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Post-delivery brachial plexus injury in neonates: A case series

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MedPharmRes, 2019, 3  
MedPharmRes  
journal of University of Medicine and Pharmacy at Ho Chi Minh City  
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Case series  
Post-Delivery Brachial Plexus Injury in Neonates: A Case Series  
Vo Minh Tuana*, Bui Thi Hong Nhub, Nguyen Ba My Nhib, Tran Diep Tuana  
aUniversity of Medicine and Pharmacy at HCMC, 217 Hong Bang, District 5, Ho Chi Minh City, Vietnam;  
bTu Du hospital, 284 Cong Quynh, District 1, Ho Chi Minh City, Vietnam.  
Received Jan 02, 2019: Revised Jan 16, 2019: Accepted Feb 01, 2019  
Abstract: %UDFKLDOꢀSOH[XVꢀLQMXU\ꢀLQꢀQHRQDWHVꢀLVꢀDꢀUDUHꢀREVWHWULFDOꢀFRPSOLFDWLRQꢉꢀEXWꢀLWꢀFDQꢀFDXVHꢀKXJHꢀDQ[LHW\ꢀWRꢀ  
parents if occurring and sometimes leading to legal disputes in obstetrical practice. Trauma during birth delivery  
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injury in our study included large fetus, interventional delivery, prolonged second stage of labor and shoulder  
dystocia. All the cases were treated with physiotherapy and recovered after 3 - 6 months. Family counseling and  
infants’ recovery played an important role in the management of those cases.  
Keywords: %UDFKLDOꢀSOH[XVꢎꢀGHOLYHU\ꢎꢀLQMXU\ꢉꢀSK\VLRWKHUDS\ꢎꢀQHRQDWDOꢂ  
1. INTRODUCTION  
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by studies. This injury may spontaneously recover, data  
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comes from the anterior and posterior spinal horns, integrates  
in spinal canal and goes out through intervertebral foremen  
(Figure 1). That is why the most accepted cause of brachial  
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This action will increase cervico-shoulder angle causing  
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dystocia [1].  
Figure 1. 'LVWULEXWLRQꢀRIꢀEUDFKLDOꢀSOH[XVꢂ  
*Address correspondence to Vo Minh Tuan at University of Medicine and  
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© 2019 MedPharmRes  
Post-Delivery Brachial Plexus Injury in Neonates  
MedPharmRes, 2019, Vol. 3, No. 1  
9
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III) and none of serious injury (Grade II). All those cases were  
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forceps deliveries) and two cesarean sections. There were  
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births. Female infants accounted for 6 and the remaining 4  
were male. There was one transverse fetal presentation only  
among ten cases, and it was delivered through cesarean  
section, the rest was cephalic presentation. The cases with  
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cases. All the cases had unilateral injury and were treated with  
physiotherapy. Almost all infant patients were monitored at  
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(Table 2).  
in obstetrics and new-borns with 2,000 patient beds. Tu Du  
is a central level hospital providing treatment, training and  
research services. The hospital is appointed by the Ministry of  
Health as the highest level of referral for 32 provinces/towns  
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born here each year. In clinical practice, we found many cases  
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without history of shoulder dystocia.  
2. CASE SERIES  
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recruited those cases by using total sampling method. All  
ten cases without history of shoulder dystocia were selected  
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All the injured arms or hands were recovered well without  
any sequela or limited movement.  
3. DISCUSSION  
ꢀ
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include obesity, diabetes mellitus, history of large fetus  
delivery, shoulder dystocia and history delivery of brachial  
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postures and functions (Table 1), there were seven cases with  
minor injury (Grade IV), three with moderate injury (Grade  
Table 1. The Mallet grading system for shoulder function.  
Grade I  
Flail shoulder  
Grade II  
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Grade III  
Grade IV  
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Normal shoulder  
Grade V  
Table 2. &DVHꢀSUR¿OHV  
No Sex Gestational Weight  
age at birth  
Risk factors  
Management Outcomes  
1
2
F
F
3UHꢁWHUP  
Full term  
Full term  
Full term  
Full term  
Full term  
Full term  
3UHꢁWHUP  
Full term  
Full term  
2100g Twin  
Recovered  
Recovered  
Recovered  
Recovered  
Recovered  
Recovered  
Recovered  
Recovered  
Recovered  
Recovered  
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3K\VLRWKHUDS\ꢀ  
3K\VLRWKHUDS\  
3K\VLRWKHUDS\  
3K\VLRWKHUDS\  
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3K\VLRWKHUDS\  
3K\VLRWKHUDS\  
3K\VLRWKHUDS\  
3K\VLRWKHUDS\  
ꢈꢇꢊꢊJ 3URORQJHGꢀꢈnd stage, forceps delivery  
3400g Cesarean section, fetal distress  
3000g Forceps delivery  
ꢌꢍꢋꢊJ 3URORQJHGꢀꢈnd stage, forceps delivery, large fetus  
ꢆꢊꢋꢊJ Forceps delivery, large fetus  
3700g Large fetus  
3
M
F
4
ꢋ
M
F
6
7
M
M
F
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ꢈꢍꢊꢊJ Cesarean section, transverse presentation, Adenomyosis  
ꢌꢋꢊꢊJ 3URORQJHGꢀꢈnd stage, forceps delivery.  
