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Opinions about the occurrence of this disease are divided:

. Damage to the brachial plexus occurs due to excessive stretching of the latter during childbirth or direct pressure from the obstetrician’s fingers on the neck area and pressing of the plexus between the collarbone and the first rib, which can occur during extraction of the fetus.

The cause of brachial plexitis in newborns is a fracture of the clavicle.

The cause is natal (birth) injuries of the spinal cord and cervical spine (A. Yu. Ratner)

The main objectives of rehabilitation of the affected hand are:

• Prevention of contractures in the joints of the affected limb

• Prevention of atrophy of the muscles of the arm, shoulder girdle, chest

• Improving blood circulation in the affected limb and its trophism

• Stimulation of active physiological movements in all joints of the hand.

Treatment by position

Treatment with position is one of the first rehabilitation and preventive measures carried out from the first days after the birth of a child.

• The child’s arm should be fixed in the following position: the shoulder is abducted by 60°, externally rotated by 45°, the arm is bent at the elbow joint by 100-110°, a cotton swab is inserted into the palm with bent fingers and bandaged. This position of the arm is ensured by positioning it so that the head of the humerus is in the glenoid cavity. The correct position of the hand is carried out in a special splint. In this case, one end of the splint is fixed on the back, the other fixes the arm with the shoulder abducted and the forearm bent upward (the placement of the child’s arm in the splint is done by an orthopedist in a clinic or orthopedic center).

In the first (acute) period of the disease, medication, physiotherapeutic treatment and therapeutic positioning of the limb are carried out.

Massage and exercise

Massage and exercise. In the acute period of the disease (up to 1.5 - 2 months), passive exercises are used for the affected limb.

• Before starting classes, you need to slightly warm the child’s shoulder joint with a warm diaper for 10 minutes, and then with warm hands do a light stroking and massage of the shoulder girdle, shoulder joint, and shoulder. Then proceed to very careful passive movements in all joints of the affected arm, combining these movements with a light stroking massage of the entire arm.

• Gradually they move on to massage the entire torso and limbs (according to the age and physical condition of the child) and perform some reflex exercises based on innate reflexes: Robinson, Babkin (upper), cervical-tonic reflexes.

• From the age of one month, massage is carried out in a differentiated manner. For paretic muscles: scapula, deltoid, triceps, supinators and extensors of the hand (except for the brachioradialis, as well as long back muscles), strengthening massage techniques are performed. For muscles with increased tone, arm flexors, which are prone to the rapid formation of flexion contractures, relaxing massage techniques are used, these are the subscapularis muscle, the muscles of the anterior surface, the chest (pectoralis major muscle), the biceps brachii muscle, and the brachioradialis muscle.

Passive gymnastics, movements in the hand

First of all, it is necessary to fix the shoulder joint of the paretic arm with your hand, and then slowly, plastically carry out flexion of the arm (its upper part) anteriorly, posterior extension, abduction, adduction, outward rotation of the shoulder and circular movements, well fixing the shoulder joint, combining all these movements with slight vibration.

• In the elbow and wrist joints, passive movements are made in two directions, this is flexion and extension, and also necessarily turning the hand with the palm up (supination). These movements, especially the last one, must be carried out several times a day, at least 8 - 10 times.

• When performing exercises, much attention should be paid to the fingers, especially the movement of 1 finger of the hand.

Such repeated exercises throughout the day are possible only with the help of trained parents, so training parents in therapeutic exercises should be mandatory. Constantly performing exercises will help to avoid contractures, trophic changes in muscles, stiffness in the joints of the hands, strengthening of vicious postures, and will help to cultivate correct (physiological) movement in the joints.

Active independent movements and exercises

• Reflex exercises are active movements that are based on the child’s unconditioned reflexes: Robinson’s reflex (the child grabs the toy when it touches his palm); the Moro reflex (grasping movements with the hands) is caused by clapping your hands close to the child or patting his buttocks; cervical-tonic reflexes; symmetrical and asymmetrical (change in position of the child’s hands due to a change in the position of his head, rotation or tilt), Galant reflex.

Active movements are caused in the child by the urge to make independent movements when addressing or the opportunity to interest by turning on the child’s tactile, visual and auditory analyzers.

• Active movements for the affected hand are initially given in easier conditions: in warm water, with the support of the hand, lying on a smooth surface.

• When improving the functionality of movement in the hand, an active, purposeful action is performed: a request to grab a toy, hold it, stimulate support on the forearms and hands while lying on the stomach (to facilitate this position, first place a bolster or a diaper folded several times under the child’s chest); Perform a sit-down with support from both hands. To make this exercise easier, at the very beginning it is necessary to lay the child on his back so that his head and upper body are elevated on the pillow.

Second period of illness and treatment

It begins around the second month of a child’s life, when he begins to have active movements of his arms and legs. The objectives of this period are the development and active training of the child’s psyche and motor skills. During this period, as before, the tasks of preventing contractures of the affected limb and improving tissue trophism are carried out.

