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Factors associated with neonatal brachial palsy in shoulder dystocia: a longitudinal study
Javier Sánchez-Romero1,2, Almudena Jiménez-Méndez3, Lucía Begoña Díaz-Meca3
1Department of Obstetrics and Gynecology, Pediatrics and Surgery, University of Murcia, Crtra. Cartagena-Madrid s/n El Palmar, Murcia, Spain. javier.sanchez14@um.es.
Insights
Maternal obesity, operative delivery, and prolonged shoulder dystocia increase neonatal brachial plexus injury (BPI) risk. Recovery is linked to clavicle fracture and rehabilitation.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Pediatric Surgery
Background:
- Shoulder dystocia (SD) is a significant obstetric emergency.
- Neonatal brachial plexus injury (BPI) is a potential complication of SD.
- Understanding risk factors and recovery predictors for BPI is crucial for improved neonatal outcomes.
Purpose of the Study:
- To analyze factors associated with brachial plexus injury (BPI) following shoulder dystocia (SD).
- To identify predictors of BPI development and recovery after SD.
- To inform clinical management and prevention strategies for SD-related BPI.
Main Methods:
- A longitudinal prospective study was conducted from January 2019 to December 2020.
- Data from 13,414 deliveries were analyzed, focusing on 69 cases of SD.
- Multivariable logistic regression and survival analysis were employed to assess BPI risk and recovery.
Main Results:
- The incidence of SD was 0.65%, with an average resolution time of 102.1 seconds.
- Neonatal BPI was associated with maternal BMI > 30 kg/m² (OR=7.91), prolonged SD resolution (>120 seconds, OR=14.4), and operative delivery (OR=6.8).
- BPI recovery was linked to clavicle fracture (HR=0.31) and specific rehabilitation treatment (HR=9.2).
Conclusions:
- Maternal BMI over 30 kg/m², operative delivery, and SD lasting over 120 seconds are significant risk factors for neonatal BPI.
- Clavicle fracture and dedicated rehabilitation significantly influence BPI recovery.
- These findings highlight key areas for intervention to mitigate BPI risk and enhance recovery.
Objectives:
The main goal is to analyze factors related to brachial plexus injury (BPI) after Shoulder Dystocia (SD).
Material And Methods:
Longitudinal prospective analysis of SD arose in a tertiary hospital from 1/1st/ 2019 to 12/31st/ 2020. A multivariable logistic regression for BPI after SD and a survival analysis for BPI recovery after SD were performed.
Results:
In this period 13,414 deliveries were attended, 10,676 of those were vaginal deliveries (79.6%) reporting 69 cases of SD, with an incidence of 0.65%. SD required 102.1 seconds (SD) 10.8 as an average for solving it. Internal maneuvers were needed in 42.0% of SD reported. Neonatal BPI was suspected in 23 newborns (33.3%) at birth. Neonatal BPI at 48 hours of life was statistically associated with maternal BMI above 30 kg/m² (OR = 7.91; CI 95% 1.3-47.7; p = 0.024), > 120 seconds for solving SD (OR = 14.4; CI95% 1.7-121.82; p = 0.014) and operative delivery (OR = 6.8; CI 95% 1.2-37.6; p = 0.028). The BPI recovery was statistically associated with clavicle fracture (HR = 0.31 CI 95% 0.10-0.96 p = 0.042) and specific rehabilitation treatment (HR = 9.2 CI 95% 1.87-45.23 p = 0.006).
Conclusions:
The following factors were associated with neonatal BPI at 48 hours of life: Maternal BMI above 30 kg/m², operative delivery, or shoulder dystocia that requires more than 120 seconds for solving it. The BPI recovery was associated with clavicle fracture and specific rehabilitation treatment.
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