Risk factors for brachial plexus injury with and without shoulder dystocia.

Abstract

OBJECTIVE:

To ascertain whether brachial plexus palsy (BPP) that occurs without shoulder dystocia (SD) represents a traction injury during unrecognized SD or a natural phenomenon with a different mechanism of injury, we compared risk factors and outcomes between SD-associated and non-SD-associated BPP.

STUDY DESIGN:

Neonates with BPP after cephalic vaginal delivery were pooled from all deliveries at Johns Hopkins (June, 1993-December, 2004) and a dataset of litigated permanent BPP from multiple institutions (1986-2003), grouped by SD association based on clinician documentation and compared by using Fisher exact and t tests.

RESULTS:

Thirty percent of 49 non-SD-BPP and 11% of 280 SD-BPP lacked all risk factors for SD (P = .002). Compared with SD-BPP infants, non-SD-BPP infants were average weight (P < .001) and had cord pH less than 7.10 (P = .01) more commonly and exhibited a trend toward posterior shoulder involvement (P = .06). Nearly all non-SD-BPP were temporary, whereas more than 90% of permanent BPP were associated with SD (odds ratio 17, 7.3-39.6).

CONCLUSION:

Non-SD-BPP is uncommon and likely mechanistically distinct from SD-BPP. Risk factors, birth weight, fetal acidosis, posterior arm involvement, and injury severity distinguish between shoulder dystocia-related brachial plexus injuries and those not recorded as such.

• Authors: Edith D Gurewitsch, Elizabeth Johnson, Sayeh Hamzehzadeh, Robert H Allen
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 194 Issue 2 Pg. 486-92 (Feb 2006) ISSN: 1097-6868 [Electronic] United States
• PMID: 16458651 (Publication Type: Comparative Study, Journal Article, Research Support, U.S. Gov't, P.H.S.)

Topics

• Brachial Plexus (injuries)
• Cesarean Section (statistics & numerical data)
• Delivery, Obstetric (statistics & numerical data)
• Female
• Humans
• Infant, Newborn
• Obesity (epidemiology)
• Paralysis, Obstetric (epidemiology)
• Pregnancy
• Risk Factors
• Shoulder Injuries