Obstetric paralysis: causes, symptoms, treatment, consequences

Injuries that are associated with labor are called obstetric paralysis or postpartum paresis. They are not always associated with a mistake or incorrect actions of the doctor during the operation, in some cases, such an injury can be detected in advance. In the world for 1000 newborns, there are two children born with obstetric paralysis.

Nature of the problem

This is a consequence of the birth injury of newborn children, in which damage to the brachial plexus and cervical roots is observed. Particularly common is the development of upper paralysis, which is called Duchenne-Erb paralysis. The name comes from the names of the French neurologist Duchenne and the German doctor Erb, since it was they who discovered and studied this pathology in the 19th century. The problem is still relevant today, despite modern technology and medical advances in the field of obstetric care.

Causes

The development of obstetric paralysis in most cases is caused by the manipulation of doctors in difficult births that occur in the following cases:

1. Gluteal presentation of the fetus. In this case, during childbirth, the baby's chest and collarbone are damaged.
2. Heavy removal of the baby from the birth canal if the baby is too large, that is, weighs more than four kilograms, while the size of the fetal head exceeds the permissible parameters.
3. Narrow hips and a small basin of a woman in childbirth.
4. Exceeding the allowable norm for the baby in the birth canal due to hypoxia.

In these cases, the gynecologist must use some additional measures or tools that can lead to the development of birth injuries in newborns. These causes of obstetric paralysis include:

1. Squeezing the fetus, in which pressure is applied to the upper abdomen by hands, helping to promote the fetus through the birth canal.
2. Use of obstetric forceps.
3. Damage to the sternocleidomastoid muscle, which also leads to obstetric paralysis of newborns. In addition, it is such damage in most cases that causes torticollis.

Symptoms

After the completion of the birth process, the child is examined by the anesthetist and neonatologist for birth injury in the newborn. Doctors should evaluate the condition of a newly born baby on the Apgar scale, one of the criteria of which is the mobility of the lower and upper limbs. That is, birth trauma can be diagnosed at the very first examination of the baby.

1. The presence of pathology is indicated by the immobility of the baby’s upper limb when touched, in addition, the affected area of ​​the limb prevents it from bending or unbending correctly, it simply hangs along the body.
2. A decrease in sensitivity or its complete absence in the affected limb is one of the signs of the presence of obstetric paralysis. Diagnosis is by tapping with a medical hammer.
3. The absence of a mouth reflex, that is, the child does not even try to suck a finger, also indicates a birth injury in a newborn.
4. With such a diagnosis as Duchenne-Erb paralysis, the baby’s shoulder is turned inside out, the hand looks like a doll’s limb, the shoulder blade is shifted relative to the spine, while the movements of the fingers are fully preserved, and the head bends to the affected side.
5. With paralysis, Degerin-Klumpke, the arm is turned inward, and the hand hangs and does not react to anything. The fingers do not work with such paralysis, in most cases the hand takes the form of a “clawed paw”, that is, the phalanges of the fingers are in a bent state and do not bend.
6. With obstetric paralysis, blood supply to the affected limb is disturbed, as evidenced by the fact that the hand is cold to the touch.
7. In addition, with this type of paralysis, the patient suffers hypoxia, resulting in an acute lack of oxygen, which leads to damage to the baby’s brain. All this is manifested by trembling of the baby's limbs, increased nervous excitability and constant crying.

Classification

Paralysis is classified based on the location of the lesion. Thus, there are three types of birth injuries that can subsequently provoke flaccid paralysis of the muscles of the upper limbs.

1. Upper. This type of pathology, or as it is also called Duchenne-Erb paralysis, is the result of a birth injury to the nerve endings of the upper spinal cord and cervical vertebra.
2. Lower. Dejerine-Klumpke paralysis or lower obstetric paralysis develops due to damage to the nerve endings of the lower cervical vertebra and spinal cord.
3. Total paralysis of the upper extremities is the most severe form of pathology that affects the entire upper limb of a newborn.

