Neonatal brachial plexus palsy with vaginal birth after cesarean delivery: a case-control study

Area of Science:

• Obstetrics and Gynecology
• Neonatal Health
• Perinatal Outcomes

Background:

• Vaginal birth after cesarean delivery (VBAC) is a common obstetric practice.
• Neonatal brachial plexus palsy (NBPP) is a potential complication of childbirth.
• Understanding NBPP rates in VBAC is crucial for informed decision-making.

Purpose of the Study:

• To determine the incidence of NBPP in VBAC deliveries.
• To compare the characteristics of neonates with NBPP following VBAC to control infants.
• To provide data for counseling women considering VBAC.

Main Methods:

• Retrospective analysis of a cesarean registry.
• Identification of term, nonanomalous singleton pregnancies undergoing VBAC.
• Matching of NBPP cases with control subjects (gestational age, diabetes status).

Main Results:

• The incidence of NBPP among 11,313 VBACs was 2.0 per 1000 births.
• NBPP infants were significantly more likely to be macrosomic (≥4000g) compared to controls (48% vs 10%).
• Infants with NBPP had higher rates of neonatal intensive care unit (NICU) admission (30% vs 13%).

Conclusions:

• The risk of NBPP following VBAC is low.
• Macrosomia is a significant risk factor for NBPP in the VBAC population.
• Women desiring VBAC should be informed of the low NBPP rate and encouraged to attempt labor if eligible.