title: Neonatal injury at cephalic vaginal delivery: a retrospective analysis of extent of association with shoulder dystocia.
abstract: OBJECTIVE
  To describe the risk factors and labor characteristics of Clavicular fracture (CF) and brachial plexus injury (BPI); and compare antenatal and labor characteristics and prognosis of obstetrical BPI associated with shoulder dystocia with obstetrical BPI not associated with shoulder dystocia.
  
  
  METHODS
  This retrospective study consisted of women who gave birth to an infant with a fractured clavicle or BPI between January 2009 and June 2013. Antenatal and neonatal data were compared between groups. The control group (1300) was composed of the four singleton vaginal deliveries that immediately followed each birth injury. A multivariable logistic regression model, with backward elimination, was constructed in order to find independent risk factors associated with BPI and CF. A subgroup analysis involved comparison of features of BPI cases with or without associated shoulder dystocia.
  
  
  RESULTS
  During the study period, the total number of vaginal deliveries was 44092. The rates of CF, BPI and shoulder dystocia during the study period were 0,6%, 0,16% and 0,29%, respectively. In the logistic regression model, shoulder dystocia, GDM, multiparity, gestational age >42 weeks, protracted labor, short second stage of labor and fetal birth weight greater than 4250 grams increased the risk of CF independently. Shoulder dystocia and protracted labor were independently associated with BPI when controlled for other factors. Among neonates with BPI whose injury was not associated with shoulder dystocia, five (12.2%) sustained permanent injury, whereas one neonate (4.5%) with BPI following shoulder dystocia sustained permanent injury (p = 0.34).
  
  
  CONCLUSIONS
  BPI not associated with shoulder dystocia might have a higher rate of concomitant CF and permanent sequelae.
authors.affiliation: Department of Perinatology, Dr Zekai Tahir Burak Research and Training Hospital, Ankara, Turkey.
authors.forename: Cantekin
authors.initials: C
authors.lastname: Iskender
authors.affiliation: Department of Perinatology, Dr Zekai Tahir Burak Research and Training Hospital, Ankara, Turkey.
authors.forename: Oktay
authors.initials: O
authors.lastname: Kaymak
authors.affiliation: Department of Perinatology, Dr Zekai Tahir Burak Research and Training Hospital, Ankara, Turkey.
authors.forename: Kudret
authors.initials: K
authors.lastname: Erkenekli
authors.affiliation: Department of Obstetrics and Gynecology, Bursa Şevket Yılmaz Research and Education Hospital, Bursa, Turkey.
authors.forename: Emin
authors.initials: E
authors.lastname: Ustunyurt
authors.affiliation: Department of Perinatology, Dr Zekai Tahir Burak Research and Training Hospital, Ankara, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Uygur
authors.affiliation: Department of Neonatology, Dr Zekai Tahir Burak Research and Training Hospital, Ankara, Turkey.
authors.forename: Halil Ibrahim
authors.initials: HI
authors.lastname: Yakut
authors.affiliation: Department of Perinatology, Dr Zekai Tahir Burak Research and Training Hospital, Ankara, Turkey.
authors.forename: Nuri
authors.initials: N
authors.lastname: Danisman
mesh_terms: D000328:Adult; D001720:Birth Injuries / Q000209:etiology*; D001917:Brachial Plexus / Q000293:injuries*; D002968:Clavicle / Q000293:injuries*; D036861:Delivery, Obstetric; D004420:Dystocia / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies; D000070599:Shoulder Injuries; D014710:Version, Fetal / Q000009:adverse effects; D055815:Young Adult