Obstetric brachial plexus palsy: a prospective study on risk factors related to manual assistance during the second stage of labor

• Published in: Acta obstetricia et gynecologica Scandinavica Vol. 86; no. 2; pp. 198 - 204
• Main Authors: Mollberg, Margareta, Wennergren, Margareta, Bager, Börje, Ladfors, Lars, Hagberg, Henrik
• Format: Journal Article
• Language: English
• Published: Oxford, UK Informa UK Ltd 01.01.2007; Blackwell Publishing Ltd; Taylor & Francis
• Subjects: Adult; Biological and medical sciences; Birth Injuries - etiology; Birth Weight; Brachial Plexus - injuries; Brachial Plexus Neuropathies - etiology; Case-Control Studies; Delivery, Obstetric - adverse effects; Delivery, Obstetric - methods; Delivery. Postpartum. Lactation; Disorders; Female; Gynecology. Andrology. Obstetrics; Humans; Infant, Newborn; Labor Stage, Second; Medical sciences; Midwifery; Multivariate Analysis; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Obstetric brachial plexus palsy; obstetrical maneuvers; Pregnancy; Pregnancy Outcome; Prospective Studies; Risk Factors; shoulder dystocia; Shoulder Injuries; Nervous system diseases; Obstetric brachial plexus palsy; Pregnancy disorders; Motor system disorder; Brachial plexus; Gynecology; Manuals; Labor; Epidemiology; Obstetrics; Prospective; Clinical stage; obstetrical maneuvers; Shoulder; shoulder dystocia; Dystocia; Risk factor; Delivery disorders; Paralysis; Neurological disorder
• ISSN: 0001-6349; 1600-0412; 1600-0412
• DOI: 10.1080/00016340601089792

Background. To evaluate the association between obstetric brachial plexus palsy and obstetrical maneuvers during the second stage of delivery. Methods. Prospective population-based case control study. Cases of obstetric brachial plexus palsy were compared with a randomly selected control group with regard to obstetric management. Results. Five or more obstetrical maneuvers were used to deliver the infants in 82% in the obstetric brachial plexus palsy group versus 1.8% in the controls. Risk factors independently associated with obstetric brachial plexus palsy were force applied when downward traction was imposed on the fetal head (odds ratio 15.2; 95% confidence interval 8.4-27.7). The incidence of obstetric brachial plexus palsy in the infants in the population was 3.3‰. At 18 months of age 16.1% (incidence of 0.05%) of children had residual functional deficits and downward traction with substantial force was applied in all these cases. Conclusions. Forceful downward traction applied to the head after the fetal third rotation represents an important risk factor of obstetric brachial plexus palsy in vaginal deliveries in cephalic presentation.