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Hamdi N, Alhamdan H, Alshenaiber F, Almutairi S, Alturaiki N. Subscapularis Z-plasty With Coracoidectomy for Internal Rotation Contracture in Children With Brachial Plexus Birth Injury. Cureus 2023; 15:e47740. [PMID: 38021901 PMCID: PMC10676218 DOI: 10.7759/cureus.47740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES Brachial plexus birth injury (BPBI) is a rare dystocia complication. Although it has a good prognosis, a significant number retain functional impairment to varying degrees. The data concerning shoulder function improvement and complication rates are conflicting due to variations in outcome measures between the studies. Therefore, we report our experience with this approach. METHODS It was a retrospective study conducted at King Faisal Specialist Hospital and Research Center in Riyadh (FSH&RC), Saudi Arabia. Data such as patient demographics, Mallet scores, and passive external rotation (PER) in adduction and abduction were retrieved from the medical records. RESULTS In active shoulder function, Mallet score significantly improved (P=0.00). The improvement was most remarkable in active external rotation movement (P=0.00) followed by hand to the neck. However, no significant gain was observed in active abduction and hand-to-back. At the final follow-up, with a mean of 2.9 years, the improvement in PER in adduction and abduction was maintained. Compared to six months postoperative, no significant difference was found in hand-to-neck, hand-to-back, and total Mallet score. CONCLUSION Subscapularis z-lengthening with coracoidectomy was consistently effective in correcting internal rotation contraction in a patient with BPBI. Significant improvements were observed in the Mallet score and PER in adduction and abduction.
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Affiliation(s)
- Nizar Hamdi
- Department of Orthopedic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Hend Alhamdan
- Department of Orthopedic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Faisal Alshenaiber
- Department of Orthopedic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Saleh Almutairi
- Department of Orthopedic Surgery, King Abdulaziz Medical City, Riyadh, SAU
| | - Nouf Alturaiki
- Department of Research, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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Jaufuraully S, Lakshmi Narasimhan A, Stott D, Attilakos G, Siassakos D. A systematic review of brachial plexus injuries after caesarean birth: challenging delivery? BMC Pregnancy Childbirth 2023; 23:361. [PMID: 37198580 DOI: 10.1186/s12884-023-05696-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 05/10/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Caesarean section (CS) is widely perceived as protective against obstetric brachial plexus injury (BPI), but few studies acknowledge the factors associated with such injury. The objectives of this study were therefore to aggregate cases of BPI after CS, and to illuminate risk factors for BPI. METHODS Pubmed Central, EMBASE and MEDLINE databases were searched using free text: ("brachial plexus injury" or "brachial plexus injuries" or "brachial plexus palsy" or "brachial plexus palsies" or "Erb's palsy" or "Erb's palsies" or "brachial plexus birth injury" or "brachial plexus birth palsy") and ("caesarean" or "cesarean" or "Zavanelli" or "cesarian" or "caesarian" or "shoulder dystocia"). Studies with clinical details of BPI after CS were included. Studies were assessed using the National Institutes for Healthy Study Quality Assessment Tool for Case Series, Cohort and Case-Control Studies. MAIN RESULTS 39 studies were eligible. 299 infants sustained BPI after CS. 53% of cases with BPI after CS had risk factors for likely challenging handling/manipulation of the fetus prior to delivery, in the presence of considerable maternal or fetal concerns, and/or in the presence of poor access due to obesity or adhesions. CONCLUSIONS In the presence of factors that would predispose to a challenging delivery, it is difficult to justify that BPI could occur due to in-utero, antepartum events alone. Surgeons should exercise care when operating on women with these risk factors.
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Affiliation(s)
- Shireen Jaufuraully
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK.
| | | | - Daniel Stott
- Elizabeth Garrett Anderson Wing, University College Hospital, London, UK
| | - George Attilakos
- Elizabeth Garrett Anderson Wing, University College Hospital, London, UK
| | - Dimitrios Siassakos
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (BRC), London, UK
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Youssefzadeh AC, Tavakoli A, Panchal VR, Mandelbaum RS, Ouzounian JG, Matsuo K. Incidence trends of shoulder dystocia and associated risk factors: A nationwide analysis in the United States. Int J Gynaecol Obstet 2023. [PMID: 36707062 DOI: 10.1002/ijgo.14699] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 01/07/2023] [Accepted: 01/26/2023] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To examine recent incidence trends and characteristics of shoulder dystocia. METHODS This is a retrospective cohort study querying the Healthcare Cost and Utilization Project's National Inpatient Sample. The study population included 9 913 838 vaginal deliveries for national estimates from January 2016 to December 2019. The main outcome measure was the diagnosis of shoulder dystocia. A binary logistic regression model was used to identify characteristics of shoulder dystocia in multivariable analysis. RESULTS Shoulder dystocia was reported in 228 120 deliveries (23.0 per 1000). The incidence of shoulder dystocia increased from 21.0 to 24.6 per 1000 deliveries during the 4-year study period (17.1% relative increase, P < 0.001). In a multivariable analysis, the recent year of delivery remained an independent factor for shoulder dystocia: adjusted odds ratio (aOR) compared with 2016, 1.09 (95% confidence interval [CI], 1.08-1.11), 1.13 (95% CI, 1.12-1.14), and 1.18 (95% CI, 1.16-1.19) for 2017, 2018, and 2019, respectively. Large for gestational age (aOR 4.33 [95% CI, 4.25-4.40]), diabetes mellitus (pregestational aOR, 4.78 [95% CI, 4.63-4.94], and gestational aOR, 1.69 [95% CI, 1.66-1.71]), and vacuum-assisted delivery (aOR, 2.18 [95% CI, 2.15-2.21]) exhibited the largest risks for shoulder dystocia. CONCLUSION This national-level analysis identified various risk factors for shoulder dystocia and demonstrated that shouder dystocia cases are increasing gradually in the United States.
