title: Obstetric brachial plexus palsy: a prospective study on risk factors related to manual assistance during the second stage of labor.
abstract: BACKGROUND
  To evaluate the association between obstetric brachial plexus palsy and obstetrical maneuvers during the second stage of delivery.
  
  
  METHODS
  Prospective population-based case control study. Cases of obstetric brachial plexus palsy were compared with a randomly selected control group with regard to obstetric management.
  
  
  RESULTS
  Five or more obstetrical maneuvers were used to deliver the infants in 82% in the obstetric brachial plexus palsy group versus 1.8% in the controls. Risk factors independently associated with obstetric brachial plexus palsy were force applied when downward traction was imposed on the fetal head (odds ratio 15.2; 95% confidence interval 8.4-27.7). The incidence of obstetric brachial plexus palsy in the infants in the population was 3.3 per thousand. At 18 months of age 16.1% (incidence of 0.05%) of children had residual functional deficits and downward traction with substantial force was applied in all these cases.
  
  
  CONCLUSIONS
  Forceful downward traction applied to the head after the fetal third rotation represents an important risk factor of obstetric brachial plexus palsy in vaginal deliveries in cephalic presentation.
authors.affiliation: Perinatal Center, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, University of Göteborg, Göteborg, Sweden. margareta.mollberg@vgregion.se
authors.forename: Margareta
authors.initials: M
authors.lastname: Mollberg
authors.forename: Margareta
authors.initials: M
authors.lastname: Wennergren
authors.forename: Börje
authors.initials: B
authors.lastname: Bager
authors.forename: Lars
authors.initials: L
authors.lastname: Ladfors
authors.forename: Henrik
authors.initials: H
authors.lastname: Hagberg
mesh_terms: D000328:Adult; D001720:Birth Injuries / Q000209:etiology*; D001724:Birth Weight; D001917:Brachial Plexus / Q000293:injuries*; D020516:Brachial Plexus Neuropathies / Q000209:etiology*; D016022:Case-Control Studies; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007748:Labor Stage, Second; D015999:Multivariate Analysis; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors; D000070599:Shoulder Injuries