Case-control study of risk factors of obstetrical brachial plexus palsy

( views:98, downloads:0 )
YANG Su-ting(Department of Obstetrics and Gynecology,Qilu Hospital of Shandong University,Jinan 250012, China)
ZHANG Xiang-li(Department of Obstetrics and Gynecology,Qilu Hospital of Shandong University,Jinan 250012, China)
Journal Title:
Chinese Journal of Obstetrics and Gynecology
Volume 46, Issue 11, 2011
Key Word:
Brachial plexus neuropathies;Obstetric labor complications;Risk factors

Abstract: Objective To study the risk factors of obstetrical brachial plexus palsy (OBPP).Methods Forty-six newborn infants with OBPP were recruited between January 1997 and December 2009 from Technical Appraisement Center for Medical Malpractice of Shandong province as OBPP group.In the control group,138 newborn infants delivered in the same time,same hospital and same gender were collected,with a ratio of 1:3.All the cases were analyzed retrospectively.The newborn,maternal,childbirth data and working experience of midwives were analyzed by univariate and multivariate logistic regression analysis.Results ( 1 ) External pelvimetries of the two groups were normal.All were singleton newborns by vaginal deliveries with cephalic presentation.Twenty-two newborns had left unilateral palsies,and the other 24 had right unilateral palsies.The numbers of the whole,upper and fore arm type were 17,26 and 3,respectively.The maternal age,gravidity,parity and gestational weeks were higher in OBPP group than in the control group ( P < 0.05 ).( 2 ) The maternal antepartum body mass index ( BMI ) [ ( 29.5 ± 2.4 ) kg/m2 ],height of the uterus [ (34.9 ± 2.4) cm ] and abdominal circumference [ ( 105 ± 6) cm ] in OBPP group were higher than those in the control group [ ( 26.1 ± 2.5 ) kg/m2,( 33.7 ± 2.2 ) cm and ( 99 ± 5 ) cm,respectively ] ( P < 0.05 ).The newborn birth weight in OBPP group [ ( 4390 ± 489 ) g ] was significantly higher than the control group [ ( 3404 ± 360 ) g] ( P < 0.01 ).The working experience of midwives in OBPP group [ ( 5.2 ± 2.3 ) years ] was less than the control group [ ( 8.9 ± 5.4) years ] ( P < 0.01 ).(3) There was a higher proportion of instrumental delivery ( 28.3% vs.3.6% ),uterine atony (28.3% vs.6.5% ),prolonged second stage(8.7% vs.0.7% ) and fetal malposition( 10.9% vs.2.9% ) in the OBPP group than in the control group ( P < 0.05 ).(4) Univariate logistic analysis showed that the P values of maternal age,antepartum BMI,height of uterus,abdominal circumference,newborn birth weight,gravidity,second stage duration,instrumental delivery,fetal malposition,uterine atony and working experience of midwives were all less than 0.10.And the working experience of midwives was a protective factor.(5)The factors listed above were taken as variables,selected stepwise regression for multivariate logistic regression analysis.Boundary value was 0.10.It showed that the antepartum BMI ( OR =1.733 ) and newborn birth weight ( OR =1.004 ) were related to OBPP ( P < 0.10 ).The significance of maternal antepartum BMI was higher than birth weight.Conclusions The maternal antepartum BMI is the most important risk factor for OBPP,and the newborn birth weight is the other risk factor.The working experience of midwives is a protective factor.

  • [1]Mcneely PD,Drake JM.A systematic review of brachial plexus surgery for birth-related brachial plexus injury.Pediatr Neurosurg,2003,38:57-62.
  • [2]Andersen J,Watt J,Olson J,et al.Perinatal brachial plexus palsy.Paediatr Child Health,2006,11:93-100.
  • [3]Doumouchtsis SK,Arulkumaran S.Are all brachial plexus injuries caused by shoulder dystoeia? Obstet Gynecol Surv,2009,64:615-623.
  • [4]Gosk J,Rutowski R.Analysis of risk factors for perinatal brachial plexus palsy.Ginekol Pol,2005,76:270-276.
  • [5]高仕长,孟炜.分娩性臂从神经损伤危险因素的病例对照研究.中华手外科杂志,2002,18:193-196.
  • [6]Comninos AC,Vassalos EG.Clinical observations on the use of the vacuum extractor.Geburtshilfe Frauenheilkd,1962,22:1259-1263.
  • [7]陆志方,夏春林,刘大成.新生儿臂丛损伤发生机制研究进展.中国临床解剖学杂志,2009,27:626-628.
  • [8]Foad SL,Mehlman CT,Ying J.The epidemiology of neonatal brachial plexus palsy in the United States.J Bone Joint Surg Am,2008,90:1258-1264.
  • [9]Alfonso I,Papazian O.Intrauterine shoulder weakness and obstetric brachial plexus palsy.Pediatr Neurol,2004,31:225-227.
  • [10]Gherman RB,Ouzounian JG,G oodwin TM.Brachial plexus palsy:an in utero injury? Am J Obstet Gynecol,1999,180:1303-1307.
  • [11]Bahm J,Ocampo-Pavez C,Noaman H.Microsurgical technique in obstetric brachial plexus repair:a personal experience in 200 cases over 10 years.J Brachial Plex Peripher Nerve Ini,2007,2:1-7.
  • [12]Mollberg M,Wennergren M.Obstetric brachial plexus palsy:a prospective study on risk factors related to manual assistance during the second stage of labor.Acta Obstet Gynecol Scand,2007,86:198-204.
  • [13]Alfonso DT.Causes of neonatal brachial plexus palsy.Bull NYU Hosp Jt Dis,2011,69:11-16.
  • [14]Vahratian A,Zhang J,Troendle JF,et al.Maternal prepregnancy overweight and obesity and the pattern of labor progression in term nulliparous women.Obstet Gynec,2004,104:943-951.
  • [15]Chu SY,Kim SY,Lau J,et al.Maternal obesity and risk of stillbirth:a meaanalysis.Am J Obstet Gynecol,2007,197:223-228.
  • [16]漆洪波,吴味辛.孕期肥胖对阴道分娩的影响.中国实用妇产科杂志,2005,21:434-436.
  • [17]Denison F C,Price J,Graham C,et al.Maternal obesity,length of gestation,risk of postdates pregnancy and spontaneous onset of labour at term.BJOG,2008,115:720-725.
  • [18]Ecker JL,Greonberg JA,Norwitz ER,et al.Birthweight as a predictor of brachial plexus injury.Obstet Gynecol,1997,89:643-647.
WanfangData CO.,Ltd All Rights Reserved
About WanfangData | Contact US
Healthcare Department, Fuxing Road NO.15, Haidian District Beijing, 100038 P.R.China
Tel:+86-010-58882616 Fax:+86-010-58882615