Intrapartum risk factors for permanent brachial plexus injury

Poggi, Sarah; Stallings, Shawn P.; Ghidini, Alessandro; Spong, Catherine Y.; Deering, Shad; Allen, Robert H.

doi:10.1067/s0002-9378(03)00654-9

Cited by 69 publications

(42 citation statements)

References 14 publications

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“…24 Sex ratio in injured group was 1,21:1 for male infants, which is not statistically significant difference in comparison to the control group where sex ratio was 1,26:1. These results are similar to results of other authors who haven't found significant difference regarding the gender distribution, 5 but there are also a few authors who found that incidence of brachial plexus injuries is higher among female infants. 25 Birth weight in an injured group varied from 2200 to 5500 grams, the mean value was 3858.1±587.7 grams.…”

Section: Discussionsupporting

confidence: 82%

“…14 Almost all authors in their studies confirm that obstetrical maneuvres increase risk for brachial plexus injuries with infants. 5,12,14,15 Swedish authors investigated the influence of induction of the labor on brachial plexus palsy of newborns during 7 years period (100 000 labors were studied). According to them, induction of labor is not the risk factor for brachial plexus palsy, that is similar to our results.…”

Section: Discussionmentioning

confidence: 99%

“…4 The risk factors for brachial plexus injuries during delivery may be divided in three categories: neonatal factors, maternal factors or some other characteristics of second stage of labor. 5 The abnormal position of fetal arm (abduction and external rotation of shoulder when the arm remaining behind the head) causes the streching roots of brachial plexus and thus leads to injure nerve roots. 6,7 The other mechanisms of brachial plexus injuries are traction of head and neck of infants in vertex presentation of infants, extreme traction of shoulder and hyperextension of arms in breech presentation.…”

Section: Introductionmentioning

confidence: 99%

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Etiological risk factors for brachial plexus palsy

Hudić¹,

Fatušić²,

Sinanović³

et al. 2006

The Journal of Maternal-Fetal & Neonatal Medicine

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SUMMARY.During a period of nine years, from 01. 01. 1996 to 31. 12. 2004, 45 544 live-born children were analyzed.The analysis is retrospective and is based on medical documentation of the Clinic for Gynecology and Obstetrics, Clinic for Neurology, and Clinic for Rehabilitation and Physiatrics of University Clinical Center Tuzla. The 86 newborns with brachial plexus palsy have been recorded, the prevalence is 1.86 per 1000 live-born children. Analyzing maternal and neonatal factors, and the delivery pattern itself, it has been found that the highest risk-factors for brachial plexus injury are birth weight over 4000 grams, precipitous second stage of labor (<15 minutes), and vacuum-extractor assisted delivery of newborns. Brachial plexus palsy was more frequent when the newborns' mothers were overweight, with a body mass index ³29 kg/m 2 . None of the parturient women, whose newborns were diagnosed with brachial plexus palsy, had a narrowed pelvis. Newborns, who were delivered vaginally, were not diagnosed to have a higher frequency of brachial plexus palsy compared to newborns who were delivered by Caesarean section, but newborns with vaginal breech delivery have had a higher incidence of brachial plexus palsy. Newborns, whose mothers were older than 35, had have brachial plexus palsy more frequently; statistically significant difference between primiparas and multiparas was not found. A total of 39 newborns (45.2%) were diagnosed to have a fracture of clavicle, which was the most frequently combined damage with brachial plexus injury. The 42 newborns (48.8%) had an Apgar score of £7 in the first minute after delivery, which indicates intrapartal distress of fetus and points to traumatic nature of these deliveries. Average birth weight of newborns with plexus brachialis damage was 3858±grames, which, for an average gestation age of 38.8±1,8 weeks of gestation, corresponds to eutrophic newborns. Both male and female newborns were diagnosed to have plexus brachialis equally and almost all deliveries (97.7%) started spontaneously. The majority of newborns were born early in the morning between 2-3 hours or afternoon between 14-15 hours. Izvorni~lanakKlju~ne rije~i: kljenut brahijalnog pleksusa, novoro|en~e, rizi~ni~imbenici SA@ETAK. U devetgodi{njem vremenskom razdoblju od 01. 01. 1996. do 31. 12. 2004. godine analizirano je 45 564`ivoro|ene novoro|en~adi. Analiza je retrospektivna, bazirana na medicinskoj dokumentaciji Klinike za ginekologiju i aku{erstvo, Klinike za neurologiju i Klinike za rehabilitaciju i fizijatriju Univerzitetsko-klini~kog centra Tuzla. Registrirano je 86 novoro|en~adi s paralizom pleksusa brahijalisa, incidencija je 1,89 na 1000`ivoro|ene novoro|en~adi. Analizom maternalnih i neonatalnih faktora, te samog tijeka poroda utvr|eno je da su najve}i rizi~ni faktori za nastanak povrede pleksusa brahijalisa porodna te`ina novoro|en~eta preko 4000 grama, skra}eno drugo porodno doba (<15 minuta) te ra|anje novoro|en~eta uz pomo} vakuum ekstraktora. Povreda pleksusa brahijalisa~e{}e nastaje kod novor...

