Shoulder dystocia without versus with brachial plexus injury: a case-control study.
OBJECTIVE
To delineate factors that differentiate shoulder dystocia with and without brachial plexus injury (BPI).


METHODS
A case-control study culled from an established shoulder dystocia database. Cases of shoulder dystocia-related BPI were identified and matched (1:1) with a control group of shoulder dystocia in which BPI did not result. Odds ratios (OR) and 95% confidence intervals (CI) were calculated.


RESULTS
From 1980 to 2002, there were 89 978 deliveries with 46 cases of dystocia and BPI. The rate of dystocia with BPI was 0.5 per 1000 births and of permanent BPI, 0.9/10 000 deliveries. The two groups were similar for maternal demographics, diabetes, gestational age, induction, use of epidural, the duration of labor, operative vaginal delivery, rate of macrosomia, and maneuvers used to relieve the dystocia. Fracture of the clavicle occurred significantly less often among those without (2%) vs. with BPI (17%; OR 0.10, 95% CI 0.01, 0.88).


CONCLUSIONS
Neither antepartum nor intrapartum factors can differentiate the patient who will have shoulder dystocia with vs. without BPI.
Chauhan
Suneet P
SP
Aurora Health Care, West Allis, WI 53227, USA. mfmchauhan@aol.com
Christian
Briery
B
Gherman
Robert B
RB
Magann
Everett F
EF
Kaluser
Chad K
CK
Morrison
John C
JC
D000328:Adult; D001917:Brachial Plexus / Q000293:injuries*; D016022:Case-Control Studies; D016208:Databases, Factual; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D004420:Dystocia / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008499:Medical Records; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D000070599:Shoulder Injuries; D014922:Wisconsin / Q000453:epidemiology