Risk factors for brachial plexus injury and permanent sequelae due to shoulder dystocia

• Published in: Nigerian journal of clinical practice Vol. 25; no. 12; pp. 2016 - 2023
• Main Authors: Elmas, B, Ercan, N, Ersak, D, Ozdemir, E, Çelik, I, Tapisiz, O, Akay, A, Yucel, E, Armangil, M, Tekin, O
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.12.2022; Medknow Publications and Media Pvt. Ltd
• Subjects: Brachial Plexus - injuries; Brachial plexus neuritis; Complications and side effects; Delivery, Obstetric; Diagnosis; Disease Progression; Dystocia; Dystocia - epidemiology; Dystocia - etiology; Female; Fractures, Bone - epidemiology; Humans; Infant, Newborn; Pregnancy; Risk Factors; Shoulder Dystocia; Nigeria; sequelae; Brachial plexus injury; vaginal delivery; obstetric palsy; shoulder dystocia; maneuvers
• ISSN: 1119-3077
• DOI: 10.4103/njcp.njcp_464_22

Aim: The primary aim of this study was to determine the risk factors for the occurrence of brachial plexus injury in cases of shoulder dystocia. Secondly, it was aimed to determine the factors affecting the occurrence of permanent sequelae in cases with brachial plexus injury. Subjects and Methods: ICD-10 codes were scanned from the records of patients who gave birth between 2012 and 2018, and the records of patients with brachial plexus injury and shoulder dystocia were reached. Shoulder dystocia cases with brachial plexus damage were accepted as the study group, and shoulder dystocia cases without brachial plexus damage were considered the control group. Shoulder dystocia patients with brachial plexus injury and without injury were compared for 2-year orthopedics clinic follow-up reports, surgical intervention, permanent sequelae status as well as birth data, maternal characteristics, and maneuvers applied to the management of shoulder dystocia. Results: Five hundred sixty births with shoulder dystocia were detected. Brachial plexus injury was observed in 88 of them, and permanent sequelae were detected in 12 of these patients. Maneuvers other than McRobert's (advanced maneuvers) were used more and clavicle fracture was seen more in the group with plexus injury (P < 0.05, P < 0.05, respectively). Logistic regression analysis was performed to determine the risk factors of brachial plexus injury. Brachial plexus injury was observed 4.746 times more in infants who were delivered with advanced maneuvers and 3.58 times more in infants with clavicle fractures at birth. Conclusion: In patients with shoulder dystocia, the risk of brachial plexus injury increased in deliveries in which advanced maneuvers were used and clavicle fracture occurred.