• Passive exercises are still given attention, especially raising the arm up, extending and abducting the shoulder while fixing the shoulder blades, flexing the shoulder and elbow joints with supination of the forearm.

• Considering the lag in psychomotor development in children with obstetric paresis, it is necessary to perform all these special exercises against the background of the development of the entire musculoskeletal system of the child, his mental and speech development. Exercises should be combined with a general massage. It is necessary to select sets of exercises in accordance with the true psychomotor development of the sick child, and not with his biological age.

In order to stimulate active movements in a child in a paretic arm, you can use the “induced limitation” method, based on the fact that the more often the affected limb is stimulated, the more it will respond and recover faster. The main technique of this method is to limit movement in a healthy limb by fixing it for a certain time.

From 4-5 months, you need to make sure that the child brings his hand to his mouth with the palm of his hand, and not the back, it is recommended to give a pacifier to the affected hand so that the child tries to correctly take it and bring it to his mouth.

It is recommended to carry out physical exercises in water. Swimming with correction of the movements of the child's arms by adults and targeted exercises in the bath (+ 36 ° C) help in solving special tasks of exercise therapy (prevention of contractures, prevention of atrophy of the muscles of the arm, shoulder girdle, chest, improvement of nutrition in the tissues of the affected limb, development of active physiological movements in all joints of the hand, general strengthening, improvement of the child’s health).

Attention! Follow the recommendations of your doctor, consult a specialist, and if necessary, undergo training.

Obstetric paralysis is a disorder in the upper limb of a newborn baby that occurs due to incorrect obstetric tactics during childbirth. The immediate cause of this disorder is the brachial plexus - a “tangle” of nerve endings.

The main symptoms of the pathology are deterioration in mobility and sensitivity of the upper limb on the affected side. The pathology is complicated by contracture - “jamming” of the arm in the shoulder joint and the inability to perform any movements in it.

A preliminary diagnosis is made based on clinical signs and information about how the birth took place and whether pregnancy pathology was observed. Additional research methods are used to clarify the degree of violation. The pathology is treated with drugs that improve nerve conduction.

Obstetric paralysis: what is it?

Obstetric paralysis is one of the oldest problems in obstetrics, the relevance of which has not diminished over several centuries - from the time when obstetrics just began to develop as a branch of medicine, and to the present day. The occurrence of pathology depends both on the tactics of obstetric care in general and on the skills of the obstetrician - careless actions under time pressure (lack of time) can lead to the development of pathology, due to which the child’s quality of life will be irreversibly reduced. The problem also lies in the fact that obstetric paralysis is difficult to influence - the condition of the affected upper limb can be improved, but it is not possible to completely return it to normal, even with modern advances in the medical field. This is explained by the general pattern of nervous structures - the irreversibility of pathological tissue and cellular processes that occur in them.

Obstetric paralysis: who is to blame?

The immediate cause of the development of obstetric paralysis is damage to the nerve branches that make up the brachial plexus as the baby moves through the birth canal. Such damage can be either compression of the nerve structures or their more serious damage - tears of varying degrees.

Damage to a baby's brachial plexus can occur when the obstetrician:

• removes it from the mother’s womb, grasping the shoulder girdle with his fingers;
• uses auxiliary instruments - obstetric forceps.

Factors that contribute to the occurrence of the described pathology are also identified. This:

• prolonged labor;
• large fruit;
• birth of a child in a “shirt”;
• incorrect behavior of a woman during childbirth;
• threat of perineal rupture.

Intrauterine hypoxia of the fetus (insufficient oxygen supply to its body) is one of the most significant factors that increases the risk of developing obstetric paralysis. Against this background, the risk of ischemia increases - oxygen starvation of tissues, due to which nerve structures become extremely sensitive to even minor damage due to incorrect obstetric care.

The following disorders can cause the development of intrauterine fetal hypoxia:

• placental insufficiency - this is the name given to the disturbance of blood flow in the “mother-placenta-fetus” system, which is why fetal hypoxia develops;
• severe late – a perverted reaction of the mother’s body to the presence of a fetus in the uterus;
• improper attachment of the placenta, due to which the exit from the uterine cavity may be blocked to varying degrees (it is also called the uterine os);
• premature (separation from the inner surface of the uterus) with normal attachment;
• – its protracted terms;
• intoxication of the fetal body - poisoning with toxic substances. It can occur when both waste products of microorganisms and external toxins enter its tissues (as a rule, these are substances that are used in everyday life, agriculture, industry, as well as some medicines);
• anomalies of intrauterine development - a violation of both the formation and further growth and development of organs and tissues.

Factors accompanying the development of fetal hypoxia, and therefore the occurrence of obstetric paralysis, are:

Why does prolonged labor increase the risk of obstetric paralysis? There are two reasons:

• fetal hypoxia develops, promoting its development;
• when its signs appear, the obstetrician tries to quickly remove the child from the mother’s womb and in a hurry, he may inadvertently grab the shoulder and damage the brachial plexus.

