Original Article
Obstetric brachial plexus injury: risk factors related to recovery

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Abstract

Objective: To investigate if multivariate risk calculation can discriminate those infants who do not recover after an obstetric brachial plexus injury (OBPI). Study design: All liveborn infants without lethal congenital abnormalities from 1988 through 1996 with a gestational age ⩾30 weeks were included. Outcome variables were all OBPI and non-recovered OBPI. Risk calculation was performed by univariate analysis for all infants and by multivariate logistic analysis for all singleton infants delivered vaginally in cephalic presentation. Results: A total of 62 of 13 366 liveborn infants sustained an OBPI (0.46%). Seventeen (27%) did not recover completely. Birth weight, female sex, second stage >60 min, diabetes, multiparity, maternal age and non-Caucasian origin were important risk factors for non-recovered OBPI. A model without birth weight, which can not be measured accurately antepartum, is considerably less effective. Risk factors for all OBPI and for non-recovered OBPI were similar. Conclusion: A predictive multivariate model is of limited value due to the low incidence of non-recovered OBPI. However, it may be useful to discriminate individual cases with exceptional risk.

Introduction

Obstetric brachial plexus injury (OBPI) is generally considered to be caused by stretching or tearing of the roots of the brachial plexus. This may result from difficulty delivering the anterior shoulder, but also from breech extraction [1]. The incidence of OBPI varies between 1–4/1000 liveborn infants [2], [3], [4], [5], [6], [7], [8]. It is reported that 80–90% of these infants recover completely within 1 year [2], [3], [4], [5]. Late sequelae vary from minor loss of function to complete paralysis of the arm. Neurosurgery may improve outcome but will never achieve complete recovery [9].

In view of the lifelong impact prevention of non-recovered OBPI would be of great importance. Although several studies have described risk factors for OBPI and have unanimously concluded that risk factors are of low predictive value, these studies never addressed the interaction between variables by multivariate analysis while taking the severity of the lesion or the recovery rate into account. Therefore we reviewed our database with special interest for the relation of obstetric parameters with prevalence and recovery of OBPI.

Section snippets

Material and methods

All infants with OBPI born alive from 1988 through 1996 in the obstetric department of the Academic Medical Center, Amsterdam, were reviewed. The hospital is a level 3 referral center and serves primary and secondary care only for a limited area around the hospital. A major part of the population in this area immigrated during recent years, mainly from Surinam, West Africa and the Indian subcontinent. Most primary obstetric care is provided by independent midwives, who refer only when

Results

During the study period 13 366 infants were born alive in our hospital without lethal congenital abnormalities at a gestational age ⩾30 weeks.

Sixty-two of these infants sustained an OBPI (incidence 0.46%). Twenty-two recovered completely within 1 month and 23 showed delayed complete recovery (Table 1). Of the 17 infants (27%) with remaining paresis, 11 were treated surgically. Three of these have a lasting severe paresis, while the others have only mild paresis. Two of the infants had a

Comment

The rate of OBPI in our study is higher than usually reported [2], [3], [4], [5], [6], [7], [8]. This can in part be explained by the fact that due to the Dutch obstetric care system most of the uneventful deliveries in our catchment area were attended by independent midwives and these are not included in our study.

An other explanation may be the high number of immigrants. Non-Caucasian women had an eight-fold higher risk when corrected for birth weight in our logit analysis. Data from an

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