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Risk Factors for Perinatal Brachial Plexus Palsy: A Retrospective Review of a Single-Institution's Eleven-Year Experience
Anne E. Glenney, BA; Meeti Mehta, BS; Alexander Comerci, BS; Hilary Liu, BS; Elizabeth A. Moroni MD MHA; Yusuf Surucu, MD; Kacey Marra, PhD; Alexander J. Davit, MD
University of Pittsburgh Medical Center (UPMC)
2023-02-01
Presenter: Anne E. Glenney
Affidavit:
Vu Nguyen
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Hand
Intro: Perinatal brachial plexus palsy (PBPP) is a flaccid paralysis of the upper extremity that occurs due to birth trauma and is associated with numerous risk factors. Our study characterizes risk factors for PBPP and quantifies their importance in predicting likelihood of PBPP.
Methods: A retrospective review of patients with PBPP presenting to our institution between 2008 and 2020 was conducted. Variables included demographics, birth history, the presence of risk factors e.g., shoulder dystocia, maternal diabetes; management and outcomes.
Results: 173 patients met inclusion criteria; 54.9% were Male. 86.5% of births were vaginal deliveries; all were single gestations. 73 patients (42.2%) had at least one risk factor: 48 (27.7%) had shoulder dystocia, 13 (7.5%) had maternal diabetes mellitus, 10 (5.8%) had prolonged labor, 6 (3.5%) had fetal macrosomia; 18 (10.4%) were difficult births (n=18, 10.4%). Fetal macrosomia was associated with 10.45 times greater risk of PBPP (RR 10.45, CI 1.25-87.32, p=0.007) and shoulder dystocia was associated with a 9.05 times greater risk of PBPP (RR 9.05, CI 4.72-17.36, p<0.001). Long labor (>24 hours) was associated with 8.36 times greater risk of PBPP (RR 8.36, CI 1.83-38.07, p<0.001) and maternal diabetes mellitus was associated with 4.7 times greater risk of PBPP (RR 4.70, CI 1.51-14.61, p=0.003).
Conclusion:
Numerous risk factors were identified that increase the risk of delivering a child with PBPP, most notably: fetal macrosomia, shoulder dystocia and prolonged labor (>24h). These risk factors may be utilized to screen patients and to inform OBGYN decision-making during the delivery process.