ꢆꢋꢊꢊJ Large fetus  
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10  
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MedPharmRes, 2019, Vol. 3, No. 1  
Vo et al.  
one case with pregnancy diabetes only, and no cases with  
history of large fetus delivery, shoulder dystocia [2]. As per  
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maternal diabetes mellitus had no relation with newborn  
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[4]. However, the history of large fetus delivery or shoulder  
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pregnancies [4].  
correlation between the second stage duration and brachial  
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Interventional delivery was demonstrated as an independent  
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nine-fold [7] (Figure 2). Cesarean section can partly protect,  
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there were two cases with cesarean section of which one case  
was transverse presentation in adenomyosis uterus and the  
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case was emergency cesarean section due to fetal distress in  
non-obese and non-diabetic mother, cephalic presentation,  
with birthweight of 3400g. In 2016, Mohammad M. Al-  
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dystocia often occurs in newborn with heavy weight, but still  
in newborn with moderate birthweight. Other studies reported  
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prolonged second stage of labor, interventional delivery,  
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injury only in breech delivered newborns with gestational age  
On the newborn end, together with shoulder dystocia,  
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All our cases were detected early after birth mainly based  
on history of newborn dystocia, interventional delivery,  
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Figure 2. Traumatic mechanism in forceps delivery  
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delivery [6]. In our study there were no breech deliveries,  
three cases of prolonged second stage of labor. However, the  
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Post-Delivery Brachial Plexus Injury in Neonates  
MedPharmRes, 2019, Vol. 3, No. 1  
11  
Author details:ꢀ ꢑꢃꢒꢀ 0'ꢉꢀ 3K'ꢉꢀ )DFXOW\ꢀ RIꢀ 0HGLFLQHꢉꢀ  
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Ho Chi Minh City, Vietnam.  
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had signs of mobility imbalance in two arms or such labor  
problems as shoulder dystocia, clavicle fracture, humeral  
fracture and so on; second, those infants need to be referred  
to relevant specialty institutions within one month after birth  
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be collaboration between internal medicine physician and  
neuro-surgery physician in the management of brachial  
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Acknowledgements: :HꢀDUHꢀLQGHEWHGꢀWRꢀWKHꢀSDUWLFLSDQWVꢀ  
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Competing interests: The authors declare that they have  
no competing interests.  
X-ray is the imaging method of choice, and can reveal  
clavicle or humeral fracture, or even shoulder dislocation.  
MRI and electromyograph are less frequently used, and for  
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physiotherapy may well improve the infant’s motility  
capacity [10]. In our ten cases, all were well improved in  
motility after treatment. According to studies, recovery  
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injury detection and therapy approach. By some studies, the  
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Availability of data: Data of 10 medical records are  
available upon request to the corresponding author.  
Ethics approval and consent to participate: Informed  
consent was obtained from all patients’ parents. The data was  
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processing and write up.  
Funding: Nil.  
REFERENCES  
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4. CONCLUSION  
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in obstetrical practice, almost all cases are self-recovered.  
However, if serious injuries are ignored or late detected,  
recovery may be slow or long-term complications may remain  
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be happened even though infant delivered without history  
of shoulder dystocia. Therefore, in obstetrical practice, it  
should be early detected for maternal characteristics (such as  
diabetes mellitus, obesity), fetal characteristics (such as large  
fetus, clavicle fracture) and labor issues (such as abnormal  
presentations, prolonged labor, assisted delivery...) to set up  
appropriate management. As a result, newborn injuries in  
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ACKNOWLEDGEMENTS  
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Authors’ contributions: Tuan Vo, Nhi Nguyen, Tuan  
Tran contributed to the design of the study, data interpretation  
conduct and analyses of the research and critically revised the  
manuscript. Nhu Bui contributed to the design of the study,  
data collection and drafted the manuscript. All authors read  
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