Comparison in Obstetric Management on Infants With Transient and Persistent Obstetric Brachial Plexus Palsy

Mollberg, Margareta; Lagerkvist, Anna-Lena; Johansson, Urban; Johansson, Annika; Hagberg, Henrik

doi:10.1177/0883073808320620

Cited by 31 publications

(21 citation statements)

References 18 publications

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“…20 That the traction was usually downward comports with the 60% right-sided injury in our population as left occipitoanterior or left occipitotransverse presentation occurs more frequently (less than twice as often) than right occipitoanterior or right occipitotransverse.…”

Section: Discussionmentioning

confidence: 99%

“…With 104 infants, Poggi et al 24 concluded that operative delivery does not worsen the degree of injury. Mollberg et al 20 found a correlation between the amount of downward traction and injury severity. No study has systematically examined the relationship of obstetric factors and birthweight with the neurological severity of the OBPL.…”

Section: Introductionmentioning

confidence: 99%

“…[15][16][17][18] High birthweight, shoulder dystocia and forceful downward traction during delivery have been previously identified as the strongest risk factors for the occurrence of an OBPL. [18][19][20][21][22] Additionally, infants with a permanent injury were shown to have had a higher birthweight compared with those with a transient injury (4519 versus 4143 g). 20,23 Detailed research to relate obstetric antecedents with the neurological severity, i.e.…”

Section: Introductionmentioning

confidence: 99%

“…[18][19][20][21][22] Additionally, infants with a permanent injury were shown to have had a higher birthweight compared with those with a transient injury (4519 versus 4143 g). 20,23 Detailed research to relate obstetric antecedents with the neurological severity, i.e. the number of spinal nerves that was damaged, has been performed twice.…”

Section: Introductionmentioning

confidence: 99%

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Correlating birthweight with neurological severity of obstetric brachial plexus lesions

Pondaag

Allen

Malessy

2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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Objective To investigate the nature and extent of neurosurgically treated obstetric plexus lesions with obstetric and neonatal precedents.Design Retrospective analysis of prospectively collected data.Setting Leiden, the Netherlands.Population A 9-year cohort of infants (n = 206) neurosurgically treated for obstetric brachial plexus lesion at a tertiary referral centre for nerve lesions.Method Obstetric and neonatal data (parity, diabetic status, pregnancy gestation, mode of cephalic delivery and birthweight) were collected using a standardised protocol and correlated to neurological severity of the brachial plexus lesion.Main outcome measure Neurological severity of the brachial plexus lesion.Results Nulliparous women delivered significantly lower birthweight newborns (P = 0.016), injuries in those infants were associated with the least severe injury classification. The most prominent association in ordinal logistic regression was between neurological injury severity and larger birthweight (P < 0.001).Conclusions Birthweight is correlated with neurological severity of the injury in a group of infants experiencing brachial plexus injury resulting from cephalic vaginal delivery.Keywords Birthweight, complete brachial plexus injury, Erb's palsy, obstetric brachial plexus lesion, permanent birth injury, shoulder dystocia.Please cite this paper as: Pondaag W, Allen R, Malessy M. Correlating birthweight with neurological severity of obstetric brachial plexus lesions. BJOG

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Correlating birthweight with neurological severity of obstetric brachial plexus lesions

Pondaag

Allen

Malessy

2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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“…[1][2][3]5,6,16,21,23,26,30,32,34,35,38,41,[47][48][49][57][58][59]62,65 Cases of macrosomia, clavicle facture, and humerus fracture were identified within all newborn records (Appendix 2). Classifications of heavy for gestational age (not macrosomia), fetal or birth asphyxia, and intracranial nontraumatic hemorrhage were available for Ontario records only.…”

Section: Variablesmentioning

confidence: 99%

Obstetrical brachial plexus injury: burden in a publicly funded, universal healthcare system

