The immediate and long-term outcome of obstetric birth trauma

Gordon, Myron; Rich, Herbert; Deutschberger, Jerome; Green, Marvin

doi:10.1016/0002-9378(73)90727-8

Cited by 199 publications

(91 citation statements)

References 3 publications

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“…The incidence of OBPI as reported in the literature varies from 0.9 to 4.4 per 1000 live births (Gordon et al 1973, Treffers et al 1976, Hardy 1981, Sjöberg et al 1988, Bager 1997, Peleg et al 1997. A recent study in our own hospital showed an incidence of 4.6 per 1000 live births .…”

mentioning

confidence: 67%

Neurological recovery in obstetric brachial plexus injuries: an historical cohort study

Hoeksma

Steeg

Nelissen

et al. 2004

Develop Med Child Neuro

177

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An historical cohort study was conducted to investigate the rate and extent of neurological recovery in obstetric brachial plexus injury (OBPI) and to identify possible prognostic factors in a cohort of children with OBPI from birth to 7 years. All children (n=56; 31 females, 25 males) with OBPI were evaluated at fixed time intervals by one examiner. They underwent a final neurological examination at a mean age of 3 years 10 months (range 1 to 7 years). Neurological outcome was not as favourable as is often reported: complete neurological recovery occurred in 37 out of 56 children (66%). In half of these there was delayed recovery, in which case complete neurological recovery was assessed from 1.5 to 16 months of age (median age 6.5 months, SD 4.2 months). External rotation and supination were the last to recover and recovered the least. Although biceps function at three months was considered to be the best indicator for operative treatment, external rotation and supination were found to be better in predicting eventual complete recovery. Initial symptoms directly post partum were not found to be prognostic. Functional outcome was mainly reported to be good.

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mentioning

confidence: 67%

Neurological recovery in obstetric brachial plexus injuries: an historical cohort study

Hoeksma

Steeg

Nelissen

et al. 2004

Develop Med Child Neuro

177

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“…According to several previous studies (15,33), recovery begins early, by the age of a few weeks, and proceeds up to at least the end of the third month (1,(35)(36)(37).…”

Section: Prognosismentioning

confidence: 86%

“…Bilateral OBPP is reported in up to 23% of cases and occurs mostly in the setting of breech presentation, during which excessive traction on both shoulders may be applied to deliver the head (15,33). The majority of infants with OBPP have a unilateral lesion affecting C5-C6 (C7) (34).…”

Section: Prognosismentioning

confidence: 99%

High birthweight and shoulder dystocia: the strongest risk factors for obstetrical brachial plexus palsy in a Swedish population‐based study

