Abstract
PurposeTo describe the risk factors and labor characteristics of Clavicular fracture (CF) and brachial plexus injury (BPI); and compare antenatal and labor characteristics and prognosis of obstetrical BPI associated with shoulder dystocia with obstetrical BPI not associated with shoulder dystocia.MethodsThis retrospective study consisted of women who gave birth to an infant with a fractured clavicle or BPI between January 2009 and June 2013. Antenatal and neonatal data were compared between groups. The control group (1300) was composed of the four singleton vaginal deliveries that immediately followed each birth injury. A multivariable logistic regression model, with backward elimination, was constructed in order to find independent risk factors associated with BPI and CF. A subgroup analysis involved comparison of features of BPI cases with or without associated shoulder dystocia.ResultsDuring the study period, the total number of vaginal deliveries was 44092. The rates of CF, BPI and shoulder dystocia during the study period were 0,6%, 0,16% and 0,29%, respectively. In the logistic regression model, shoulder dystocia, GDM, multiparity, gestational age >42 weeks, protracted labor, short second stage of labor and fetal birth weight greater than 4250 grams increased the risk of CF independently. Shoulder dystocia and protracted labor were independently associated with BPI when controlled for other factors. Among neonates with BPI whose injury was not associated with shoulder dystocia, five (12.2%) sustained permanent injury, whereas one neonate (4.5%) with BPI following shoulder dystocia sustained permanent injury (p = 0.34).ConclusionBPI not associated with shoulder dystocia might have a higher rate of concomitant CF and permanent sequelae.
Highlights
Clavicular fracture (CF) during delivery is a relatively common complication of labor and delivery
Several risk factors for CF have been identified in the literature, including fetal macrosomia [1,2,3,4,5,6,7,8], shoulder dystocia [3,7,9,10], gestational diabetes mellitus (GDM)[1], oxytocin use to augment labor [2], operative delivery [9], prolonged second stage of labor [4] and meconium staining of amniotic fluid [1]
It has been suggested that brachial plexus injury (BPI) not related to shoulder dystocia has a worse prognosis than BPI associated with shoulder dystocia in terms of permanent neurologic sequelae [11,12]. The purpose of this retrospective study was (1) to describe the risk factors for CF; (2) to describe the risk factors for BPI; (3) and to compare antenatal and labor characteristics and prognosis of obstetrical BPI associated with shoulder dystocia with obstetrical BPI not associated with shoulder dystocia
Summary
Clavicular fracture (CF) during delivery is a relatively common complication of labor and delivery. Several risk factors for CF have been identified in the literature, including fetal macrosomia [1,2,3,4,5,6,7,8], shoulder dystocia [3,7,9,10], gestational diabetes mellitus (GDM)[1], oxytocin use to augment labor [2], operative delivery [9], prolonged second stage of labor [4] and meconium staining of amniotic fluid [1] Among these factors, only increased fetal birth weight has been consistently associated with neonatal CF. This disparity has been attributed to the inherent subjectivity of the clinician’s definition and differences in selfreporting of the shoulder dystocia [1,8]
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