What is an obstetric brachial plexus injury?

Obstetric brachial plexus injury (OBPI) is a condition that affects newborns, typically occurring during childbirth. The brachial plexus is a network of nerves located in the neck and shoulder area, responsible for controlling movement and sensation in the arm, hand, and fingers.

When these nerves are stretched, compressed, or torn during delivery, it can lead to varying degrees of weakness, loss of sensation, or paralysis in the affected arm. OBPI is often associated with difficult deliveries, particularly those involving shoulder dystocia, where the baby’s shoulder becomes lodged behind the mother’s pelvic bone during birth.

Risk factors

Several risk factors can contribute to OBPI. A larger-than-average baby, prolonged labour, or the use of instruments like forceps or vacuum extraction can increase the likelihood of this injury.

Mothers with diabetes or those who have previously given birth to large babies are also at higher risk. However, even with these risk factors, it is important to note that OBPI is relatively rare and often preventable with proper obstetric care.

The severity of obstetric brachial plexus injuries varies widely, ranging from mild to severe. In mild cases, the nerves are stretched but not torn, allowing for spontaneous recovery within weeks to months. However, in more severe cases, the nerves may be torn or detached from the spinal cord, leading to more long-term complications, such as muscle weakness or permanent loss of function in the affected arm.

Treatment

Treatment for OBPI depends on the extent of the injury. In many cases, physical therapy is sufficient to promote recovery by helping to maintain the range of motion and strengthen the affected muscles. For more severe injuries, surgery may be necessary to repair the damaged nerves.

This may involve nerve grafts, nerve transfers, or other specialized procedures. Early intervention is crucial to optimize outcomes, so it is important for parents to seek prompt medical attention if OBPI is suspected. While the prognosis for obstetric brachial plexus injury varies, with appropriate care and intervention, many children regain significant function over time.