A large fetus is a risk factor for the same reasons - labor is delayed, oxygen starvation of the child develops, and the brachial plexus may be damaged due to hasty manipulations to remove it.

note

The risk of developing obstetric paralysis increases sharply if the fetal weight is 4 kg or more.

Entanglement of the umbilical cord of the fetus can provoke disorders that are fraught with hypoxia - these are:

• premature placental abruption;
• fetal presentation is its incorrect position in relation to the axis of the uterus.

When a child is born in the “sac” (fetal sac), the risk of both direct injury to the brachial plexus and hypoxia, which leads to this damage indirectly, increases.

Breech presentation of the fetus is fraught with the development of obstetric paralysis for the following reasons:

• it causes difficulties in moving the child along the birth canal and, as a result, increases the risk of compression in the brachial plexus area. This increases the likelihood of a tear or rupture of the sternocleidomastoid muscle, against which the brachial plexus is damaged and obstetric paralysis occurs;
• due to difficulties in moving the child along the birth canal, obstetric forceps can be used, the use of which increases the risk of damage to the brachial plexus.

Incorrect behavior of a woman during childbirth can also indirectly contribute to the development of obstetric paralysis in a child - due to a prolonged labor process, as well as due to disruption of the child’s progress along the birth canal.

note

If there is a threat of rupture of the mother's perineum, the removal of the child can be hasty or, on the contrary, delayed, which is fraught with damage to the brachial plexus, leading to obstetric paralysis.

Development of pathology

Obstetric palsy is a classic neurological disorder. Damaging factors (mechanical impact on the brachial plexus or oxygen starvation of its structures) lead to disruption of nerve conduction, due to which the muscles of the upper limb do not receive adequate signals - this results in a violation of their contractions.

Depending on where the brachial plexus is damaged, there are three main types of obstetric paralysis:

• upper;
• lower;
• total.

In addition to them, it can be diagnosed combined lesion structures of different bundles, and with varying degrees of damage - this means that there are a number of clinical variants of obstetric paralysis.

Upper obstetric paralysis also called Duchenne-Erb's palsy. It occurs if the structures are broken:

• superior primary bundle of the brachial plexus;
• the upper nerve roots, which extend from the spinal cord in the area of ​​the cervical vertebrae (from the first to the sixth).

Lower obstetric paralysis also known by another name - Dejerine-Klumpke palsy. The following may be affected:

• inferior bundle of the brachial plexus;
• spinal roots that correspond to the sixth cervical vertebra and those vertebrae below.

At total form The described pathology damages the structures of the entire brachial plexus. In this case, the most severe clinical picture with the most severe consequences (complications) develops.

Obstetric Paralysis Clinic

The main manifestations of obstetric paralysis are:

• muscle hypotension;
• deterioration of various types of sensitivity;
• arm hanging;
• the absence of some natural reflexes that should appear in a child at different periods of his life.

Muscular hypotonia in this case is manifested by a decrease in the tone of muscle groups that provide motor activity of the upper limb.

With obstetric paralysis, there is a deterioration in sensitivity:

• temperature;
• painful;
• tactile.

note

A child with obstetric paralysis does not pull back his hand after accidentally touching a hot cup, radiator, etc. Also, the baby does not react or reacts weakly to painful stimuli - for example, if he hits his hand on the side of the injury, he does not cry or show that he is in pain.

Arm drooping is often one of the most indicative symptoms of obstetric paralysis.. In particular, it hangs in an awkward/unnatural position, which is most noticeable if you change the general position of the child in space or put him in a crib.

The presence of obstetric paralysis is indicated by the absence of the following reflexes, which appear normally:

• Moro (the child spreads his arms and unclenches his fists, and then returns them to the reverse position in response to a blow to the surface on which he lies, extension of his lower limbs and some others);
• Robinson (the child grabs and squeezes the finger or some other object extended to him with his handle);
• palmo-oral (when pressing on the palm, the child opens his mouth and bends his head).

Impaired tone and sensitivity depend on the location of the lesion - they can be observed in that part of the arm that is closer to the shoulder joint or to the hand.

Simultaneously with the symptoms of obstetric paralysis, signs of other disorders resulting from fetal hypoxia may develop:

• excitation;
• trembling of the limbs and torso;
• violation of unconditioned reflexes.

Diagnosis of obstetric paralysis

Obstetric paralysis occurs immediately after birth. Experienced neonatologists can identify it even in mild cases, the recognition of which is often difficult - with such a course, obstetric paralysis can be diagnosed only a few months after the birth of the child. The late detection is also due to the fact that the child can be very calm by nature. At the same time, his general motor activity is reduced, due to which a slight disturbance in the movement of the affected hand becomes unnoticeable and is recognized only when the child masters new movements and becomes more active.

When examining such a baby, not only the possibilities of developing obstetric paralysis are studied, but the parameters of its other organs and systems are also assessed.

To make an accurate diagnosis, details of the anamnesis (history) of pathology and the results of additional research methods are important.

