Correlating head-to-body delivery intervals with neonatal depression in vaginal births that result in permanent brachial plexus injury

Abstract

Objective: The purpose of this study was to evaluate which variables predict neonatal depression in vaginal deliveries that result in permanent brachial plexus injury. Study Design: With the use of a data set of litigated vaginal deliveries (n = 103 deliveries) from 1978 through 1999 that resulted in permanent brachial plexus injury, detailed delivery and neonatal and pediatric information was obtained by chart review. Neonatal depression was defined as a 5-minute Apgar score of <7. Data that were extrapolated from neonates with low Apgar scores at 5 minutes were compared with neonates with Apgar scores of ≥7 with the use of the Fisher exact test, χ2 test, or one-way analysis of variance; a two-tailed probability value of <.05 was considered significant. Results: Nine of 89 neonates (10%) had low 5-minute Apgar scores. Head-to-body delivery intervals (available for 36 deliveries) were significantly longer in neonates with 5-minute Apgar scores of <7 vs ≥7 (294 ± 68 seconds vs 147 ± 82 seconds, P <.001). Differences in other clinical variables (ie, maternal weight, gestational age, diabetes mellitus, parity, birth weight, and sex) were not significant. None of the infants in this data set, which includes those infants with neonatal depression) died or had long-term asphyxia-related sequelae in the form of speech impediments, seizures, cerebral palsy, coma, or organ dysfunction. Conclusion: The head-to-body delivery interval was the only significant factor in the prediction of 5-minute Apgar score of <7 in a data set of deliveries that resulted in permanent brachial plexus injury. Despite extended times (≤6 minutes) on the perineum that resulted in a higher reduced Apgar score rate, there was no asphyxia-related morbidity. (Am J Obstet Gynecol 2002;187:839-42.)