Brachial plexus palsy: An in utero injury?

Acquired brachial plexus injury historically has been linked with excessive lateral traction applied to the fetal head, usually in association with sh oulder dystocia. Recent reports in the obstetric literature, however, have suggested that in utero forces may underlie a significant portion of these injuries. Brachial plexus palsies may therefore precede the delivery itself and may occur independent of the actions of the accoucheur. Thus we propos e that the long-held notions of a traction-mediated pathophysiologic mechan ism for all brachial plexus injuries warrant critical reappraisal. (Am J Ob stet Gynecol 1999;180:1303-7.).