When communicating with the child’s mother, you should find out the following details:

• whether any pregnancy pathology was identified in her;
• how the birth went;
• whether the child’s motor activity has changed.

Physical examination reveals the following abnormalities:

• upon examination, the arm on the affected side is hanging. With upper paralysis, it is close to the body, with the palm turned outward, and the child’s head is tilted towards it. With lower paralysis, the hand may look like a clawed paw (due to tension), and the entire arm is turned inward;
• upon palpation (palpation) - the skin of the affected upper limb is cold to the touch. The child does not respond to painful stimuli (pinching, squeezing the soft tissues of the limb). But the opposite effect may occur - increased sensitivity;
• with percussion (tapping) - percussion (using a hammer) confirms the absence of pain in the affected limb.

Instrumental methods that are used in the diagnosis of obstetric paralysis are:

From laboratory research methods in the diagnosis of the described disease, the following are used:

• – in some cases, it allows for differential diagnosis of obstetric paralysis with damage to the structures of the upper limb of an inflammatory nature. During inflammation, an increase in the number of leukocytes (leukocytosis) and ESR is detected. With a pronounced inflammatory process, a shift in the leukocyte formula to the left may also be observed;
• – the amount of potassium, sodium, chlorine, calcium and other trace elements that are important for normal nerve conduction and muscle activity is determined.

Differential diagnosis

Differential (distinctive) diagnostics are carried out:

• between different forms of obstetric paralysis;
• other pathologies.

In the latter case it is most often:

• myositis - inflammatory damage to muscle tissue;
• neuritis is inflammation of nerve fibers.

Complications

Obstetric paralysis is accompanied by complications such as:

• muscle contracture - a violation of motor activity in a joint (in this case, in the shoulder);
• ankylosis – complete blocking of movements in the shoulder joint;
• muscle atrophy - a violation of their nutrition, “depletion” of muscle tissue due to a decrease in motor activity, which is observed against the background of contracture (that is, it is a secondary complication of obstetric paralysis);
• curvature of the bones of the upper limb on the affected side - occurs due to the unnatural position of the affected upper limb. Also a secondary complication;
• paresthesia - the occurrence of atypical sensations in soft tissues in the form of “pins and needles”, numbness, and so on. Determined hypothetically, based on an understanding of the pathological processes that can occur when nerve endings are damaged.

Treatment obstetric paralysis

Early treatment for obstetric paralysis promotes better results, so it is prescribed while the child is still with the mother in the maternity hospital. Further treatment is carried out in the neurology department.

The appointments are as follows:

• immobilization of the affected upper limb;
• massage;
• physiotherapeutic treatment;
• drug therapy.

Immobilization carried out like this. The child’s injured limb is carefully extended as far as it will go (it should be moved away from the body and turned with the palm outward) and fixed. The abduction is carried out in stages, a few centimeters each time, then fixed in this position. The procedure is carried out until the arm is abducted at an angle of 90 degrees. During physiotherapeutic treatment, the splint (called an abduction splint) is removed and then reinstalled. When the limb is abducted, the child should not feel pain - otherwise he will “signal” it by crying.

note

Massage for paralysis is performed to prevent congestion in the affected upper limb (in particular, during the installation of an abduction splint). It is carried out in the form of courses, which are repeated after a short pause. Massage is prescribed for a long time.

From physiotherapeutic treatment methods First of all, thermal procedures have proven themselves well. Most often used for this disease are:

• paraffin applications;
• electrophoresis with anticholinesterase drugs and antispasmodics.

The following are prescribed as drug treatment:

• injectable antichoinesterase drugs;
• . They are also used as injections.

Prevention

Measures to prevent obstetric paralysis are:

• providing a woman with normal conditions during pregnancy - in order to prevent the occurrence of pathologies during this period or minimize their manifestations;
• preventing the influence of aggressive factors on the body of the mother and fetus - in particular, preventing the entry of toxic substances, preventing the development of infectious pathologies;
• when identifying pathologies of pregnancy - adequate medical tactics depending on the individual characteristics of the woman;
• correct management of childbirth.

Forecast

The prognosis for obstetric paralysis varies. It depends on factors such as:

Obstetric paralysis is a pathology of motor function of the upper extremities that occurs as a result of birth injury to a peripheral motor neuron (natal damage). Such damage can have different localization:

• brachial plexus and the nerve roots that form it;
• nerve roots of the upper thoracic and lower cervical segments of the spine;
• cells of the cervical enlargement of the spinal cord.

Obstetric paralysis is diagnosed in 0.2–0.3% of newborns.

Obstetric palsy is a birth injury to the brachial plexus.

Causes and risk factors

Obstetric paralysis is often caused by various obstetric manipulations used when it is difficult to remove the head and shoulders from the birth canal. These may include:

• fetal squeezing;
• rotation and traction of the shoulders and head in their fixed position;
• forceps delivery.

