title: Brachial plexus paresis associated with fetal neck compression from forceps.
abstract: Instrumental vaginal deliveries have been associated with higher risks of brachial plexus injuries. The proposed mechanisms involve the indirect association of instrumental deliveries with shoulder dystocia and nerve stretch injuries secondary to rotations of 90 degrees or more. We present a brachial plexus paresis resulting from direct compression of the forceps blade in the fetal neck. A term infant was delivered by a low Kielland forceps rotation. No shoulder dystocia was noted. The immediate neonatal exam revealed an Erb's palsy and an ipsilateral bruise in the lateral aspect of the neck. The paresis resolved during the first day of life. Direct cervical compression of the fetal neck by forceps in procedures involving rotations of the presentation may result in brachial plexus injuries.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas 77555-0587, USA.
authors.forename: Alfredo F
authors.initials: AF
authors.lastname: Gei
authors.forename: Russell A
authors.initials: RA
authors.lastname: Smith
authors.forename: Gary D V
authors.initials: GD
authors.lastname: Hankins
mesh_terms: D000328:Adult; D001720:Birth Injuries / Q000175:diagnosis / Q000209:etiology; D001917:Brachial Plexus / Q000293:injuries*; D002574:Cervical Vertebrae / Q000503:physiopathology*; D005113:Extraction, Obstetrical / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D009333:Neck / Q000503:physiopathology; D007744:Obstetric Labor Complications / Q000628:therapy; D009772:Obstetrical Forceps / Q000009:adverse effects*; D010246:Paralysis, Obstetric / Q000150:complications / Q000175:diagnosis* / Q000209:etiology; D010291:Paresis / Q000150:complications / Q000175:diagnosis / Q000209:etiology; D010298:Parity; D011247:Pregnancy; D020127:Recovery of Function; D018570:Risk Assessment