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Bénié CA, Akobé JRA, Lohourou FG, Traoré I, Kpangni JBA, Kouassi NAA, Bamba I. [Obstetrical brachial plexus palsy (PBOPP): epidemiological, therapeutic and evolutionary features of patients at the Bouaké University Hospital, Ivory Coast]. Pan Afr Med J 2021; 38:309. [PMID: 34178227 PMCID: PMC8197050 DOI: 10.11604/pamj.2021.38.309.22940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 02/06/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction la paralysie obstétricale du plexus brachial est une affection relativement rare mais qui n´a pas disparu malgré les importants progrès en obstétrique. L´objectif de cette étude était de décrire les aspects épidémiologiques, thérapeutiques et évolutifs de cette affection dans notre contexte. Méthodes analyse rétrospective sur deux ans des dossiers de nouveau-nés ayant présenté une paralysie obstétricale du plexus brachial et pris en charge au Centre Hospitalier Universitaire de Bouaké. Les enfants reçus après l´âge de 3 mois n´ont pas été inclus. Les variables étudiées étaient d´ordre épidémiologique, thérapeutique et évolutif. Résultats soixante patients ont été colligés, soit une fréquence de 28,5%. Il y avait 31 (52%) filles. L´âge moyen était de 8 jours [J0 et J35]. Les mères étaient multipares dans 94% des cas. L´accouchement a eu lieu dans un centre de santé dans 97% des cas. Tous les enfants étaient nés à terme avec 57 (95%) présentations céphaliques. L´accouchement était eutocique dans 74% des cas. Le poids moyen de naissance était de 3604g [2150g et 4500g]. Il y avait 47 cas (78%) de paralysie C5-C6. L´immobilisation coude au corps associée à la rééducation a été réalisée chez 51 enfants (85%). La rééducation a été réalisée immédiatement chez 9 enfants (15%). La récupération fonctionnelle du membre lésé a été complète chez 50 enfants (83%) après un recul de 6 mois. Conclusion la paralysie obstétricale du plexus brachial demeure une affection obstétricale d´actualité. Son traitement conservateur, seule alternative dans notre contexte donne de bons résultats.
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Affiliation(s)
- Célestin Adoubs Bénié
- Unité de Chirurgie Pédiatrique du Centre Hospitalier Universitaire de Bouaké, Bouaké, Côte d'Ivoire
| | - Jean Régis Achié Akobé
- Service d´Orthopédie Traumatologie du Centre Hospitalier Universitaire de Bouaké, Bouaké, Côte d'Ivoire
| | - Franck Grah Lohourou
- Unité de Chirurgie Pédiatrique du Centre Hospitalier Universitaire de Bouaké, Bouaké, Côte d'Ivoire
| | - Ibrahim Traoré
- Unité de Chirurgie Pédiatrique du Centre Hospitalier Universitaire de Bouaké, Bouaké, Côte d'Ivoire
| | | | | | - Inza Bamba
- Unité de Chirurgie Pédiatrique du Centre Hospitalier Universitaire de Bouaké, Bouaké, Côte d'Ivoire
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Association of Fetal Abdominal-Head Circumference Size Difference With Shoulder Dystocia: A Multicenter Study. AJP Rep 2015; 5:e099-104. [PMID: 26495163 PMCID: PMC4603871 DOI: 10.1055/s-0035-1548544] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/29/2015] [Indexed: 11/28/2022] Open
Abstract
Objective This study aims to determine if shoulder dystocia is associated with a difference in the fetal abdominal (AC) to head circumference (HC) of 50 mm or more noted on antenatal ultrasound. Study Design A multicenter matched case-control study was performed comparing women who had shoulder dystocia to controls who did not. Women with vaginal births of live born nonanomalous singletons ≥ 36 weeks of gestation with an antenatal ultrasound within 4 weeks of delivery were included. Controls were matched for gestational age, route of delivery, and diabetes status. Results We identified 181 matched pairs. Only 5% of the fetuses had an AC to HC of ≥ 50 mm. The proportion of AC to HC difference of ≥ 50 mm was significantly higher in shoulder dystocia cases (8%) than controls (1%, p = 0.002). With multivariate regression, the three significant factors associated with shoulder dystocia were AC to HC ≥ 50 mm (odds ratio [OR], 7.3; confidence interval [CI], 1.6-33.3; p = 0.010), femur length (OR, 1.1; CI, 1.0-1.2; p = 0.002), and induced labor (OR, 1.8; CI, 1.1-3.1; p = 0.027). Conclusion A prenatal ultrasound finding of a difference in AC to HC of ≥ 50 mm while uncommon is associated with shoulder dystocia.