Such mechanical factors can lead to displacement of the cervical vertebrae, cause a spasm of the blood vessels of a reflex nature, lead to ischemia and disruption of the integrity of the structures of the spinal cord, nerve roots, trunks and plexuses. A common cause of obstetric paralysis is damage to the vertebral arteries, which leads to ischemia of motor neurons in the cervical segments of the spinal cord. Obstetric paralysis is sometimes accompanied by damage to the sternocleidomastoid muscle and (or) a fracture of the clavicle. This can cause torticollis.

In the treatment of obstetric paralysis, massage, physical therapy exercises, and orthopedic correction are of no small importance in order to restore motor function.

A predisposing factor is the state of fetal hypoxia or asphyxia of the newborn, since in this case the sensitivity of the nervous system to traumatic effects sharply increases.

Most often, obstetric paralysis is observed in the following cases:

• birth of a large fetus;
• clinically narrow pelvis;
• use of obstetric benefits;
• childbirth in the breech or leg presentation.

Forms of the disease

There are three clinical forms of obstetric paralysis:

1. Top type. This is the most common form of the disease, in which there is paralysis of the muscles of the shoulder and shoulder joint. The child's arm hangs down, movements are preserved only in the hand.
2. Bottom type. Observed in 10% of cases. With it, paralysis covers the muscle groups of the hand and forearm, as a result of which there is no movement in the fingers and hand.
3. Mixed type. The most severe form of obstetric paralysis, in which movement in the affected limb is completely absent. The mixed type of obstetric paralysis accounts for 30% of the total number of cases of the disease.

Stages of the disease

Obstetric paralysis is divided into paralysis proper and paresis. With paralysis there is a complete loss of motor function, with paresis there is only weakening. Thus, paresis can be considered as a milder stage of obstetric paralysis.

Symptoms

The clinical picture of obstetric paralysis depends on the form of the disease.

Proximal (upper) obstetric paralysis

This type of obstetric paralysis is also called Duchenne-Erb palsy. It is characterized by dysfunction of the muscles of the shoulder girdle (brachioradialis, biceps, deltoid) and the muscles of the forearm (supinators and flexors).

There is no movement in the lower part of the shoulder girdle, as well as in the area of ​​the elbow joint. The affected arm is extended at all joints and lies along the body. Finger movements are preserved.

A neurological examination reveals a weakening of muscle tone, a decrease or significant weakening of tendon reflexes in the paretic limb. Unconditioned reflexes of newborns (palmo-oral, grasping, Moro) with obstetric Duchenne-Erb palsy are not determined, and with paresis they are reduced.

It is quite difficult to identify sensitivity disorders in children in the first days of life.

Obstetric paralysis requires differential diagnosis with congenital hemihypoplasia, osteomyelitis, poliomyelitis, Parrot's pseudoparalysis, and clavicle fracture.

The upper type of obstetric paralysis is often combined with damage to the phrenic nerve, leading to paresis of the diaphragm. Clinically this manifests itself:

• decreased vital capacity of the lungs;
• disturbances in the rhythm and frequency of breathing;
• asymmetrical movement of the chest.

Distal (lower) obstetric paralysis

With distal obstetric paralysis (Dejerine–Klumpke palsy), muscle paralysis occurs:

• hypothenar;
• thenar;
• vermiform and interosseous;
• long flexors of the hand and fingers.

With this form of the disease, the hand takes the position of a “clawed paw” or simply hangs, which depends on the severity of damage to the fibers of the ulnar or radial nerve.

There are no active movements in the phalangeal, wrist and elbow joints. Unconditioned reflexes of newborns are not evoked or are reduced. Movement in the shoulder joint is preserved.

Obstetric Dejerine–Klumpke palsy can also occur with damage to the sympathetic cervical fibers. In this case, the symptoms described above are joined by others:

• enophthalmos;
• ptosis;
• miosis

Total (mixed) obstetric paralysis

There are no active movements in the affected upper limb, tendon reflexes are not evoked, and muscle tone is reduced. This form of the disease is characterized by early development of muscle atrophy.

Diagnostics

Diagnosis of obstetric paralysis is carried out in the first days of a child’s life based on the identification of signs characteristic of peripheral paresis:

• areflexia;
• atony;
• motor dysfunction.

Obstetric paralysis is diagnosed in 0.2–0.3% of newborns.

With mild obstetric paralysis, motor disorders in the first days of life are not clearly detected. Therefore, special techniques and tests are used for diagnosis, for example, hanging the child’s arm while he is positioned face down in the pediatrician’s arms.

Obstetric paralysis requires differential diagnosis with congenital hemihypoplasia, osteomyelitis, poliomyelitis, Parrot's pseudoparalysis, and clavicle fracture.

Treatment

Treatment of obstetric paralysis should begin from the moment of diagnosis. Drug therapy is complex and long-term, including medications that reduce swelling, improve blood circulation and trophic processes in the nervous tissue.

In the treatment of obstetric paralysis, massage, physical therapy exercises, and orthopedic correction are of no small importance. These measures are aimed at restoring impaired motor function in a paretic hand, as well as preventing the development of contractures (for this purpose, splints and special placements are used).

