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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Obstetrics and Gynaecology CanadaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Congenital brachial palsy: incidence, causes, and outcome in the United Kingdom and Republic of Ireland.Arch Dis Child Fetal Neonatal Ed. 2003; 88: 185-189
- Risk factors for brachial plexus injury with and without shoulder dystocia.Am J Obstet Gynecol. 2006; 194: 486-492
- Obstetrical brachial plexus injury: burden in a publicly funded, universal healthcare system.J Neurosurg Pediatr. 2015; 23: 1-8
- The epidemiology of neonatal brachial plexus palsy in the United States.J Bone Joint Surg Am. 2008; 90: 1258-1264
- Spontaneous vaginal delivery: a risk factor for Erb's palsy?.Am J Obstet Gynecol. 1998; 178: 423-427
- Fetal injury associated with cesarean delivery.Obstet Gynecol. 2006; 108: 885-890
- Are all brachial plexus injuries caused by shoulder dystocia?.Obstet Gynecol Surv. 2009; 64: 615-623
- Techniques for assisting difficult delivery at caesarean section.Cochrane Database Syst Rev. 2016; (CD004944)
- Shoulder dystocia.in: Repke J.T. Intrapartum obstetrics. Churchill Livingstone, New York1996: 185-202
- Shoulder dystocia.in: O'Grady J.P. Gimovsky M.L. Operative obstetrics. Williams & Wilkins, Baltimore1995: 339-353
- Brachial plexus injury: a 23-year experience from a tertiary center.Am J Obstet Gynecol. 2005; 192: 1795-1800
- Emergency caesarean delivery in prolonged obstructed labour as risk factor for obstetric fractures-a case series.Afr J Reprod Health. 2012; 16: 119-122
- Using odds ratios as effect sizes for meta-analysis of dichotomous data: a primer on methods and issues.Psychol Methods. 1998; 3: 339-353
- Statistical power analysis for the behavioral sciences.second ed. Lawrence Erlbaum Associates, Mahwah, NJ1988
- Neonatal brachial plexus injury: obstetrical factors and neonatal management.J Pediatr Rehabil Med. 2011; 4: 113-118
- Advances in labour and risk management (ALARM) course manual.(Edisike-9. Ottawa: SOGC)2002
- Practice bulletin no. 173: fetal macrosomia.Obstet Gynecol. 2016; 128: 195-209
- Induction of labour at or near term for suspected fetal macrosomia.Cochrane Database Syst Rev. 2016; (CD000938)
- Forceps for the floating head in low cesarean section.Am J Obstet Gynecol. 1938; 35: 703-705
- Caesarean section: a manual for doctors.Australasian Medical Publishing, Sydney, Australia2006
- Delivery of the head with the Malmstrom vacuum extractor during cesarean section.Obstet Gynecol. 1962; 19: 201-203
- Neonatal brachial plexus palsy: an unpredictable injury.Am J Obstet Gynecol. 2002; 187: 1209-1212
- Brachial plexus palsy associated with cesarean section: an in utero injury?.Am J Obstet Gynecol. 1997; 177: 1162-1164
- Medical decision-making among adolescents with neonatal brachial plexus palsy and their families: a qualitative study.Plast Reconstr Surg. 2013; 131: 880e-887e
Article info
Publication history
Published online: November 07, 2018
Accepted:
April 30,
2018
Received:
February 11,
2018
Footnotes
Competing interests: The authors declare that they have no competing interests.
Identification
Copyright
© 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc.
