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 th e same complication in subsequent deliveries. However, none of the stu dies in the literature have actually attempted to estimate how high is that risk. The aims of the current paper were to investigate obstetri c brachial plexus injury in subsequent deliveries and to study other f actors associated with birth palsy, perinatal morbidity, mortality, an d motor recovery of the brachial plexus. We reviewed retrospectively t he records of 28 consecutive multiparas who presented with their child ren to our brachial plexus clinic from 1994 to 1995. Eight of the 28 m ultiparas gave birth to one or more children after having a newborn wi th brachial plexus birth palsy. These 8 mothers were delivered of a to tal of 16 newborns with brachial plexus injury. Injury was associated with vaginal mode of delivery, gestational diabetes, instrumental deli veries, and fetal macrosomia. One neonatal death and significant perin atal morbidity were observed in the affected newborns. Seven newborns (44%) had total birth palsy and the remaining 9 had Erb's palsy. Excel lent 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 t he same complication in subsequent deliveries and consideration may be given to delivery of subsequent macrosomic babies by cesarean section .