newborns with brachial plexus injury. Injury was associated with vaginal mode of delivery, gestational diabetes, instrumental deliveries, and fetal macrosomia. One neonatal death and significant perinatal morbidity were observed in the affected newborns. Seven newborns (44%) had total birth palsy and the remaining 9 had Erb's palsy. Excellent recovery of the limb occurred in only one-third of the patients. It was concluded that multiparas who had previously been delivered of large infants with brachial plexus injury are at high risk of having the same complication in subsequent deliveries and consideration may be given to delivery of subsequent macrosomic babies by cesarean section.