Obstetric Brachial Plexus Injury in Subsequent Deliveries

Al-Qattan, M. M.; El-Sayed, Amel A. F.; Al-Kharfy, Tm; Al-Jurayyan, Nasir A.M.

doi:10.1177/229255039600400406

Cited by 5 publications

(5 citation statements)

References 8 publications

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“…14 A brachial plexus injury in a previous delivery has also been associated with subsequent deliveries complicated by brachial plexus injury. 15 Use of forceps or vacuum techniques during delivery 16 and clavicular and humeral fractures are also associated with brachial plexus injuries. 17,18 Shoulder dislocations and clavicular, rib, and humeral fractures can all present a picture that can be confused with a brachial plexus injury (pseudoparalysis).…”

Section: Discussionmentioning

confidence: 99%

Obstetrical Brachial Plexus Palsy

Borschel

Clarke

2009

Plastic and Reconstructive Surgery

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In this article, the authors review their approach to evaluation, operative management, and reconstructive technique. Brachial plexus injuries in the newborn are usually managed nonoperatively. The timing and indications for primary surgery vary significantly between institutions. The motor examination is used to determine which infants would benefit from operative management. Patients are selected based on established criteria, such as the Toronto Test Score, applied at age 3 months. However, some cases are initially less clear, and we may recommend delaying operative management until age 6 months or as late as age 9 months if the child fails the cookie test. Neuroma excision, sural nerve grafting, and nerve transfers are performed when indicated by clinical motor examination. The use of selective motor nerve transfers, either in combination with nerve grafting or alone, has allowed nerve coaptations to be performed closer to the neuromuscular junction, which may further improve regeneration. Children undergoing primary surgery experience low rates of perioperative morbidity, and they experience gains in motor function until 3 or 4 years postoperatively, at which point recovery stabilizes.

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Section: Discussionmentioning

confidence: 99%

Obstetrical Brachial Plexus Palsy

Borschel

Clarke

2009

Plastic and Reconstructive Surgery

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“…By comparison, the lifetime costs for a case of NBPP, excluding potential loss in productivity and earning capacity, is estimated at more than US$1 million . Caesarean section is only indicated in selected cases: women with previous children with permanent NBPP, macrosomic pregnancies complicated by diabetes, and a high global risk identified by the obstetrician.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for neonatal brachial plexus palsy: a systematic review and meta‐analysis

Looven

Roy

Tanghe

et al. 2019

Develop Med Child Neuro

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Aim To provide a comprehensive update on the most prevalent, significant risk factors for neonatal brachial plexus palsy (NBPP). Method Cochrane CENTRAL, MEDLINE, Web of Science, Embase, and ClinicalTrials.gov were searched for relevant publications up to March 2019. Studies assessing risk factors of NBPP in relation to typically developing comparison individuals were included. Meta‐analysis was performed for the five most significant risk factors, on the basis of the PRISMA statement and MOOSE guidelines. Pooled odds ratios (ORs), 95% confidence intervals (CIs), and across‐study heterogeneity (I2) were reported. Reporting bias and quality of evidence was rated. In addition, we assessed the incidence of NBPP. Results Twenty‐two observational studies with a total sample size of 29 419 037 live births were selected. Significant risk factors included shoulder dystocia (OR 115.27; 95% CI 81.35–163.35; I2=92%), macrosomia (OR 9.75; 95% CI 8.29–11.46; I2=70%), (gestational) diabetes (OR 5.33; 95% CI 3.77–7.55; I2=59%), instrumental delivery (OR 3.8; 95% CI 2.77–5.23; I2=77%), and breech delivery (OR 2.49; 95% CI 1.67–3.7; I2=70%). Caesarean section appeared as a protective factor (OR 0.13; 95% CI 0.11–0.16; I2=41%). The pooled overall incidence of NBPP was 1.74 per 1000 live births. It has decreased in recent years. Interpretation The incidence of NBPP is decreasing. Shoulder dystocia, macrosomia, maternal diabetes, instrumental delivery, and breech delivery are risk factors for NBPP. Caesarean section appears as a protective factor. What this paper adds The overall incidence of neonatal brachial plexus palsy is 1.74 per 1000 live births. The incidence has declined significantly. Shoulder dystocia, macrosomia, maternal diabetes, instrumental delivery, and breech delivery are the main risk factors. Prevention is difficult owing to unpredictability and often labour‐related risk.

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“…14 History of OBPP in a previous pregnancy is another risk factor. 16 Al-Qattan and al-Kharfy 16 reported a high recurrence rate in women with history of previous childbirth with permanent OBPP and advocated elective cesarean delivery in these pregnancies especially if there is also macrosomia. However it is uncertain whether these results would also apply to cases of previous temporary OBPP.…”

Section: Obstetric Risk Factorsmentioning

confidence: 99%

Is it possible to reduce obstetrical brachial plexus palsy by optimal management of shoulder dystocia?

Doumouchtsis

Arulkumaran

2010

Annals of the New York Academy of Sciences

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Obstetrical brachial plexus palsies (OBPP) have been historically attributed to the impaction of the fetal shoulder behind the symphysis pubis and to excessive lateral traction of the fetal head during maneuvers to deliver the fetal shoulders in shoulder dystocia. Shoulder dystocia is indeed a major risk factor as it increases the risk for OBPP 100-fold. The incidence of OBPP following shoulder dystocia varies widely from 4% to 40%. However, a significant proportion of OBPPs are secondary to in utero injury. The propulsive forces of labor, intrauterine maladaptation, and compression of the posterior shoulder against the sacral promontory as well as uterine anomalies are possible intrauterine causes of OBPP. Many risk factors for OBPP may be unpredictable. Early identification of risk factors for shoulder dystocia, as well as appropriate management when it occurs, may improve our ability to prevent the occurrence of OBPP in those cases that are caused by shoulder dystocia.

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Obstetric Brachial Plexus Injury in Subsequent Deliveries

Abstract: Two cases of obstetrical brachial plexus injury in subsequent deliveries in the same family are described. Medicolegal aspects, review of the literature and recommendations regarding its prevention are given.

Cited by 5 publications

References 8 publications

Obstetrical Brachial Plexus Palsy

Obstetrical Brachial Plexus Palsy

Risk factors for neonatal brachial plexus palsy: a systematic review and meta‐analysis

Is it possible to reduce obstetrical brachial plexus palsy by optimal management of shoulder dystocia?

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