Effect of operative vaginal delivery on the outcome of permanent brachial plexus injury.
OBJECTIVE
To evaluate whether operative vaginal delivery worsens the extent and/or degree of permanent brachial plexus injury.


METHODS
We utilized a dataset (n = 104) of vaginal deliveries resulting in permanent brachial plexus injury that ultimately underwent litigation. We excluded patients on whom neonatal injury information was incomplete (n = 5). Patients who had an operative vaginal delivery (n = 33) were compared with those who did not (n = 66) in regard to neonatal outcome and the location and extent of neurologic injury.


RESULTS
The 2 classes were similar in demographic and obstetric variables. There were no differences in rates of 5-minute Apgar scores < 7 (17.9%, or 5/28, vs. 5.2%, or 3/57, P = .1), complete neurologic injury to the brachial plexus (C5-T1) (39%, or 13/33, vs. 38%, or 25/66; P = 1.0) or avulsion of the nerve roots (44%, or 12/27, vs. 36%, or 18/50; P = .5) between those with operative or spontaneous vaginal delivery.


CONCLUSIONS
Operative vaginal delivery did not increase the severity of impairment in a dataset of deliveries resulting in permanent brachial plexus injury.
Poggi
Sarah H
SH
Departments of Obstetrics and Gynecology and of Pharmacology, Georgetown University Hospital, Washington, D.C., USA. shp2@gunet.georgetown.edu
Ghidini
Alessandro
A
Allen
Robert H
RH
Pezzullo
John C
JC
Rosenbaum
Ted C
TC
Spong
Catherine Y
CY
D000328:Adult; D001917:Brachial Plexus / Q000293:injuries*; D036861:Delivery, Obstetric / Q000379:methods*; D004420:Dystocia / Q000150:complications* / Q000517:prevention & control; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009772:Obstetrical Forceps; D011247:Pregnancy; D011843:Radiculopathy / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012782:Shoulder; D016896:Treatment Outcome; D014620:Vacuum Extraction, Obstetrical