Brachial plexus injury rate unchanged in 20 years.(Obstetrics)

WASHINGTON -- The rate of brachial plexus injury, as well as that of permanently disabling brachial plexus injury, hasn't changed in 20 years, Suneet P. Chauhan, M.D., said at the annual meeting of the Central Association of Obstetricians and Gynecologists.

This finding is "a major surprise," given that many physicians now use several interventions thought to prevent the brachial plexus injury (BPI) or ameliorate its effects on the neonate, said Dr. Chauhan of Spartanburg (S.C.) Regional Medical Center.

Dr. Chauhan and his associates reviewed the experience at their center with brachial plexus injuries over a 23-year period, from 1980 through 2002. There were 89,978 deliveries, including 85 vaginal deliveries in which brachial plexus injury occurred. Only about one-third of these cases (30) involved fetal macrosomia (birth weight of 4,000 g or more).

The average duration of BPI symptoms was 3 weeks. Sixteen percent of the injuries involved fracture of the humerus, clavicle, or both. Twelve percent of the injuries were permanent, which is consistent with rates of 6%-21% permanent disability reported in the literature, Dr. Chauhan noted.

Only 2 of these cases--"that's 2 out of nearly 90,000 deliveries"--have been litigated. One was settled in favor of the physician; the other case is still pending.

Neither the rate of brachial plexus injury nor the rate of permanently disabling BPI changed over the study period, despite the upsurge during that time in the use of sonography to estimate fetal weight, cesarean deliveries to avert shoulder dystocia, and maneuvers such as McRoberts positioning and suprapubic pressure to minimize trauma from shoulder dystocia.

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