762 Factors associated with brachial plexus injury following shoulder dystocia

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Brachial plexus injury is an adverse outcome of shoulder dystocia that is difficult to predict and prevent. This study sought to identify risk factors for brachial plexus injury in shoulder dystocia, particularly examining prioritization of delivery of the posterior arm. This was a retrospective, case-control study of deliveries with shoulder dystocia, comparing characteristics between those with and without associated neonatal brachial plexus injuries. All shoulder dystocia cases between January 1, 2010 and December 31, 2019 were identified from a contemporaneously maintained obstetrical database and confirmed via chart review. Maternal BMI, birth weight, delivery provider, number of shoulder dystocia maneuvers used, and prioritization of delivery of the posterior arm (defined as inclusion of posterior arm within the first three maneuvers), were examined. 639 cases of shoulder dystocia were identified. 55 (8.6%) were complicated by brachial plexus injury. Brachial plexus injury was significantly more common with use of more maneuvers and prioritization of the posterior arm. Maternal BMI (available for 602) and neonatal birth weight were higher in the group with brachial plexus injury than without (36.5 vs. 33.3, p = 0.0007 and 4058 vs. 3865, p = 0.001). There was no difference in brachial plexus injury rate based on delivery provider (resident, midwife, or attending p = 0.31, available for 378). After controlling for BMI and birth weight, prioritization of the posterior arm remained associated with increased odds of brachial plexus injury (OR 3.37, CI 1.06-10.75, p = 0.04). This study corroborated previously identified factors associated with brachial plexus injury. The increased odds of brachial plexus injury associated with prioritization of the posterior arm stands in contrast to earlier data, which has suggested this maneuver has similar rates of injury to others and has the highest rate of successful delivery. Further research is needed to elucidate the ideal balance between number and order of maneuvers, in order to optimize management of shoulder dystocia.View Large Image Figure ViewerDownload Hi-res image Download (PPT)