Brachial Plexus Injuries
Brachial plexus is a collection of nerves that exit the spinal cord in the neck, and supply the nerve impulses to the arms. If the head is twisted or bent to an extreme degree during the process of a vaginal delivery, these nerves can be stretched and damaged to an extent that results in a partial or complete paralysis of the arm on the side affected. This paralysis is also called Erb’s palsy, and it is usually related to the delivery of a large baby where the body of the baby is too large to fit through the birth canal after the delivery of the head. Since the head is normally the largest part of the baby at delivery, when the head is delivered the rest of the body usually follows quickly and without difficulty. However, in cases where the baby is large, usually greater than 4000 grams (or about 8½ pounds), the body is somewhat larger and it may not easily move through the birth canal. When a baby's head or body is too large to fit through the mother's pelvis, it is known as cephalopelvic disproportion (CPD).
If the baby is too large to easily fit through the birth canal, and if this condition is not recognized by the obstetrician before the process of delivery occurs, then the delivery will be difficult, which is known as dystocia. Because the shoulder of the baby becomes trapped behind the pelvic bone after the head is delivered, this condition is more commonly referred to as a shoulder dystocia. When this occurs, the obstetrician must utilize certain maneuvers to attempt to deliver the impacted shoulder. It is during this process that the nerves in the brachial plexus can become stretched. In severe cases the nerves can be pulled from their attachment to the spinal cord, which is known as an avulsion. In such cases, the effect will usually cause complete paralysis of the arm and hand, and at birth the baby can be seen to have a limp arm.
Although it may be difficult to diagnose a cephalo-pelvic disproportion in a patient before the process of delivery occurs, a prolonged or difficult labor without adequate progress over time can be an indication for this condition. When diagnosed, the baby should be delivered by C-section to avoid the likely trauma at birth. The possibility of a larger than normal baby is often associated with gestational diabetes, and all women require some basic minimum level of testing for this condition during the pregnancy. When
gestational diabetes is diagnosed during the pregnancy, the obstetrician and the patient should strongly consider delivery by C-section to avoid injury to the baby.
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