Mollberg

Hagberg

Bager

et al. 2005

Acta Obstet Gynecol Scand

137

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Background: Obstetric brachial plexus palsy (OBPP) at birth is one important cause of neurological disability in children and adults; the incidence has increased substantially in Sweden over the past decade. Several risk factors for OBPP have been identified, e.g. high birth weight and shoulder dystocia, but it remains difficult to predict based on antenatally available information. Despite extensive research on OBPP, there is no generally accepted strategy for prevention. The overall objective of this thesis is to study predisposing risk factors for OBPP in vaginally delivered infants and to identify specific obstetric procedures that are strongly associated with OBPP. Based on this knowledge, our ultimate aim is to develop a prevention strategy with respect to manual assistance in the second stage of labour. Methods: Paper I reports on a retrospective case-control study aimed at investigation of the incidence and risk factors for OBPP in a large population studied in 1987-1997. All deliveries recorded in the Swedish Medical Birth Register during the period were investigated. Cases of OBPP were compared with all cases without OBPP. Paper II describes a retrospective casecontrol study, the purpose of which was to identify risk factors for OBPP, specifically in women delivered by vacuum extraction. The groups with and without OBPP were compared with regard to possible risk factors, including those linked to the vacuum extraction procedure. The aim of the prospective population-based case-control study presented in Paper III was to evaluate the association between OBPP and obstetric manoeuvres during the second stage of delivery. Obstetric management in OBPP cases was compared to management in a randomly selected control group. Paper IV and Paper III are based on the same cases. The aims of the study presented in Paper IV were a) to describe neurological deficits in children with remaining OBPP at 18 months of age; b) to compare maternal, infant and obstetric data in infants with and without OBPP at 18 months of age and c) to evaluate if differences in force applied in downward traction of the head (ranked on a 100-point visual analogue scale) correlated to the number of affected nerve roots (C5-C6, C5-C7, C5-Th1). Results:The incidence of OBPP in Sweden increased from 0.17% to 0.27% between 1987 and 1997. Infants with high birth weight, especially >4500 g, were at increased risk of shoulder dystocia and OBPP. However, high birth weight was not or only weakly overrepresented among children with persistent OBPP, compared with those who recovered, suggesting that other factors are important. Hence, many factors related to prolonged second stage and difficulties in delivering the shoulders were overrepresented in the OBPP group, compared to controls. In particular, forceful downward traction applied to the head after the fetal third rotation represented an important risk factor for OBPP in cephalic-presentation vaginal deliveries. Downward traction of the head had been applied more often and with greater force in the...

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“…Perinatal asphyxia is fre q u e n t l y associated with OBP 4,7,14 . The theory that hypotonia induced by perinatal hypoxia predisposes the fetus to a brachial plexus stretch injury seems logical 1 5 , but lacks experimental confirmation.…”

Section: Discussionmentioning

confidence: 99%

Prognostic relevance of risk factors for obstetrical brachial plexopathy

Heise

Gherpelli

2006

Arq. Neuro-Psiquiatr.

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-We did a case-control study to verify if the birthweight, forceps delivery or perinatal asphyxia have any significant effect on the prognosis of obstetrical brachial plexopathy. Group A was composed of 25 infants who completely re c o v e red at the age of 6 months. Group B was composed of 21 infants who w e re still not able to remove a blindfold from the face with the affected limb in the sitting position at the age of 12 months. There was no statistical diff e rence of the median birthweight or median first minute Apgar score between the groups. There was also no relation between birthweight higher than 4000g, first minute Apgar score lower than 6 or forceps delivery with a poor prognosis.KEY WORDS: brachial plexus, obstetric paralysis, risk factors, birth weight, obstetrical forceps, Apgar score .Relevância prognóstica dos fatores de risco para plexopatia braquial obstétrica RESUMO -Realizamos um estudo caso-controle para verificar se o peso ao nascimento, parto forceps ou asfixia perinatal apresentam efeito significativo no prognóstico da plexopatia braquial obstétrica. O gru p o A foi composto por 25 lactentes que apresentavam recuperação completa aos 6 meses de idade. O grupo B foi composto por 21 lactentes incapazes de remover uma venda do rosto com o membro acometido na posição sentada aos 12 meses de idade. Não houve diferença significativa entre as medianas de peso ao nascimento ou do boletim Apgar do primeiro minuto entre os grupos. Também não foi observada re l a ç ã o e n t repeso ao nascimento maior que 4000g, boletim Apgar do primeiro minuto menor do que 6 ou part o forceps com um prognóstico desfavorável.PA L AV R A S -C H AVE: plexo braquial, paralisia obstétrica, fatores de risco, peso ao nascimento, forceps obstétri-co, escore de Apgar.

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The immediate and long-term outcome of obstetric birth trauma

Cited by 199 publications

References 3 publications

Neurological recovery in obstetric brachial plexus injuries: an historical cohort study

Neurological recovery in obstetric brachial plexus injuries: an historical cohort study

High birthweight and shoulder dystocia: the strongest risk factors for obstetrical brachial plexus palsy in a Swedish population‐based study

Prognostic relevance of risk factors for obstetrical brachial plexopathy

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