Treatment of obstetric paralysis also includes physical therapy (for example, acupuncture, paraffin or ozokerite applications, electrophoresis of drugs).

Possible complications and consequences

With moderate and severe obstetric paralysis, discoordination of the tone of the flexor and extensor muscles leads to the fairly rapid formation of contractures, scoliosis of the cervicothoracic spine, and asymmetrical position of the shoulder girdle.

Obstetric paralysis is sometimes accompanied by damage to the sternocleidomastoid muscle and (or) a fracture of the clavicle. This can cause torticollis.

Forecast

The course and prognosis of obstetric paralysis depend on the severity of damage to the nerve structures. With mild degrees of the disease, it is usually possible to achieve complete restoration of motor function in the affected upper limb within six months. In other cases, complete recovery does not occur, and pathological attitudes develop.

Prevention

Prevention of obstetric paralysis consists of rational management of childbirth. For breech presentation or a large fetus, a planned caesarean section is preferable. In case of shoulder dystocia, timely episiotomy is indicated, which allows the obstetrician to lower the shoulders using the necessary manipulations.

Postpartum paresis or obstetric paralysis- These are injuries associated with childbirth. Their cause is not always due to improper provision of medical care; some factors cannot be corrected in advance. There are approximately 2 cases of paresis per 1000 newborns. Until now, this problem cannot be solved medically.

Unlike paralysis, obstetric paresis is accompanied by a weakening of muscle function. With paralysis, whether temporary or permanent, the patient suffers from a complete loss of control over an arm or leg, or sometimes over the entire body. The body of a newborn is very fragile, any wrong movement can cause injury.

Birth injuries are one of the most unpleasant sources of child health problems. Even a completely healthy fetus, if the process is not carried out correctly, can develop complications for which it will have to be treated for the rest of its life. Obstetric paresis and paralysis are neurological disorders that in most cases affect the shoulder region and lead to immobility of one or both arms. Obstetric paralysis of the lower extremities is less common.

Even very careful preparation for childbirth and choosing a good clinic does not guarantee that birth trauma will not occur, which will lead to obstetric paresis. You can get such an injury not only during natural childbirth, but also during a caesarean section. Some factors causing paralysis depend on the size of the fetus and the characteristics of its position inside the uterus.

The risk is influenced by the individual characteristics of the child: the strength of the muscle frame and bones, the date of birth. There are factors that can provoke obstetric paresis or paralysis:

• narrow pelvis or discrepancy between its size and fetal parameters;
• child weight exceeding 4 kg;
• incorrect position (feet forward, angle);
• protracted process of delivery - difficult birth, requiring special tools and the use of dangerous methods (turning the fetus inside the womb, using a vacuum extractor).

Due to one or more reasons, the child turns during birth so that his head or upper limbs (less often lower) get stuck in the birth canal. Fragile bones and muscles are strongly compressed by the mother's bones, which causes pinching of the nerves. All this leads to poor circulation, and one of the consequences is obstetric paresis.

Sometimes the degree of damage to the nerve roots is so high that they completely stop working and paralysis develops. Most often, paresis of the arm in a newborn occurs, involving the muscles: deltoid, brachioradialis, triceps, teres minor and serratus anterior.

Forms of neurological damage

Doctors distinguish 3 forms of obstetric paralysis and paresis. Classification is necessary to determine the severity of the pathology:

• Top type. The most common form of neurological disorder, which causes paralysis of the muscles of the shoulder girdle and joints. It is noticeable by the fact that the arm hangs without tone, only the hand moves.
• Bottom type. Occurs in approximately 1 in 10 cases. Paralysis damages the hands and forearms.
• Mixed type. Occurs in 30% of cases; with obstetric paralysis, there is complete absence of movement along the entire limb - from the hand to the shoulder.

The last type of disease is one of the most severe forms. The stages of development of obstetric paresis are also distinguished: acute period, lasting up to 1 month, early period, developing up to 1 year, late recovery period up to 3 years of age, and residual effects.

Symptoms of a neurological disorder

The symptoms of obstetric paresis depend on the form of the disease. Upper or proximal paralysis, which belongs to the most common group, is also called Duchenne-Erb. Symptoms of this disorder:

• the work of the shoulder girdle and forearm is disrupted;
• there is complete absence of movement in the elbow;
• the injured arm simply lies along the body, all joints are straightened;
• movement is partially or completely retained in the fingers;
• upon examination, muscular hypotonicity and a significant weakening of tendon reflexes are detected;
• with paralysis, unconditioned reflexes are absent, and with obstetric paresis they are severely suppressed.

In the first days of life, it is almost impossible to recognize paralysis, even if the doctor conducts a thorough examination.

Important! To make a diagnosis, it is necessary to distinguish paresis from such serious disorders as: osteomyelitis, clavicle fracture, hemihypoplasia, poliomyelitis, Parrot syndrome.