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Etiological risk factors for brachial plexus palsy

Hudić¹,

Fatušić²,

Sinanović³

et al. 2006

The Journal of Maternal-Fetal & Neonatal Medicine

View full text Add to dashboard Cite

show abstract

“…Other data collected (from maternal charts) included maternal age, race, maternal body mass index (BMI), pregestational or gestational diabetes, labor induction, oxytocin, epidural anesthesia, operative vaginal delivery (including type and indication), neonatal birth weight and labor characteristics. Precipitous second stage of labor was considered to be <20 min, 6 and prolonged second stage was defined as longer than 3 h for nulliparous women with epidural, 2 h of nulliparous without epidural and for parous women with epidural and longer than 1 h for parous women without epidural.…”

Section: Methodsmentioning

confidence: 99%

“…4 The possibility of neonatal injury is the key reason why shoulder dystocia is of such concern, and there may be certain factors that set cases of shoulder dystocia with injury apart from those without. Although several studies have looked at factors related specifically to brachial plexus injury, [5][6][7] only one study has examined the injured patients within a shoulder dystocia group to see if any factors set them apart. 8 This study, however, was limited in power and was unable to identify any risk factors which predicted brachial plexus injury.…”

Section: Introductionmentioning

confidence: 99%

What factors are associated with neonatal injury following shoulder dystocia?

et al. 2006

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Objective: To identify factors associated with the development of neonatal injury in the setting of shoulder dystocia.Study design: Medical record ICD-9 codes and a computerized perinatal database were reviewed to identify cases of shoulder dystocia from January 1996 to January 2001 in a tertiary care center. For confirmation of the diagnosis and collection of data, both maternal and neonatal charts were then reviewed and neonatal injuries categorized as either neurological (brachial plexus injury) or skeletal (clavicular fracture, humeral fracture). Shoulder dystocia cases were divided into groups based on the presence of neonatal injury at delivery or at discharge (with or without Erb's palsy). The group with neonatal injury was compared for demographic and obstetrical factors to the group without injury (control). w 2 test, MannWhitney test and logistic regression were used as appropriate.Results: During this 5-year period, there were 25 995 deliveries and 206 (0.8%) confirmed cases of shoulder dystocia. Of these cases, 36 (17.5%) had neonatal injury diagnosed at delivery and 25 (12%) remained with significant residual injury at discharge. Of these there were 19 cases of Erb's palsy and six cases of clavicular fracture. No association was found between neonatal injury and maternal age, ethnicity, diabetes, operative vaginal delivery or number of obstetrical maneuvers. However, maternal body mass index >30 kg/m 2 , a second stage of labor >20 min and a birth weight >4500 g were all associated with an increased risk of neonatal injury at delivery and at discharge, including Erb's palsy. After logistic regression analysis, only a second stage of delivery >20 min remained significantly associated with neonatal injury at discharge. Conclusion:In our population, maternal obesity was associated with an increased risk of neonatal injury after shoulder dystocia. In addition, a short second stage of labor (<20 min) was associated with a lower rate of neonatal injury.

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