Intrapartum risk factors for permanent brachial plexus injury - 28/08/11
, Shawn P Stallings, MD b, Alessandro Ghidini, MD a, Catherine Y Spong, MD a, Shad H Deering, MD a, Robert H Allen, PhD c
Reprint requests: Sarah H. Poggi, MD, 3800 Reservoir Road, 3PHC, Washington, DC 20007Abstract |
Objective |
The purpose of this study was to compare maternal, neonatal, and second stage of labor characteristics in shoulder dystocia deliveries that result in permanent brachial plexus injury with shoulder dystocia deliveries that result in no injury.
Study design |
Our cases were culled from a database of deliveries that resulted in permanent brachial plexus injuries and matched to control cases that were taken from a database of consecutive shoulder dystocia deliveries from one hospital. Deliveries that resulted in injury were excluded from the control cases; those cases with no recorded shoulder dystocia were excluded from the cases. Matching was for birth weight (±250 g), parity, and diabetic status. Rates of precipitous and prolonged second stage, operative delivery, neonatal depression, and average number of shoulder dystocia maneuvers used were compared between the two groups with χ2 test, Fisher exact test, and the Student t test; a probability value of <.05 was considered significant.
Results |
There were 80 matched patients, of which 26 patients were nulliparous and 11 patients were diabetic. Mothers of the uninjured group were younger than those of the injured group (23.7±6.2 years vs 27.4±5.1 years, P<.001). The injured group had a significantly higher rate of 5-minute Apgar scores of <7 (13.9% vs 3.8%, P=.04). Differences in maternal weight, body mass index, height, race, gestational age, average number of maneuvers, head-to-body delivery interval, operative delivery rate, prolonged second stage rate, precipitous second stage rate, and sex were not significant between groups. The rates of precipitous second stage for both groups (28.0% injured and 35.0% uninjured) were more than triple the rates of prolonged second stage (9.5% injured and 11.3% uninjured).
Conclusion |
No characteristic of second-stage of labor predicts permanent brachial plexus injury. Precipitous second stage is the most prevalent labor abnormality that is associated with shoulder dystocia.
Le texte complet de cet article est disponible en PDF.Keywords : Erb-Duchenne palsy, forceps, second stage of labor, shoulder dystocia, total palsy, vacuum
Plan
 | Presented at the Twenty-Third Annual Meeting of the Society of Maternal-Fetal Medicine, San Francisco, Calif, February 3-8, 2003. |
Vol 189 - N° 3
P. 725-729 - septembre 2003 Retour au numéro
Article précédent
- Oral misoprostol for premature rupture of membranes at term
- Joan M.G. Crane, Tina Delaney, Donna Hutchens
- Patterns of abnormal pudendal nerve function that are associated with postpartum fecal incontinence
- Myra Fitzpatrick, Conor O'Brien, P.Ronan O'Connell, Colm O'Herlihy
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?