The danger of superior paresis may be associated with damage to the nerve located in the phrenic region. Because of this, paralysis of the diaphragm occurs, accompanied by the impossibility of normal breathing: rhythm and frequency are disrupted, lung capacity decreases, and the chest moves asymmetrically.

Ghosts of lower paralysis

Distal obstetric paralysis or paresis affects the muscles of the hand and fingers. The pathology can be recognized by the special position of the hand; it becomes like a clawed paw. When the muscle fibers are completely immobilized, palm drooping is detected.

The movements characteristic of healthy children are completely absent: active movement of the wrist joint, phalanges, and elbows. At the same time, the activity of the shoulder joints is completely preserved. Also, paralysis, which is called Dejerine-Klumpke, may include damage to the cervical sympathetic muscles. In this case, the child has deviations:

• enophthalmos– the eyeball differs from normal, it is located deeper in the orbit;
• ptosis– the child’s upper eyelid “sinks” and droops on one or both sides. Pathology can be either complete or partial;
• miosis– the pupil enlarges and becomes more than 3 mm in diameter.

Total paralysis

This form combines paresis of the upper limbs along the entire course, including the shoulder girdle. Tendon reflexes are completely absent, there is no active movement, and muscle tone upon palpation is determined to be reduced. Muscle atrophy gradually develops.

Treatment of obstetric abnormalities

The treatment tactics for obstetric paresis are individual in each individual case. Treatment of the pathology begins with the first acute period and continues until the consequences completely pass.

Important! In rare cases, the acute course of obstetric pathology causes irreversible consequences that cannot be completely eliminated.

It is necessary to distinguish the stages of residual effects after obstetric paresis, which persist until the end of life:

• mild degree – movements are slightly limited, the person fully retains the ability to self-service;
• medium degree - significant restriction of mobility of the joints of the child’s right or left hand, as a result of which in adult life he is somewhat limited in self-care;
• severe degree - active movement of the joints becomes impossible, most often persists in one hand.

Treatment options vary slightly at different stages after neurological injury.

Therapy in the acute and initial recovery period

The acute and recovery stages are subject to conservative treatment, which is aimed at:

• to eliminate painful sensations;
• preventing inflammation due to paralysis.

To do this, use a cardboard splint, which is used to fix the shoulder at an angle of 60 degrees, moving it to the side and bending the elbow to 100 degrees.

From the 4th week of life, the installed splint is removed to wash the baby and treat the skin for bedsores. During this time, the traumatic consequences completely disappear, and muscle deformation is prevented.

From 3 months, a removable plaster splint is used to correct obstetric paresis. Increase the abducted limb limit to 90 degrees. Gradually, elbow bending should be reduced to 130-150 degrees, while the limb should be 140 degrees above the head.

Important! Be sure to carry out exercise therapy, massage, use thermal physiotherapy with mud, paraffin or ozokerite, and electrophoresis.

Additionally, phonophoresis is prescribed with substances that resolve congestion: diphenhydramine, novocaine. The child should take vitamins internally, as well as special medications to restore muscle fibers and neural connections.

Conservative therapy for obstetric paresis should be carried out in courses of 10-30 days, depending on the drugs used and the severity of symptoms. The breaks between courses are 1-3 months. A similar plan is used for any recovery stage up to 3 years. With proper treatment, functioning occurs in 55% of cases, but severe stages of the primary disorder limit this percentage to 7%.

When the child grows up, but the functions of his limbs are not restored, surgery is prescribed.

Surgical intervention

Surgically, obstetric paresis is treated in 3 directions: surgery on the shoulder girdle, nerves and bones. Combined methods are also used, which involve intervention on soft tissues and bones.

Important! Types of surgery affecting the tendon-muscular system are preferred, but interventions to restore bones are prescribed much less frequently.

The most common type of intervention is muscle transfer, which was first performed in 1905. The pectoralis major muscle was used for the transplant. Combined operations with muscle tissue transplantation are now used to prevent joint rotation.

After surgery for obstetric paresis, long-term rehabilitation is prescribed. After the operation, a thoracobrachial plaster bandage is applied, and the patient wears it for at least 4 weeks. Then the procedures begin again Exercise therapy And physiotherapy, including electrophoresis, massage and myostimulation. Most often, operations to eliminate the consequences of a neurological disorder are performed at 3-7 years of age.

It is possible to eliminate obstetric paresis through surgical intervention in most cases, and the outcome of the operations is favorable. However, subsequent social adaptation and rehabilitation are strongly related to the degree of damage to the shoulder joint. Throughout life, patients are not recommended to perform high sports activities and heavy physical labor, especially when using the shoulder girdle.

Obstetric paresis or paralysis is a serious birth injury that cannot be ignored. With adequate treatment and good rehabilitation, pathology does not prevent patients from living a full life, but in some cases restrictions arise that prevent people from doing certain things.

Erb's palsy is diagnosed in a newborn when the upper brachial nerve plexus is injured or damaged. Most often, paralysis of the arm is a consequence of a birth injury, which causes a tear or rupture of some muscles. The injury is dangerous because in severe cases there is bleeding. After a scar forms on the affected area, the nerve plexus is compressed a second time, which disrupts nerve conduction and causes problems with blood circulation. What to do in this case? Is it possible to help a child?

