Summary about Disease
Obstetrical palsy, also known as brachial plexus birth palsy (BPBP), is a paralysis or weakness of the arm caused by injury to the brachial plexus nerves during childbirth. The brachial plexus is a network of nerves that originates in the neck and shoulder and controls movement and sensation in the arm, hand, and fingers. The severity of the injury can range from mild stretching to complete avulsion (tearing) of the nerves from the spinal cord.
Symptoms
Symptoms vary depending on the severity and location of the nerve damage, but can include:
Weakness or paralysis in the arm or hand
Decreased movement or sensation in the arm or hand
Limp or paralyzed arm
Asymmetrical Moro reflex (startle reflex)
Abnormal positioning of the arm (e.g., internally rotated)
Clawed hand
Horner's syndrome (drooping eyelid, constricted pupil, decreased sweating on one side of the face) – usually associated with more severe injuries.
Causes
Obstetrical palsy is typically caused by stretching or tearing of the brachial plexus nerves during delivery. Risk factors include:
Large birth weight
Breech presentation
Shoulder dystocia (shoulder gets stuck during delivery)
Prolonged labor
Use of forceps or vacuum extraction during delivery
Maternal diabetes
Medicine Used
There is no specific "medicine" that cures obstetrical palsy. Treatment focuses on managing symptoms and promoting nerve recovery. Medications might include:
Pain relievers (analgesics) for discomfort
Muscle relaxants (in some cases)
Botulinum toxin (Botox) injections to manage muscle imbalances
Is Communicable
Obstetrical palsy is NOT communicable. It is a result of physical trauma during childbirth, not an infectious disease.
Precautions
Since obstetrical palsy is a birth injury, precautions primarily focus on minimizing risk factors during labor and delivery:
Careful monitoring during labor and delivery.
Proper management of shoulder dystocia.
Consideration of Cesarean section in high-risk cases (e.g., large baby, breech presentation).
Early physical therapy after birth to improve arm and hand function.
How long does an outbreak last?
Obstetrical palsy is not an infectious disease that has outbreaks. It is a condition resulting from a birth injury. The duration of symptoms and recovery varies widely depending on the severity of the nerve damage. Some babies recover spontaneously within a few months. Others require long-term therapy or surgery.
How is it diagnosed?
Diagnosis is typically made based on:
Physical examination: Assessing arm movement, reflexes, and sensation.
Review of the birth history: Identifying risk factors such as shoulder dystocia.
Electromyography (EMG): Measures the electrical activity of muscles to assess nerve function.
Nerve conduction studies: Measure the speed at which electrical signals travel through nerves.
Imaging studies (MRI or CT myelography): In severe cases, to visualize the brachial plexus nerves and spinal cord.
Timeline of Symptoms
At birth: Weakness or paralysis of the affected arm is typically noticed immediately.
First few weeks/months: Observation of spontaneous recovery (movement improving). Physical therapy may begin.
3-6 months: Assessment of progress. If there is little or no improvement, further intervention (e.g., surgery) may be considered.
Ongoing: Continued monitoring and therapy to maximize arm and hand function. Some degree of residual weakness or impairment may persist despite treatment.
Important Considerations
Early intervention is key: Starting physical therapy early can significantly improve outcomes.
Multidisciplinary approach: Treatment often involves a team of specialists, including pediatricians, neurologists, orthopedic surgeons, physical therapists, and occupational therapists.
Psychological support: Parents may need support to cope with the challenges of caring for a child with obstetrical palsy.
Long-term follow-up: Regular monitoring is important to assess progress and address any complications.
Variability in outcomes: The extent of recovery varies considerably from child to child.