Correlating birthweight with neurological severity of obstetric brachial plexus lesions

Abstract

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

Association between Diabetes in Pregnancy and Shoulder Dystocia by Infant Birth Weight in an Era of Cesarean Delivery for Suspected Macrosomia

“…Current clinical practice may also prevent those shoulder dystocia cases with the highest risk of infant morbidity because the risk of permanent brachial plexus injury in shoulder dystocia increases with rising birth weight. 12,13 Hence, our results should be interpreted with caution. While we do not suggest that current delivery guidelines be changed, our data do provide additional data that can inform delivery planning for providers and pregnant individuals with diabetes.…”

Prevalence and Pattern of Birth Brachial Plexus Injuries Seen in Nigeria

“…This correlation has also been suggested by other authors. [30][31][32][33] In this study, there was a male predominance for BBPI (62%) and the right hand also showed predominance over the left hand. Hamzat et al 13 explained that since the culture in Africa regards the use of the right hand as more acceptable than that of the left hand in greeting, eating, and even writing, any injuries to the right hand after birth would be quickly noticed.…”

Causation of permanent brachial plexus injuries to the anterior arm after shoulder dystocia – Literature review

“…A different neuro-surgical team concluded, in their review of children with permanent NBPI from the Netherlands, that traction during SD was likely to be causative: 17 In this neurosurgical series of 206 OBPL infants, it is shown that the neurological severity of the OBPL correlated with the birthweight of the child. This disproportion probably reflects the severity of the shoulder dystocia and the probably stronger clinician-applied traction that occurred during birth.Therefore, permanent NBPI appears to be related to excessive traction by accoucheurs that widens the angle between the foetal head and shoulder.…”