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Brachial Plexus Birth Injury in Elective Versus Emergent Caesarean Section: A Cohort Study

Published:November 07, 2018DOI:https://doi.org/10.1016/j.jogc.2018.05.002

      Abstract

      Objective

      Although Caesarean section (CS) is protective for brachial plexus birth injury (BPBI), the incidence is not zero. A trial of labour with unfavourable intrauterine positioning is hypothesized to result in excessive force on the brachial plexus. The purpose of this study was to determine the risk of BPBI in emergent CS versus elective CS.

      Methods

      This was a retrospective cohort study. The authors used a nationwide demographic sample of all infants born in Canada from 2004 to 2012. BPBI diagnoses, risk factors, and national incidence data were obtained from the Canadian Institute for Health Information Discharge Abstract Database and Hospital Morbidity Database. The primary outcome was risk of BPBI in emergent CS versus elective CS.

      Results

      BPBI incidence was 1.24 per 1000 live births. Known biases may have underestimated the incidence. CS (elective and emergent) was protective for BPBI as compared with vaginal delivery (odds ratio [OR] 0.15; 95% confidence interval [CI] 0.13–0.18, P < 0.0001). Emergent CS was a moderately strong risk factor for BPBI versus elective CS (OR 3.14; 95% CI 1.79–5.10, P = 0.0001).

      Conclusion

      Emergent CS is a moderate risk factor for BPBI compared with elective CS. Intrauterine positioning with a trial of labour may provide an antenatal etiology in these distinct cases.

      Résumé

      Objectif

      Bien que la césarienne réduise le risque de lésion obstétricale du plexus brachial (LOPB), elle ne l'élimine pas. Il a été proposé qu'un essai de travail lorsque la position intra-utérine est défavorable pourrait exercer une force excessive sur le plexus brachial. Cette étude visait à comparer le risque de LOPB associé aux césariennes d'urgence et aux césariennes planifiées.

      Méthodologie

      Il s'agissait d'une étude de cohorte rétrospective. Les auteurs ont utilisé un échantillon démographique national comprenant tous les bébés nés au Canada de 2004 à 2012. Les données sur les diagnostics, les facteurs de risque et l'incidence nationale de LOPB ont été tirées de la Base de données sur les congés des patients et de la Base de données sur la morbidité hospitalière de l'Institut canadien d'information sur la santé. L'issue primaire était le risque de LOPB associé aux césariennes d'urgence et aux césariennes planifiées.

      Résultats

      L'incidence de LOPB était de 1,24 par 1 000 naissances vivantes. Des biais connus peuvent avoir entraîné une sous-estimation de l'incidence. La césarienne (d'urgence et planifiée) réduisait le risque de LOPB par rapport à l'accouchement par voie vaginale (RC : 0,15; IC à 95 % : 0,13–0,18, P < 0,0001). Comparativement à la césarienne planifiée, la césarienne d'urgence était associée à une hausse modérée du risque de LOPB (RC : 3,14; IC à 95 % : 1,79–5,10, P = 0,0001).

      Conclusion

      Comparativement à la césarienne planifiée, la césarienne d'urgence est associée à une hausse modérée du risque de LOPB. Le positionnement intra-utérin avant un essai de travail peut fournir une étiologie prénatale dans ces cas particuliers.

      Key Words

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