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A Comparison of Shoulder Dystocia-Associated Transient and Permanent Brachial Plexus Palsies

From the Department of OB/GYN, Division of Maternal/Fetal Medicine, National Naval Medical Center, Bethesda, Maryland; Department of OB/GYN, Division of Maternal/Fetal Medicine, Kaiser Permanente, Baldwin Park, California; Uniformed Services University of the Health Sciences, Department of OB/GYN, Bethesda, Maryland; Department of OB/GYN, Division of Maternal/Fetal Medicine, Women’s and Children’s Hospital, University of Southern California School of Medicine, Los Angeles, California; and Childbirth Injury Prevention Foundation, Pasadena, California.

OBJECTIVE: To estimate differences between shoulder dystocia-associated transient and permanent brachial plexus palsies.

METHODS: We performed a retrospective case-control analysis from national birth injury and shoulder dystocia databases. Study patients had permanent brachial plexus palsy and had been entered into a national birth injury registry. Cases of Erb or Klumpke palsy with documented neonatal neuromuscular deficits persisting beyond at least 1 year of life were classified as permanent. Cases of transient brachial plexus palsy were obtained from a shoulder dystocia database. Non-shoulder dystocia–related cases of brachial plexus palsy were excluded from analysis. Cases of permanent brachial plexus palsy (n = 49) were matched 1:1 with cases of transient brachial plexus palsy.

RESULTS: Transient brachial plexus palsy cases had a higher incidence of diabetes mellitus than those with permanent brachial plexus palsy (34.7% versus 10.2%, odds ratio [OR] 4.68, 95% confidence interval [CI] 1.42, 16.32). Patients with permanent brachial plexus palsies had a higher mean birth weight (4519 ± 94.3 g versus 4143.6 ± 56.5 g, P < .001) and a greater frequency of birth weight greater than 4500 grams (38.8% versus 16.3%, OR, 0.31, 95% CI 0.11, 0.87). There were, however, no statistically significant differences between the two groups with respect to multiple antepartum, intrapartum, and delivery outcome measures.

CONCLUSION: Transient and permanent brachial plexus palsies are not associated with significant differences for most antepartum and intrapartum characteristics.

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