Document Detail

Birth weight as a predictor of brachial plexus injury.
MedLine Citation:
PMID:  9166293     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To examine the relationship between birth weight and brachial plexus injury and estimate the number of cesareans needed to reduce such injuries. METHODS: All 80 neonatal records coded for brachial plexus injury from October 1985 to September 1993 at the Brigham and Women's Hospital in Boston, Massachusetts, were studied along with linked maternal files. Birth weight, method of delivery, presence or absence of shoulder dystocia, and any diagnosis of maternal gestational or nongestational diabetes were abstracted. Data for the group with brachial plexus injury were compared with data for live-born infants without this injury during the same period. The sensitivity and specificity of birth weight as a predictor of brachial plexus injury were calculated. Further, the number of cesarean deliveries necessary to prevent a single brachial plexus injury was estimated using various weight cutoffs (4000, 4500, and 5000 g) for elective cesarean delivery. RESULTS: Among 77,616 consecutive deliveries, there were 80 brachial plexus injuries identified, for an incidence of 1.03 per 1000 live births. The incidence of brachial plexus injury increased with increasing birth weight, operative vaginal delivery, and the presence of glucose intolerance. In the group of women without diabetes, between 19 and 162 cesarean deliveries would have been necessary to prevent a single immediate brachial plexus injury. Among women with diabetes, between five and 48 additional cesareans would have been required. CONCLUSION: Although birth weight is a predictor of brachial plexus injury, the number of cesarean deliveries necessary to prevent a single injury is high at most birth weights. Because of the large number of cesarean deliveries needed to prevent a single brachial plexus injury in infants born to women without diabetes, it is difficult to recommend routine cesarean delivery for suspected macrosomia in these women.
J L Ecker; J A Greenberg; E R Norwitz; A S Nadel; J T Repke
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  89     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  1997 May 
Date Detail:
Created Date:  1997-06-24     Completed Date:  1997-06-24     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  643-7     Citation Subset:  AIM; IM    
Department of Obstetrics and Gynecology, University of California, San Francisco, USA.
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MeSH Terms
Birth Injuries / etiology*,  prevention & control
Birth Weight*
Brachial Plexus / injuries*
Cesarean Section
Diabetes, Gestational / complications
Dystocia / complications
Fetal Macrosomia / complications
Infant, Newborn
Retrospective Studies
Risk Factors
Sensitivity and Specificity
Comment In:
Obstet Gynecol. 1997 Sep;90(3):479   [PMID:  9277666 ]
Obstet Gynecol. 1997 Sep;90(3):479-80   [PMID:  9277667 ]

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