[Incidence and etiology of brachial plexus upper arm paralysis in newborn infants. A review and basic principles for legal assessment].

Objective: Brachial plexus injury (BPI) is a rare complication of pregnancy which is out of proportion involved in medical litigation. The aim of this study was to establish the relationship between shoulder dystocia (SD) and BPI and the frequency of BPI without explanation.

Method: The pertinent literature was reviewed. In total 86 papers of the international literature were evaluated in regard to the frequency of SD and BPI and their relationship. Also BPI without obstetrical explanation were of interest (birth weight < 4000 g, cesarian section, palsies without SD).

Conclusions: This literature review allows for the following conclusions: 1. The large number of papers describing SD in contrast to the much smaller numbers of BPI justifies the proposal to use the term SD only when it is associated with BPI. Otherwise the term "difficult shoulder delivery" seems more adequate and might reduce the number of papers. 2. The large number of BPI without SD, unexplained palsies without explanation and PPI at newborns with a birthweight < 4000 g do not allow a prima facie conclusion that BPI is the result of poor obstetrics (especially pulling on the head). 3. The lack of an operating note might establish such an association as well as the misinterpretation or failure of appropriate manoeuvers published in the literature. 4. The lack of a service regulation regarding the treatment of SD might be considered as failure of organisational standards.