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Are there modifiable risk factors that may predict the occurrence of brachial plexus injury?

Journal of Perinatology volume 35, pages 349–352 (2015)Cite this article

Subjects

Abstract

Objective:

To identify risk factors, particularly modifiable, associated with brachial plexus injury.

Study Design:

A retrospective case–control study conducted at a single hospital between the years 1993 and 2012. All neonates who were diagnosed of brachial plexus injury were included. A control group matched at a ratio of 1:2 was randomly selected. Demographic and obstetric data were obtained from the hospital discharge register with ICD-9 codes and crosschecked with the labor medical records. All medical files were manually checked and validated. A stepwise logistic regression model was performed to identify independent predictors for brachial plexus injury before delivery among those found significant in the univariate analysis.

Results:

Of all 83 806 deliveries that took place during this period, 144 cases of brachial plexus injury were identified (1.7/1000 deliveries). Overall, 142 cases and 286 controls had available data. Among the study group, 41 (28.9%) had documented shoulder dystocia compared with 1 (0.4%) among the controls (P<0.0001). Logistic regression analysis revealed that maternal age above 35 years (P=0.01; odds ratio (OR) 2.7; 95% confidence interval (CI) 1.3 to 5.7), estimated fetal weight before delivery (P<0.0001; OR 2.5; 95% CI 1.7 to 3.8, for each 500 g increase), vaginal birth after cesarean (P=0.02; OR 3.3; 95% CI 1.2 to 8.8) and vacuum extraction (P=0.02; OR 3.6; 95% CI 1.2 to 10.3) were all found to be independent predictors for developing brachial plexus injury. When stratifying the analysis according to parity, vacuum delivery was found to be an independent risk factor only among primiparous women (OR 6.0; 95% CI 1.7 to 21.6).

Conclusions:

The findings suggest that very few factors contributing to brachial plexus injury are modifiable. For that reason, it remains an unpredictable and probably an unavoidable event.

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References

  1. Adler JB, Patterson RL Jr . Erb’s palsy: longterm results of treatment in eighty-eight cases. J Bone Joint Surg Am 1967; 49: 1052–1064.

    Article  CAS  Google Scholar 

  2. Walle T, Hartikainen-Sorri AL . Obstetric shoulder injury. Associated risk factors, prediction and prognosis. Acta Obstet Gynecol Scand 1993; 72: 450–454.

    Article  CAS  Google Scholar 

  3. McFarland LV, Raskin M, Daling JR, Benedetti TJ . Erb/Duchenne’s palsy: a consequence of fetal macrosomia and method of delivery. Obstet Gynecol 1986; 68: 784–788.

    CAS  PubMed  Google Scholar 

  4. Hardy AE . Birth injuries of the brachial plexus. Incidence and prognosis. J Bone Joint Surg Br 1981; 63: 98–101.

    Article  Google Scholar 

  5. Levine MG, Holroyde J, Woods JR, Siddiqi TA, Scott M, Miodovnik M . Birth trauma: incidence and predisposing factors. Obstet Gynecol 1984; 63: 792–795.

    CAS  PubMed  Google Scholar 

  6. Gordon M, Rich H, Deutschberger J, Green M . The immediate and long-term outcome of obstetric birth trauma. I. Brachial plexus paralysis. Am J Obstet Gynecol 1973; 117: 51–56.

    Article  CAS  Google Scholar 

  7. Donnelly V, Foran A, Murphy J, McParland P, Keane D, O'Herlihy C . Neonatal brachial plexus palsy: an unpredictable injury. Am J Obstet Gynecol 2002; 187: 1209–1212.

    Article  Google Scholar 

  8. Sandmire HF, Demott RK . Controversies surrounding the causes of brachial plexus injury. Int J Gynaecol Obstet 2009; 104: 9–13.

    Article  Google Scholar 

  9. Sandmire HF, DeMott RK . The Green Bay cesarean section study, IV: the physician factor as a determinant of cesarean birth rates for the large fetus. Am J Obstet Gynecol 1996; 174: 1557–1564.

    Article  CAS  Google Scholar 

  10. Jennett RJ, Tarby TJ, Kreinick CJ . Brachial plexus palsy: an old problem revisited. Am J Obstet Gynecol 1992; 166: 1673–1676.

    Article  CAS  Google Scholar 

  11. Doumouchtsis SK, Arulkumaran S . Are all brachial plexus injuries caused by shoulder dystocia? Obstet Gynecol Surv 2009; 64: 615–623.

