Limited usefulness of fetal weight in predicting neonatal brachial plexus injury

• Published in: American journal of obstetrics and gynecology Vol. 179; no. 3; pp. 686 - 689
• Main Authors: Bryant, David R., Leonardi, Michael R., Landwehr, Joseph B., Bottoms, Sidney F.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.09.1998; Elsevier
• Subjects: Adult; Biological and medical sciences; Birth injuries; Birth Injuries - epidemiology; Birth Injuries - prevention & control; birth weight; Body Weight; Brachial Plexus - injuries; cesarean delivery; Cesarean Section; Diseases of mother, fetus and pregnancy; Female; fetal macrosomia; Fetal Macrosomia - pathology; Fetal Macrosomia - surgery; Fetus - anatomy & histology; Forecasting; Gynecology. Andrology. Obstetrics; Humans; Infant, Newborn; Infant, Newborn, Diseases - epidemiology; Infant, Newborn, Diseases - etiology; Medical sciences; Morbidity; Paralysis - epidemiology; Paralysis - etiology; Pregnancy; Pregnancy. Fetus. Placenta; birth weight; fetal macrosomia; Birth injuries; cesarean delivery; Endocrinopathy; Human; Nervous system diseases; Prognosis; Pregnancy disorders; Diabetes mellitus; Vertex presentation; Morbidity; Macrosomia; Pregnancy; Fetal diseases; Vaginal route; Newborn; Malformation; Cohort study; Birth weight; Peripheral nerve disease; Delivery; Brachialis plexus syndrome
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/S0002-9378(98)70065-1

OBJECTIVE: The objectives were to determine the neonatal morbidity rate from vaginal birth and examine fetal weight–based injury-prevention strategies. STUDY DESIGN: Selected neonatal morbidities were categorized by birth weight for all vertex vaginal deliveries occurring during a 12-year period. Sensitivity, specificity, and predictive values for brachial palsy were calculated at increasing birth weight cutoff levels. A policy of cesarean delivery for macrosomic infants was evaluated. RESULTS: There were 80 cases of brachial palsy among 63,761 infants (0.13%). In mothers without diabetes, rates in the 4500- to 4999-g and >5000-g groups were 3.0% and 6.7%, respectively. A threshold of 3700 g had a sensitivity of 71% and a specificity of 86%; the positive predictive value was 0.56%. To prevent a single case of permanent injury, 155 to 588 cesarean deliveries are required at the currently recommended cutoff weight of 4500 g. CONCLUSIONS: The rates of lasting morbidity do not justify routine cesarean delivery for infants without diabetic complications weighing <5000 g. (Am J Obstet Gynecol 1998;179:686-9.)