Brachial plexus injuries are an interdisciplinary challenge to obstetricians, neonatologists and plexus surgeons. The incidence of brachial plexus injuries is 1-4/1,000 live births, and the incidence of permanent lesions has been estimated to be 1/10,000 live births. Shoulder dystocia is associated with a 75-100-fold increase in plexus injuries. The antenatal (intrauterine) development of brachial plexus injuries is still a matter of controversial debate. The early recognition of antenatal risk factors of shoulder dystocia and its proper management by experienced obstetricians are mandatory; 90% of brachial plexus injuries recover without clinical sequelae for the newborn, however, 10% of the cases may lead to severe pareses requiring surgical intervention. Microsurgical nerve reconstruction should be performed in these cases within the first three months after birth. In this context, the intraoperative findings are of high prognostic relevance. The pathophysiology of birth-associated plexus brachialis injuries has been investigated in recently published experimental studies. An open dialogue between the specialists involved may be a great support for the parents of newborns suffering from plexus brachialis injuries. Medico-legal conflicts lasting for years should be avoided, and appropriate plexus surgical treatment by an experienced surgeon should be offered in good time after a careful diagnosis.
Georg Thieme Verlag KG Stuttgart-New York.