OBSTETRIC ANTECEDENTS OF SURGICALLY TREATED OBSTETRIC BRACHIAL-PLEXUSINJURIES

Objective To determine whether the anatomy of an obstetric brachial pl exus lesion (OBPL) is causally related to the preceding obstetric hist ory. Design Anatomical classification of the OBPL during reconstructiv e neurosurgical treatment in consecutive infants who had surgery for O BPL between 1986 and 1994 and relating these findings with the charact eristics of the preceding birth. Setting De Wever Hospital, Heerlen, T he Netherlands. Subjects All infants who had surgical treatment for OB PL between 1 April 1986 and 1 January 1994 (n = 130). Results An Erb's C5-C6 injury was preceded more frequently by a difficult breech birth (19/26 cases or 73 %). In contrast, the more extensive forms of Erb's palsy classified as a C5-C7 injury or a total palsy with a C5-T1 inju ry were observed more frequently after complicated cephalic birth (52/ 59 or 88 %, and 43/45 or 96 %, respectively). The extent of anatomical damage as expressed by the incidence of an avulsion of one or more sp inal nerves was 18/26 (69 %) in Erb C5-C6, 13/59 (22 %) in Erb C5-C7 a nd 21/45 (47 %) in total C5-T1 palsy. Conclusion The Erb's C5-C6 palsy , occasionally bilateral and/or complicated by phrenic nerve injury, w as the most frequent form of OBPL after a breech birth. The more exten sive form of Erb's palsy and the total palsy were observed more freque ntly after delivery in a cephalic presentation. The pure form of Erb's palsy and the total palsy were characterised by a higher incidence of nerve avulsions than the extensive form of Erb's palsy.