Evaluation of the Obstetrical Brachial Plexus Injuries with Forensic Perspective

Abstract

Aim: Obstetrical brachial plexopathy (OBP) is the loss of function of the brachial plexus due to a traumatic, idiopathic, or iatrogenic reason since birth. OBP mostly occurs with a traumatic background that is secondary to a difficult birth. In this study, we aimed to investigate the medical characteristics of the OBP cases, which were evaluated for malpractice reasons by the Forensic Medicine and define the features that should be considered in the forensic evaluation of OBP. Methods: The medical files of all cases with OBP evaluated in the 2nd Specialization Board of the Council of Forensic Medicine between 2013 and 2017 due to malpractice were included in the study. The dates of birth, maternal ages, comorbid diseases of the mother, the number of pregnancies, birthplaces and birth weeks, birth weights, and additional comorbid pathologies were investigated retrospectively. Results: A total of 287 cases were evaluated in this study. The mean age of forensic evaluation was found to be 2.9 +/- 2.3 years. All patients were born with vaginal delivery except one caesarean case. In 55% of cases had shoulder dystocia, 16% clavicle fracture, 4% humerus fracture and humeral head dislocation were detected. 23.3% of the cases had a history of a difficult birth and 11.5 % had assisted delivery. In 45% of cases had developmental pathologies accompanied by hypotonia. None of the cases were evaluated as medical malpractice. Conclusion: Standard medical records of cases with OBPs contained sufficient information for neurological and forensic evaluation. Our study shows the OBP's does not only originate from the traumatic etiology; about half of the cases have different comorbid pathologies, especially neurodevelopment problems. In order to achieve standardization and understand the comorbidities of plexopathy better, it would be appropriate to expand the medical data in detail.