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Relationship between parity and brachial plexus injuries

Journal of Perinatology volume 36, pages 357–361 (2016)Cite this article

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Abstract

Objective:

Few characteristics have been identified as risk factors for brachial plexus injuries. We sought to investigate a potential relationship with multiparity based on clinical observation at our institution.

Study Design:

In this retrospective case series, we analyzed all brachial plexus injuries recognized at or after delivery between October 2003 and March 2013 (n=78) at a single academic medical institution. Patient, infant, labor and delivery characteristics were compared for women with and without prior vaginal deliveries.

Result:

Of the 78 injuries, 71 (91%) occurred after a vaginal delivery and 7 (9%) after a cesarean delivery. Of the 71 injuries after a vaginal delivery, 58% occurred in women with a prior vaginal delivery (n=41, 5.7 per 10 000 live births) compared with 42% without a prior vaginal delivery (n=30, 4.0 per 10 000 live births). Multiparous patients had shorter labor courses and fewer labor interventions than nulliparous patients. Providers clinically underestimated the birth weights to a greater extent in multiparas than in nulliparas (median underestimation 590 vs 139 g, P=0.0016). The median birth weight was 4060 g in the multiparous group, which was significantly larger than affected infants born to the nulliparous group (3591 g, P=0.006). The affected infants of the multiparous group were, as expected, significantly larger than their previously born siblings (median 567 g larger, P<0.001).

Conclusion:

Brachial plexus injuries occurred as frequently in multiparous patients as in nulliparous patients. In general, multiparous patients are more likely to have larger infants; however, providers significantly underestimate the birth weight of their infants. The findings of this study should deter providers from assuming that a prior vaginal delivery is protective against brachial plexus injuries.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA, USA

    M A Clapp, J Bsat, S E Little, C A Zera, N A Smith & J N Robinson

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  1. M A Clapp
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  2. J Bsat
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  3. S E Little
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  4. C A Zera
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Correspondence to M A Clapp.

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Clapp, M., Bsat, J., Little, S. et al. Relationship between parity and brachial plexus injuries. J Perinatol 36, 357–361 (2016). https://doi.org/10.1038/jp.2015.205

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