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Affiliation(s)
- Ariane C Youssefzadeh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Amin Tavakoli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Viraj R Panchal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Rachel S Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA.,Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Joseph G Ouzounian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
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Prevalence of perinatal factors in infants with brachial plexus birth injuries and their association with injury severity. J Perinatol 2022; 43:578-583. [PMID: 36585508 DOI: 10.1038/s41372-022-01594-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To determine the prevalence of perinatal factors associated with brachial plexus birth injury (BPBI) in affected infants and their relationship with BPBI severity. STUDY DESIGN Retrospective study of BPBI infants prospectively enrolled in a multicenter registry. The prevalence of perinatal factors was calculated. Infants were stratified by injury severity and groups were compared to determine the association of severity and perinatal factors. RESULTS Seven-hundred-ninety-six BPBI infants had a mean 4.2 ± 1.6 perinatal factors. Nearly all (795/796) reported at least one factor, including shoulder dystocia(96%), no clavicle fracture (91%), difficult delivery(84%), parity >1(61%) and birthweight >4000 g(55%). Ten-percent (74/778) had Horner's syndrome and 28%(222/796) underwent nerve surgery. Birth asphyxia and NICU admission were significantly associated with injury severity. CONCLUSIONS NICU admission and asphyxia were associated with BPBI severity. An improved understanding of the relationship between perinatal factors and BPBI severity may be used to guide early referral to BPBI providers and support prevention efforts.
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Habek D, Prka M, Luetić AT, Marton I, Medić F, Miletić AI. Obstetrics injuries during shoulder dystocia in a tertiary perinatal center. Eur J Obstet Gynecol Reprod Biol 2022; 278:33-37. [PMID: 36113284 DOI: 10.1016/j.ejogrb.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study will present our results in management of fetal shoulder dystocia with special consideration of maternal and neonatal outcome. STUDY DESIGN A retrospective study was performed at a university tertiary perinatal center. The study included data of singleton vaginal term deliveries in the period of 15 years (2006-2020). Analized informations include: obstetrics maternal and neonatal data and outcomes. RESULTS This period included 45,687 deliveries with diagnosed shoulder dystocia in 254 (0.7 %) cases in vaginal deliveries. Most of the deliveries were spontaneous births 69.7 %, induced deliveries 30.3 %, 47.2 % primiparas and preexisting or gestational diabetes in 21.7 %. The delivery was managed by vacuum extraction in 13.8 %, mediolateral episiotomy in 48.0 % of births, most of the shoulder dystocia were unilateral anterior, while only two cases were diagnosed as more difficult bilateral and 5 cases were recurrent. 87.4 % cases were resolved by McRobert's maneuver, 7.8 % by Barnum's 3.9 % by Wood's maneuver and one case was managed by Menticoglou and by Bourgoise-Siegemundin maneuver. 4.3 % injuries were classified as OASIS of III/IV degree, early postpartum hemorrhage due in 1.6 %. 54.3 % of newborns were male sex, 61.0 % of newborns had birth weight of above 4000 g (mean 4071 g). Maximal Apgar scores were atributed to 92.5 % in first and to 97.2 % in fifth minute, one case that requaired resuscitation. Clavicle fracture was found in 9.5 %, humerus fracture in 0.4 %, transient form of Duchenne Erb obstetrics brachial palsy was diagnosed in only in 7.5 % newborns, while we have not found any case of permanent brachial palsy. CONCLUSIONS Our results confirmed that strategy of prompt identification of shoulder dystocia accompanied by cessation of axial fetal head traction decrease the risk of brachial plexus strain, injury or tear, while performance of exact obstetrical maneuvers resulted in decanceration of fetal shoulders without permanent obstetrics brachial palsy or cerebral morbidity. We think that our good results corelate with our opinion that the performance of external obstetrical manoeuvres should be done without one minute postpone since efforts should be put in sooner shoulder liberation decreasing the time of fetal hypoxia.
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Affiliation(s)
- Dubravko Habek
- University Department of Gynecology and Obstetrics, Clinical Hospital "Sveti Duh" Zagreb, School of Medicine, Catholic University of Croatia Zagreb, Croatia.
| | - Matija Prka
- University Department of Gynecology and Obstetrics, Clinical Hospital "Sveti Duh" Zagreb, School of Medicine, Catholic University of Croatia Zagreb, Croatia
| | - Ana Tikvica Luetić
- University Department of Gynecology and Obstetrics, Clinical Hospital "Sveti Duh" Zagreb, School of Medicine, Catholic University of Croatia Zagreb, Croatia
| | - Ingrid Marton
- University Department of Gynecology and Obstetrics, Clinical Hospital "Sveti Duh" Zagreb, School of Medicine, Catholic University of Croatia Zagreb, Croatia
| | - Filip Medić
- University Department of Gynecology and Obstetrics, Clinical Hospital "Sveti Duh" Zagreb, School of Medicine, Catholic University of Croatia Zagreb, Croatia
| | - Antonio Ivan Miletić
- University Department of Gynecology and Obstetrics, Clinical Hospital "Sveti Duh" Zagreb, School of Medicine, Catholic University of Croatia Zagreb, Croatia
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Barger MK. Current Resources for Evidence-Based Practice, September/October 2021. J Midwifery Womens Health 2021; 66:676-683. [PMID: 34606161 DOI: 10.1111/jmwh.13295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Mary K Barger
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California
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