Causes

Strain of the brachial plexus in babies, which leads to muscle rupture, occurs after the following auxiliary birth procedures:

• Pulling by the handle.
• Turn by the leg.
• Pelvic traction.
• Shoulder release.

As a rule, obstetricians use all these methods when:

• Breech presentation of the fetus.
• Protracted or weak labor.
• Narrow pelvis.
• Large fruit.

Often, in addition to Erb's palsy, torticollis is also diagnosed, in which the clavipectoral muscle is damaged.

Symptoms

It is worth noting that paralysis occurs in several stages:

• Acute trauma, from birth to 1 month.
• Recovery, from a month to a year.
• A chronic form that can bother you throughout your life.

Immediately after childbirth, Erb's palsy manifests itself in the form of the following symptoms:

• Decreased muscle tone.
• The child is restless and constantly cries.
• Weak breathing.
• The baby has a damaged arm with his fingers clenched into a fist, while he holds his thumb.
• The child does not move the limb at all.
• No skin irritation reaction.
• The hand is pale and cold.

Recovery takes at least 3 years. During this time, the swelling completely resolves, blood circulation in the damaged tissue is normalized, and active muscle function is restored. If the disease progresses favorably, the child slightly moves his fingers, wrist joint, and sometimes even his elbow. As the baby gains weight, at one month a deepened fold is noticeable between the shoulder and torso (doctors call it a “doll’s arm”). At 3 years of age, hypotrophy and shortening of the limb are noticeable.

With Erb's palsy, the doctor notices that the child has a smaller scapula, and in addition, it is taller than the healthy one. Also, the baby has a narrowed eye on the affected side and develops scoliosis of the cervicothoracic spine. The joints can be fully moved, but they are weakened.

Subsequently, the pathology manifests itself in the form of shoulder contracture, subluxation, and hypotrophy of the shoulder joint. It is worth noting that a flexion contracture begins to form in the elbow joint, which impairs movement.

Diagnostics

To diagnose such a serious pathology, the baby is carefully examined by a neurologist and orthopedist after birth. Also, doctors always collect anamnesis, how the birth went, and whether the pregnancy proceeded normally.

Additionally prescribed:

• Ultrasound of the cervical spine.
• Ultrasound of the shoulder joint.
• Computer myelography.
• Magnetic resonance imaging.
• Electromyography.
• Vascular Dopplerography of the spinal cord and brain.
• Rheovasography.
• Electroneuromyography.
• Dynamometry.
• X-ray.

Treatment methods

It is very important to provide timely assistance to the baby. Parents will have to be patient because the treatment will be long. Doctors use different techniques to restore a limb. First, the limb is immobilized using a removable splint. We note that this splint is used for a year, it can be removed during medical and hygienic procedures. In advanced cases, the splint must be used at night for at least 3 years.

In addition, the treatment complex includes:

• Drug therapy.
• Physiotherapy.
• Therapeutic gymnastics.
• Reflexology.

In the acute period of paralysis, analgesics can be prescribed - Analgin, Amidopyrine. A week later, physiotherapeutic procedures are performed - UHF on the brachial plexus, and the child is given vitamin B1 and C orally. To improve neuromuscular conduction, anticholinesterase drugs are prescribed - Oxazil, Proserin, Galantamine. Physical therapy, including massage, is of no small importance. It is important that treatment takes place over a long period of time.

If the child does not feel better within six months, surgical correction is prescribed. You may need neurosurgical surgery on the nerve plexus or orthopedic surgery on joints, muscles, bones. In case of toxic, infectious neuritis, surgery is prohibited.

Forecasts

If the brachial plexus is partially damaged, it is possible to restore the arm at an early stage; conservative treatment will be sufficient. Statistics prove that almost 70% of newborns with Erb's palsy showed positive dynamics after treatment, and 20% of children generally recovered completely. Only this applies to mild forms of the disease. But in the event of a complete rupture of the brachial plexus, unfortunately, there is no hope that it will heal itself.

Prevention of such severe birth trauma is of no small importance. The obstetrician must foresee everything in advance; for this, the woman is constantly monitored by a doctor. During childbirth, the obstetrician is obliged to do everything to avoid additional procedures.

So, Erb's palsy is a consequence of medical error and difficult childbirth. Unfortunately, no one is immune from pathology. Parents should not give up; it is important to pull themselves together and do their best to help the baby recover. To do this, it is necessary to constantly be observed by doctors, undergo a massage course, then take the child to physical therapy, and work with him at home. Arm paralysis is not a death sentence. If you really want to, you can help your child restore the functionality of a limb. The main thing is to believe in a successful outcome. For preventive purposes, a pregnant woman should be registered with a gynecologist and undergo all the necessary examinations so that the doctor can decide how the birth will proceed. This is the only way to prevent pathology in the baby.