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.
Original language | English (US) |
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Pages (from-to) | 486-492 |
Number of pages | 7 |
Journal | American journal of obstetrics and gynecology |
Volume | 194 |
Issue number | 2 |
DOIs | |
State | Published - Feb 2006 |
Keywords
- Complete injury
- Erb-Duchenne palsy
- Fetal acidosis
- Klumpke palsy
- Mechanism of injury
- Neurapraxia
- Permanent
- Posterior shoulder
- Spontaneous injury
- Temporary
- Vaginal delivery
ASJC Scopus subject areas
- Obstetrics and Gynecology