Cases reported "Paralysis, Obstetric"

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1/29. Long-term results of multiple muscle transfer to reconstruct shoulder function in patients with birth palsy: eleven-year follow-up.

    We evaluated the long-term clinical results of multiple muscle transfer for reconstruction of shoulder function in 10 patients with birth palsy. Multiple muscle transfer consists mainly of Harmon's deltoid shift, Ober's biceps muscle transfer, and Hoffer's latissimus dorsi muscle transfer. The follow-up ranged from 5 to 14 years with an average of 10.5 years. Two of the 10 patients showed no improvement, one due to severely atrophied latissimus dorsi muscle, and the other who had not received Hoffer's latissimus dorsi muscle transfer. Except for these two patients, an averaged flexion and external angles were 114 degrees and 25 degrees, respectively. Harmon's deltoid shift and Hoffer's latissimus dorsi muscle transfer for reconstruction of shoulder function in patients with birth palsy have proven to be a useful method in reconstructing and maintaining the function of active elevation and external rotation of the shoulder. ( info)

2/29. Management of obstetric brachial plexus palsy.

    OBPP is a disease with deleterious medical, psychological, and socioeconomic sequelae for the patient and his or her family. The majority of patients show acceptable spontaneous recovery with nonoperative management, which includes aggressive physical rehabilitation and electrical stimulation. There are patients with guarded prognosis, however, who have no chance of recovery unless they undergo early aggressive surgical reconstruction of the injured brachial plexus. It is of great importance to diagnose the injury type as early as possible, especially if there is minimal recovery in the early weeks of follow-up. This allows timely reconstruction to take place, earlier than 3 months for global palsy cases and at 3 months in Erb's type lesions, for best functional results. ( info)

3/29. Upper cervical spinal cord injury in neonates: the use of magnetic resonance imaging.

    Neonatal upper cervical spinal cord injury is associated with rotational forceps delivery and presents with quadriparesis and diaphragmatic paralysis. The underlying pathology determines neurologic outcome but is difficult to assess clinically or with simple radiographic techniques. We report 4 cases in which early magnetic resonance imaging demonstrated the extent and severity of the injury and guided management. ( info)

4/29. Modified Zavanelli maneuver for the alleviation of shoulder dystocia.

    BACKGROUND: The Zavanelli maneuver has typically been instituted when conventional maneuvers have failed to alleviate shoulder dystocia. Previously reported cases involving the Zavanelli maneuver have described cephalic replacement followed by immediate cesarean delivery. CASE: We encountered a case in which, despite the McRoberts maneuver, suprapubic pressure, wood's corkscrew manuever, and attempted extraction of the posterior fetal arm, the baby could not be delivered. The fetal vertex was partially reinserted into the vagina, and this dislodged the impacted shoulders. With expulsive efforts the mother was then able to achieve vaginal delivery of a 3870 g female infant.CONCLUSION: The modified Zavanelli maneuver may be used to successfully alleviate shoulder dystocia. ( info)

5/29. Obstetrical brachial plexus palsy.

    Since the days of Hippocrates, scripts have included descriptions of infants who were unable to move their arms. However, it was not until the mid-1700s that an obstetric cause for the paralysis was considered. In 1872, the term obstetrical brachial plexus palsy was coined when a correlation was made between excessive traction on the brachial plexus during delivery and the clinical finding of arm paralysis. Surgical intervention became the norm in the beginning of the 19th century and continued until 1930. Poor outcomes and spontaneous resolution of obstetrical brachial plexus palsy prompted a 40-year span of conservative treatment. By the late 1960s, advances in technology and microsurgical techniques revived interest in surgical intervention in the management of obstetrical brachial plexus palsy. This article focuses on obstetrically caused brachial plexus injury, including risk factors, clinical presentation, and treatment options and outcomes. An understanding of current medical practices and their outcomes also provides a basis on which to develop sound support strategies to help parents who face this dilemma. ( info)

6/29. brachial plexus paresis associated with fetal neck compression from forceps.

    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. ( info)

7/29. Obstetrical lumbosacral plexus injury.

    Injuries to the lumbosacral plexus during labor and delivery have been reported in the literature for years, but have lacked electrophysiologic testing to substantiate the location of the nerve injury. We report 2 cases with comprehensive electrophysiologic testing which localizes the site of this obstetrical paralysis to the lumbosacral trunk (L4-5) and S-1 root where they join and pass over the pelvic rim. The paralysis may be mild or severe. Small maternal size, a large fetus, midforceps rotation, and fetal malposition may place the mother at risk for this nerve injury. ( info)

8/29. Temporary Erb-Duchenne palsy without shoulder dystocia or traction to the fetal head.

    BACKGROUND: Although many retrospective studies report that brachial plexus palsies occur after vaginal delivery in the absence of recorded shoulder dystocia, there are no known prospective reports by a treating clinician (pubmed, English language only, 1952-June 2004, search terms: shoulder dystocia, nonshoulder dystocia, obstetric brachial plexus injury, Erb's palsy, Erb-Duchenne palsy, spontaneous vaginal delivery). CASE: A multiparous patient presented with a birth plan requesting that the baby be allowed to deliver on its own, without traction on the head and without suctioning. Although induced at term for elevated blood pressure, the otherwise healthy patient experienced a normal labor with a 30-minute second stage. At delivery, which was videotaped by the father, the fetal head presented over an intact perineum in a right-occiput-anterior position. Without traction, the anterior shoulder delivered spontaneously with the next contraction and Valsalva, followed by the posterior shoulder. The trunk followed routinely. The average-weight for gestational age neonate exhibited an Erb-Duchenne palsy of the right (posterior) arm that resolved on the fourth day of life. CONCLUSION: Temporary Erb-Duchenne palsy can occur in the posterior arm after normal labor and spontaneous delivery without shoulder dystocia or traction on the fetal head. ( info)

9/29. spinal cord implantation with acidic fibroblast growth factor as a treatment for root avulsion in obstetric brachial plexus palsy.

    Nerve root avulsion carries the worst prognosis among brachial plexus injuries and remains a great challenge for surgeons to repair. In this case, a boy with complete avulsion of the left-side C6 root presented with flaccid paralysis of the left arm after birth. As there was no significant spontaneous recovery, the patient underwent operation when he was 6 months old. One end of the nerve graft from the sural nerve was anastomosed with the avulsed C6 root, and the other end was implanted into the ventrolateral aspect of the spinal cord with fibrin glue containing acidic fibroblast growth factor. After 2 years of follow-up, there has been significant improvement in motor function and in electrophysiologic studies over the left upper limb. ( info)

10/29. Long-term results of primary repair of brachial plexus lesions in children.

    The results of brachial plexus reconstruction in adults are poor, despite the sophistication of the various methods used. However, the same methods used in neonates after obstetrical brachial plexus injury will give far better results because of the shorter distance, stronger potential of regeneration, and capacity of brain adaptation. Complete paralyses, associated root ruptures, and avulsions are very severe, and the end results cannot be evaluated before the end of growth. Although the end results show that the shoulder and elbow do not do as well as in upper-type lesions, the results at the level of the hand are encouraging, showing 75% with useful function after 8 years, even in patients with avulsion injuries of the lower roots. These results demonstrate the value of the early exploration and repair of the obstetric plexus. We also review our series of traumatic brachial plexus palsy in children. The results are poorer than in neonates, where may be related, in part, to a greater percentage of associated lesions in these patients. ( info)
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