BRACHIAL-PLEXUS PALSY ASSOCIATED WITH CESAREAN-SECTION - AN IN-UTERO INJURY

OBJECTIVE: Brachial plexus injury may be unrelated to manipulations pe rformed at the time of delivery, occurring in the absence of shoulder dystocia and in the posterior arm of infants with anterior shoulder dy stocia. To further support the hypothesis that some of these nerve inj uries appear to be of intrauterine origin, we present a series of brac hial plexus palsies associated with atraumatic cesarean delivery among fetuses presenting in the vertex position. STUDY DESIGN: We performed a computerized search of ail deliveries from 1991 to 1995 for the dis charge diagnoses of brachial plexus injury and cesarean section. Inclu sion criteria included cephalic presentation at the time of delivery a nd the absence of traumatic delivery. RESULTS: We noted six cases of E rb's palsy, with four palsies in the anterior shoulder and two in the posterior arm. Among those five patients undergoing cesarean section b ecause of labor abnormalities, two had uterine cavity abnormalities wh ereas one had a prolonged second stage of labor. One brachial plexus p alsy occurred in the absence of active labor. All nerve injuries were persistent at age 1 year. CONCLUSIONS: Brachial plexus palsy can be as sociated with cesarean delivery. Such palsies appear to be of intraute rine origin and are more likely to persist.