Coroneos¹,

Voineskos²,

Coroneos

et al. 2016

PED

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OBJECT The aim of this study was to determine the volume and timing of referrals for obstetrical brachial plexus injury (OBPI) to multidisciplinary centers in a national demographic sample. Secondarily, we aimed to measure the incidence and risk factors for OBPI in the sample. The burden of OBPI has not been investigated in a publicly funded system, and the timing and volume of referrals to multidisciplinary centers are unknown. The incidence and risk factors for OBPI have not been established in Canada. METHODS This is a retrospective cohort study. The authors used a demographic sample of all infants born in Canada, capturing all children born in a publicly funded, universal healthcare system. OBPI diagnoses and corresponding risk factors from 2004 to 2012 were identified and correlated with referrals to Canada’s 10 multidisciplinary OBPI centers. Quality indicators were approved by the Canadian OBPI Working Group’s guideline consensus group. The primary outcome was the timing of initial assessment at a multidisciplinary center, “good” if assessed by the time the patient was 1 month of age, “satisfactory” if by 3 months of age, and “poor” if thereafter. Joinpoint regression analysis was used to determine the OBPI incidence over the study period. Odds ratios were calculated to determine the strength of association for risk factors. RESULTS OBPI incidence was 1.24 per 1000 live births, and was consistent from 2004 to 2012. Potential biases underestimate the level of injury identification. The factors associated with a very strong risk for OBPI were humerus fracture, shoulder dystocia, and clavicle fracture. The majority (55%–60%) of OBPI patients identified at birth were not referred. Among those who were referred, the timing of assessment was “good” in 28%, “satisfactory” in 66%, and “poor” in 34%. CONCLUSIONS Shoulder dystocia was the strongest modifiable risk factor for OBPI. Most children with OBPI were not referred to multidisciplinary care. Of those who were referred, 72% were assessed later than the target quality indicator of 1 month that was established by the national guideline consensus group. A referral gap has been identified using quality indicators at clinically relevant time points; this gap should be addressed with the use of knowledge tools (e.g., a clinical practice guideline) to target variations in referral rates and clinical practice. Interventions should guide the referral process.

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Risk factors for neonatal brachial plexus palsy attributed to anatomy, physiology, and evolution

et al. 2021

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The inherent variable anatomy of the neonate and the uniquely-shaped maternal birth canal that is associated with the evolution of human bipedalism constitute risk factors for neonatal brachial plexus palsy (NBPP). For example, those neonates with a prefixed brachial plexus (BP) are at greater risk of trauma due to lateral neck traction during delivery than those with a normal or postfixed BP. Compared to adults, neonates also have extremely large and heavy heads (high head: body ratio) set upon necks with muscles and ligaments that are weak and poorly developed. Accordingly, insufficient cranial stability can place large torques on the cervical spinal nerves. In addition, the pelvic changes necessary for habitual bipedal posture resulted in a uniquely-shaped, obstruction-filled, sinusoidal birth canal, requiring the human fetus to complete a complicated series of rotations to successfully traverse it. Furthermore, although there are many risk factors that are known to contribute to NBPP, the specific anatomy and physiology of the neonate, except for macrosomia, is not considered to be one of them. In fact, currently, the amount of lateral traction applied to the neck during delivery is the overwhelming legal factor that is used to evaluate whether a birth attendant is liable in cases of permanent NBPP. Here, we suggest that the specific anatomy and physiology of the neonate and mother, which are clearly not within the control of the birth attendant, should also be considered when assessing liability in cases of NBPP.

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Comparison in Obstetric Management on Infants With Transient and Persistent Obstetric Brachial Plexus Palsy

Cited by 31 publications

References 18 publications

Correlating birthweight with neurological severity of obstetric brachial plexus lesions

Correlating birthweight with neurological severity of obstetric brachial plexus lesions

Obstetrical brachial plexus injury: burden in a publicly funded, universal healthcare system

Risk factors for neonatal brachial plexus palsy attributed to anatomy, physiology, and evolution

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