How Often are Brachial Plexus Injuries Associated with Shoulder Dystocia?
BACKGROUND AND PURPOSE:
Johnson et al. (Obstetrics & Gynecology, 2020) analyze the origins and consequences of cases of brachial plexus injuries and their relationship to shoulder dystocia
Retrospective cohort study (2012 to 2019)
Data extracted using ICD9 and ICD10 codes
All neonates with brachial plexus injury
All mothers with shoulder dystocia
Extracted cases were reviewed by a physician author
Shoulder dystocia definition
“Shoulder dystocia or any difficulty in delivery” documented in the record
Delivering clinician experience also noted
Brachial plexus injury stratified
Shoulder dystocia present vs not present
Injury transient vs persistent (present at discharge)
Temporal trends were also investigated
41,525 deliveries overall
Brachial plexus injury: 0.08% (33 cases)
Of the cases of brachial plexus injury
42% were not associated with shoulder dystocia
9% followed cesarean
Brachial plexus injury without shoulder dystocia was related to
Absence of maternal diabetes
Lower birth weights
A longer second stage of labor
Persistent brachial plexus injury was present in cases with and without shoulder dystocia (P = 0.36)
With shoulder dystocia: 89%
Without shoulder dystocia: 71%
Clinician experience was not associated with persistence of brachial plexus injury
The current study is consistent with previous reports of high frequency of brachial plexus injury that is not related to shoulder dystocia at the time of delivery
The lack of relationship between clinician experience and outcomes may indicate that team training and simulation may help in some settings (e.g. high shoulder dystocia rates) but ultimately my not result in lowering injury rates beyond a certain threshold
The authors suggest that based on the data in this study and previous literature
…both brachial plexus injury and shoulder dystocia often reflect two causally unrelated complications of uterine forces driving a fetus through the birth canal in the presence of disproportion between the passage and the shoulder girdle of the passenger
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