Pathology stages

There are three stages of obstetric paralysis, which pass one into the other:

1. Acute period. This stage of the disease occurs immediately after the injury and lasts for one month. The arm is extended along the body, the fingers are bent. There is no way to bend the arm at the elbow, raise it or turn it. The child has a weakened grasping and mouth reflex. Compared to a healthy limb, the affected arm has a lighter skin tone.
2. Recovery period. How the recovery period will proceed depends on what kind of injury was and how correctly and timely all therapeutic measures were taken and performed. If the injury was mild, then the child will gradually increase the number of movements to the full extent, the sensitivity returns fully. But, despite this, in a child by the age of three, some shortening of the affected limb becomes noticeable, the muscles on this arm will always be slightly weaker than on the healthy one.
3. The period of residual phenomena. This stage of the disease is an incomplete restoration of the affected limb. In severe Duchenne-Erb paralysis, the child develops a “puppet arm” syndrome in which a groove runs between the affected shoulder and chest. The hand remains bent, the fingers are not fully extended. Muscle atrophy in the shoulder joint in most cases leads to dislocation or subluxation of the shoulder, asymmetry is pronounced. Over time, this asymmetry of the shoulder joint leads to curvature of the spine and the development of scoliosis.

Diagnostics

Diagnostic measures to detect paralysis in a newborn baby are carried out in the first days after it is born. Since in the first days of a child’s life with mild obstetric paralysis, the symptoms may not be very clearly detected, special methods or tests can be used to identify the pathology, one of which is dropping the baby’s arms when it is placed horizontally face down on the doctor’s hands.

For an accurate determination, differential diagnostic methods may be required, in which the presence of pathologies such as osteomyelitis, polio, congenital hemigipoplasia, collarbone fracture, Parro pseudo-paralysis is detected. X-rays and electromyography are mandatory for obstetric paralysis.

Conservative therapy

All therapeutic measures to eliminate obstetric paralysis are traditional, but for each patient a set of necessary measures is individually selected based on the location of the damage and its severity. From the day of birth and until complete recovery, the child should be under the mandatory supervision of a neurologist.

Drug treatment includes injections of B vitamins, in particular vitamins B ₁ and B ₁₂ , proserin, aloe. The dosage of drugs should be observed very clearly and appropriate to the age of the patient. In most cases, these drugs are combined with antispasmodic drugs, namely: “Eufillin” and “Papaverine”. In some cases, doctors use nootropic drugs in combination with the rest of the therapy to stimulate nervous processes.

A plaster cast or abduction splint is often applied to relax the shoulder girdle. In this case, the shoulder is bent backward or to the side, in accordance with the affected area.

Effective in the treatment of obstetric paralysis are electrophoresis, mud applications. If, along with this pathology, the child has a torticollis, then applications should be applied to the collar zone too. With physiotherapy, it is effective to use paraffin and hot wraps.

Massage with obstetric paralysis plays a large role in therapy. For children, it is developed according to a special technique. It is important to remember that only a highly qualified and trusted specialist should do this massage for a newborn from 0 years old.

Surgical intervention

A surgical operation performed with obstetric paralysis is prescribed if conventional therapy did not bring the desired result. Such operations can be performed no earlier than the baby turns six months old.

The outcome of surgery to eliminate obstetric paralysis is often always favorable. However, the patient for the rest of his life should not engage in sports activities and exclude heavy physical labor, in which the shoulder girdle can be used.

Possible consequences and complications

The consequences of obstetric paralysis can be very diverse, it all depends on the severity of the disease and its form. The mild form is almost always cured completely, with an average and severe form, the patient has to limit himself in some actions throughout his life. The most severe form may result in disability for a small patient.

Forecast

The prognosis for such a disease completely depends on how quickly and timely therapeutic measures were started and on the degree of damage. Upper and lower obstetric paralysis can be completely cured, but only if the treatment was started on time and all the necessary procedures were carried out.

Total paralysis is incurable, but amenable to slight correction, but this can be achieved by long and painstaking treatment for several years. If treatment is not started on time, then bone deformation may begin. As a result, underdevelopment of the joint or its complete atrophy becomes noticeable on the affected arm.

Prevention

The main method for the prevention of obstetric paralysis is to contact only trusted, highly qualified specialists who can ensure the proper management of childbirth. Another way to prevent pathology is to remove the baby from the womb through cesarean section.

Obstetric paralysis is a very serious pathology, which in no case can be ignored. Only a quick response to the problem and timely therapy will help the child to live a full life in the future, in most cases, the child has to constantly limit himself to some actions.