    Article  Google Scholar 

  12. Ouzounian JG, Korst LM, Phelan JP . Permanent Erb’s palsy: a lack of a relationship with obstetrical risk factors. Am J Perinatol 1998; 15: 221–223.

    Article  CAS  Google Scholar 

  13. Weeks JW, Pitman T, Spinnato JA . Fetal macrosomia: does antenatal prediction affect delivery route and birth outcome? Am J Obstet Gynecol 1995; 173: 1215–1219.

    Article  CAS  Google Scholar 

  14. Rouse DJ, Owen J, Godenberg RL, Cliver SP . The effectiveness and cost of elective cesarean delivery for fetal macrosomia diagnosed by ultrasound. JAMA 1996; 276: 1480–1486.

    Article  CAS  Google Scholar 

  15. Walsh JM, Kandamany N, Ni Shuibhne N, Power H, Murphy JF, O'Herlihy C . Neonatal brachial plexus injury: comparison of incidence and antecedents between 2 decades. Am J Obstet Gynecol 2011; 204 (324): e1–e6.

    Google Scholar 

  16. Chauhan SP, Rose CH, Gherman RB, Magann EF, Holland MW, Morrison JC . Brachial plexus injury: a 23-year experience from a tertiary center. Am J Obstet Gynecol 2005; 192: 1795–1800.

    Article  Google Scholar 

  17. Gilbert WM, Nesbitt TS, Danielsen B . Associated factors in 1611 cases of brachial plexus injury. Obstet Gynecol 1999; 93: 536–540.

    CAS  PubMed  Google Scholar 

  18. Hammad IA, Chauhan SP, Gherman RB, Ouzounian JG, Hill JB, Abuhamad AZ . Neonatal brachial plexus palsy with vaginal birth after cesarean delivery: a case-control study. Am J Obstet Gynecol 2013; 208 (229): e1–e5.

    Google Scholar 

  19. Räisänen S, Vehviläinen-Julkunen K, Cartwright R, Gissler M, Heinonen S . A prior cesarean section and incidence of obstetric anal sphincter injury. Int Urogynecol J 2013; 24: 1331–1339.

    Article  Google Scholar 

  20. Faranesh R, Salim R . Labor progress among women attempting a trial of labor after cesarean. Do they have their own rules? Acta Obstet Gynecol Scand 2011; 90: 1386–1392.

    Article  Google Scholar 

  21. Coleman TL, Randall H, Graves W, Lindsay M . Vaginal birth after cesarean among women with gestational diabetes. Am J Obstet Gynecol 2001; 184: 1104–1107.

    Article  CAS  Google Scholar 

  22. Gherman RB, Ouzounian JG, Goodwin TM . Obstetric maneuvers for shoulder dystocia and associated fetal morbidity. Am J Obstet Gynecol 1998; 178: 1126–1130.

    Article  CAS  Google Scholar 

  23. Benjamin K . Part 1 Injuries to the brachial plexus: mechanisms of injury and identification of risk factors. Adv Neonatal Care 2005; 5: 181–189.

    Article  Google Scholar 

  24. Kalogiannidis I, Margioula-Siarkou C, Petousis S, Goutzioulis M, Prapas N, Agorastos T . Infant births during the internal night are at increased risk for operative delivery and NICU admission. Arch Gynecol Obstet 2011; 284: 65–71.

    Article  Google Scholar 

  25. Luo ZC, Karlberg J . Timing of birth and infant and early neonatal mortality in Sweden 1973-95: longitudinal birth register study. BMJ 2001; 323: 1327–1330.

    Article  CAS  Google Scholar 

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Acknowledgements

We thank Naama Schwartz, biostatistician, MA, Emek Medical Center, Afula, Israel, for assisting in the statistical analysis.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel

    S Zuarez-Easton, N Zafran, G Garmi, Z Nachum & R Salim

  2. Rappaport Faculty of Medicine, Technion, Haifa, Israel

    N Zafran, G Garmi, Z Nachum & R Salim

Authors
  1. S Zuarez-Easton
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  2. N Zafran
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  3. G Garmi
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  4. Z Nachum
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  5. R Salim
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Correspondence to R Salim.

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Zuarez-Easton, S., Zafran, N., Garmi, G. et al. Are there modifiable risk factors that may predict the occurrence of brachial plexus injury?. J Perinatol 35, 349–352 (2015). https://doi.org/10.1038/jp.2014.215

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  • DOI: https://doi.org/10.1038/jp.2014.215

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