PDF herunterladen
Am J Perinatol 2003; 20(6): 289-292
DOI: 10.1055/s-2003-42775
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Brachial Plexus Paresis Associated with Fetal Neck Compression from Forceps

Alfredo F. Gei, Russell A. Smith, Gary D.V. Hankins
  • Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
06. Oktober 2003 (online)

    Lizenzen und Reprints

ABSTRACT

Instrumental vaginal deliveries have been associated with higher risks of brachial plexus injuries. The proposed mechanisms involve the indirect association of instrumental deliveries with shoulder dystocia and nerve stretch injuries secondary to rotations of 90 degrees or more. We present a brachial plexus paresis resulting from direct compression of the forceps blade in the fetal neck. A term infant was delivered by a low Kielland forceps rotation. No shoulder dystocia was noted. The immediate neonatal exam revealed an Erb's palsy and an ipsilateral bruise in the lateral aspect of the neck. The paresis resolved during the first day of life. Direct cervical compression of the fetal neck by forceps in procedures involving rotations of the presentation may result in brachial plexus injuries.

KEYWORDS

Brachial plexus paresis - forceps - fetal neck compression - Kielland forceps - Erb's palsy

REFERENCES

  • 1 Gilbert W M, Nesbitt T S, Danielsen B. Associated factors in 1611 cases of brachial plexus injury.  Obstet Gynecol . 1999;  93 536-540
    CrossrefPubMedGoogle Scholar
  • 2 Perlow J H, Wigton T, Hart J, Strassner H T, Nageotte M P, Wolk B M. Birth trauma: a five year review of incidence and associated perinatal factors.  J Reprod Med . 1996;  41 754-760
    PubMedGoogle Scholar
  • 3 McFarland L V, Raskin M, Daling J R, Benedetti T J. Erb/Duchenne's palsy: a consequence of fetal macrosomia and method of delivery.  Obstet Gynecol . 1986;  68 784-788
    PubMedGoogle Scholar
  • 4 Levine M G, Holroyde J, Woods J R, Siddiqi T A, Scott M, Miodovnik M. Birth trauma: incidence and predisposing factors.  Obstet Gynecol . 1984;  63 792-795
    PubMedGoogle Scholar
  • 5 Hughes C A, Harley E H, Milmoe G, Bala R, Martorella A. Birth trauma in the head and neck.  Arch Otolaryngol Head Neck Surg . 1999;  125 193-199
    CrossrefPubMedGoogle Scholar
  • 6 Nocon J J, McKenzie D K, Thomas L J, Hansell R S. Shoulder dystocia: an analysis of risks and obstetric maneuvers.  Am J Obstet Gynecol . 1993;  168 1732-1739
    PubMedGoogle Scholar
  • 7 Hankins G DV, Leicht T, Van Hook J, Uckan E. The role of forceps rotation in maternal and neonatal injury.  Am J Obstet Gynecol . 1999;  180 231-234
    PubMedGoogle Scholar
  • 8 Pearl M L, Roberts J M, Laros R K, Hurd W M. Vaginal delivery from the persistent occiput posterior position: influence on maternal and neonatal morbidity.  J Reprod Med . 1993;  38 955-961
    PubMedGoogle Scholar
  • 9 Jennett R J, Tarby T J, Kreinick C J. Brachial plexus palsy: an old problem revisited.  Am J Obstet Gynecol . 1992;  166 1673-1677
    CrossrefPubMedGoogle Scholar
  • 10 Dunn D W, Engle W A. Brachial plexus palsy: intrauterine onset.  Pediatr Neurol . 1985;  1 367-369
    PubMedGoogle Scholar
  • 11 Gherman R B, Goodwin T M, Ouzounian J G, Miller D A, Paul R H. Brachial plexus palsy associated with cesarean section: an in utero injury?.  Am J Obstet Gynecol . 1997;  177 1162-1164
    PubMedGoogle Scholar
  • 12 De Chalain M T, Clarke H M, Curtis C G. Case report: unilateral combined facial nerve and brachial plexus palsies in a neonate following a midlevel forceps delivery.  Ann Plast Surg . 1997;  38 187-190
    PubMedGoogle Scholar
      >