Among the complications of pregnancy, injuries that can affect the fetus during labor and delivery are of special attention. We talk about the obstetric brachial palsy the most serious form of injury that can occur during part, which can cause neurological damage in the upper limbs of the newborn. It is a condition that affects 1 in 1000 children and occurs mainly during natural childbirth complicated by dystociabut also the Caesarean section although it has less frequency of these lesions, it is not completely exempt from the risk of obstetric paralysis.
What is obstetric paralysis?
Strictly speaking, we speak of obstetric brachial plexus palsy in reference to the nerve injury that can affect the newborn’s arms, forearms, and hands. The neurological deficit is due to lesions of the brachial plexus, which is the set of nerves that derive from the nerve roots present in the cervical sections (the neck), in the upper part of the trunk (the torso) and in the spinal cord.
These nerves allow movements of the arm, wrists and hands and, also extending to the skinThey also perform a sensory function.
Obstetric paralysis: the causes
Obstetric brachial palsy occurs as a consequence of abnormal traction of the fetal head during the expulsive phase of labor , leaving the shoulder blocked by the maternal pelvis. This condition causes nerve fibers to stretch (rarely snap or rupture) in most cases, and there are several factors that can increase the risk of obstetric paralysis.
The main ones include macrosomía fetal , breech presentation, hypoxia, or fetal asphyxia, as well as a twin birth. All maternal factors related to the difficulty of the uterus to contract should also be considered, with abnormalities in the dilation of the birth canalwith the presence of uterine fibroids, pelvic defects, excess weight, short stature or non-gestational diabetes.
Prolonged labor and any kind of difficulty in childbirth, such as those that require the use of forceps or suction cups, are also risk factors for the onset of obstetric paralysis.
Obstetric paralysis: Symptoms
In the presence of obstetric brachial palsy, the newborn has the affected upper limb immobile , stretched along the trunk and without reacting to stimuli. Specifically, in higher forms of obstetric paralysis, the neurological deficit mainly affects the shoulder and arm and it appears to be adducted (with elbow extended) and internally rotated (rotated inward). In this way, the back of the hand faces downward and the baby maintains control of the movements of the wrist and hand.
In multiradicular forms, however, the neurological damage affects almost exclusively the hand. In these cases, the newborn has difficulty bending the wrist and fingers while maintaining movement of the shoulder The total forms of obstetric paralysis, on the other hand, involve the sum of the symptoms of the other two variants.
Obstetric paralysis: cures and remedies
The choice of the type of treatment (conservative or surgical) depends on the severity of the obstetric paralysis and requires careful clinical evaluation. Diagnosis is made through clinical examination of individual anatomical areas. involved, ultrasonography and magnetic resonance imaging of the brachial plexus and electroneurophysiological investigations.
The treatment of choice, if possible, is the conservative the objective of which is the spontaneous recovery of the brachial biceps between the third and ninth month of the child’s life. In the forms of total paralysis or in those in which spontaneous recovery does not occur within the indicated times, repair is used. microsurgical.
This is done by using nerve grafts or through neurotization techniques (the repair of a dormant nerve by connecting to a healthy nerve). In case of doubt about the advisability of resorting to early microsurgery, a posterior approach is assessed through which to proceed with a selective reinnervation of the deficient muscles.
The earlier the rehabilitative treatment, the greater the recovery capacity. These obviously also depend on the severity of the injury and are better in superior paralysis. Rehabilitation treatment is effective in preventing joint deformities only if it is done regularly.