Obstetric brachial plexus injury in subsequent deliveries

Abstract

Surg 1996;4(4):203-204. Two cases of obstetrical brachial plexus injury in subsequent deliveries in the same family are described. Medicolegal aspects, review of the literature and recommendations regarding its prevention are given. Lésion obstétricals du plexus brachial lors des accouchements subséquentsRÉSUMÉ : Deux cas de lésions obstéricales du plexus brachial lors d'accouchements subséquents dans une même famille sont décrits ici. Les aspects médico-légaux, une revue de la littérature et des recommandations au sujet de sa prévention sont également présentés.Obstetric brachial plexus injury has gained recent attention in the plastic surgery literature because of advances in microsurgery and nerve reconstruction (1-8). Brachial plexus birth palsy is a relatively rare injury and occurs in about one in every 1000 live births. In the modern literature, it is rare to find more than one affected child in the same family. In this paper, we report on obstetric palsy in two subsequent deliveries from the same woman. Medicolegal aspects, a review of the literature and recommendations for prevention of this injury are discussed. CASE PRESENTATIONS Case 1A four-year-old girl presented to the brachial plexus clinic in Riyadh, Saudi Arabia with residual left total birth palsy. She was born vaginally at another institution after a full term uncomplicated pregnancy. The presentation was vertex, and delivery was difficult and complicated by shoulder dystocia. At birth, left total birth palsy and an ipsilateral clavicular fracture were evident. Birth weight was 4.4 kg. Good recovery of the motor power occurred, but the functional use of the limb was impaired because of an internal rotation contracture of the shoulder. Rotation osteotomy of the humerus was performed with no complications. Case 2A two-year-old boy (brother of case 1) presented at the brachial plexus clinic in Riyadh with residual left Erb's palsy. He was born vaginally at another institution (same CAN