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Eken M, Çınar M, Şenol T, Özkaya E, Karateke A. Six-year incidence and some features of cases of brachial plexus injury in a tertiary referral center. Turk J Obstet Gynecol 2015; 12:71-74. [PMID: 28913046 PMCID: PMC5558379 DOI: 10.4274/tjod.80388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/12/2015] [Indexed: 12/29/2022] Open
Abstract
Objective: To present some features and incidence of cases of brachial plexus injury in deliveries at the Department of Obstetrics and Gynecology of Zeynep Kamil Maternity and Children’s Training and Research Hospital, from January 2010 through December 2014. Materials and Methods: In total, 38.896 deliveries in the Department of Obstetrics and Gynecology of Zeynep Kamil Maternity and Children’s Training and Research Hospital, from January 2010 through December 2014 were screened from a prospectively collected database. We recorded gravidity, parity, body mass index, maternal diabetes, labor induction, gestational age at delivery, operative deliveries, malpresentations, prolonged second stage of deliveries, shoulder dystocies, clavicle and humerus fructures, estimated fetal weight, biparietal diameter, abdominal circumference, femur length, fetal sex, route of delivery, maternal age, and fetal anomalies. Results: There were 28 (72/100.000) cases of brachial plexus injury among 38.896 deliveries. In the 6-year study period, there were 18.363 deliveries via c-section, whereas 20.533 were vaginal deliveries. Conclusion: Sonographic fetal weight estimation and clinical examination performed by experienced obstetricians, and active appropriate management of shoulder dystocias seemed to attenuate the incidence of brachial plexus injury in the at risk population in our tertiary referral center.
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Affiliation(s)
- Meryem Eken
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Mehmet Çınar
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Taylan Şenol
- Zekai Tahir Maternity and Womens Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Enis Özkaya
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ateş Karateke
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
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Chauhan SP, Blackwell SB, Ananth CV. Neonatal brachial plexus palsy: incidence, prevalence, and temporal trends. Semin Perinatol 2014; 38:210-8. [PMID: 24863027 DOI: 10.1053/j.semperi.2014.04.007] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Epidemiological knowledge of the incidence, prevalence, and temporal changes of neonatal brachial plexuses palsy (NBPP) should assist the clinician, avert unnecessary interventions, and help formulate evidence-based health policies. A summary of 63 publications in the English language with over 17 million births and 24,000 NBPPs is notable for six things. First, the rate of NBPP in the US and other countries is comparable: 1.5 vs. 1.3 per 1000 total births, respectively. Second, the rate of NBPP may be decreasing: 0.9, 1.0 and 0.5 per 1,000 births for publications before 1990, 1990-2000, and after 2000, respectively. Third, the likelihood of not having concomitant shoulder dystocia with NBPP was 76% overall, though it varied by whether the publication was from the US (78%) vs. other countries (47%). Fourth, the likelihood of NBPP being permanent (lasting at least 12 months) was 10-18% in the US-based reports and 19-23% in other countries. Fifth, in studies from the US, the rate of permanent NBPP is 1.1-2.2 per 10,000 births and 2.9-3.7 per 10,000 births in other nations. Sixth, we estimate that approximately 5000 NBPPs occur every year in the US, of which over 580-1050 are permanent, and that since birth, 63,000 adults have been afflicted with persistent paresis of their brachial plexus. The exceedingly infrequent nature of permanent NBPP necessitates a multi-center study to improve our understanding of the antecedent factors and to abate the long-term sequela.
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Affiliation(s)
- Suneet P Chauhan
- Department of Obstetrics and Gynecology, University of Texas, Houston, TX.
| | - Sean B Blackwell
- Department of Obstetrics and Gynecology, University of Texas, Houston, TX
| | - Cande V Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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Neonatal brachial plexus palsy with vaginal birth after cesarean delivery: a case-control study. Am J Obstet Gynecol 2013; 208:229.e1-5. [PMID: 23211545 DOI: 10.1016/j.ajog.2012.11.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 11/13/2012] [Accepted: 11/30/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective was to determine the rate of neonatal brachial plexus palsy (NBPP) among women with vaginal birth after cesarean delivery (VBAC) and to compare the peripartum characteristics with control subjects. STUDY DESIGN The Maternal-Fetal Medicine Unit cesarean registry data were used to identify nonanomalous singleton pregnancies with VBAC and NBPP at gestational age of ≥37 weeks (term) and 4 control subjects (matched for gestational age and diabetes mellitus status but without brachial injury). Odds ratio (OR) and 95% confidence intervals (CIs) were calculated. RESULTS Among 11,313 VBACs at term, there were 23 women with NBPP (rate of 2.0/1000 women). Newborn infants with NBPP, compared with control infants, were significantly more likely to weigh ≥4000 g (48% vs 10%, respectively; OR, 8.45; 95% CI, 2.58-28.44) and to require admission to the neonatal intensive care unit (30% vs 13%; OR, 12.98; 95% CI, 2.61-72.18). CONCLUSION Women who desire VBAC should be informed about the low rate of NBPP and, if eligible, encouraged to have a trial of labor after cesarean delivery.
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Outcomes associated with a structured prenatal counseling program for shoulder dystocia with brachial plexus injury. Am J Obstet Gynecol 2012; 207:123.e1-5. [PMID: 22840721 DOI: 10.1016/j.ajog.2012.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 05/21/2012] [Accepted: 05/26/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We examined outcomes that were associated with a novel program to identify patients who are at high risk for shoulder dystocia with brachial plexus injury. STUDY DESIGN The program included a checklist of key risk factors and a multifactorial algorithm to estimate risk of shoulder dystocia with brachial plexus injury. We examined rates of cesarean delivery and shoulder dystocia in 8767 deliveries by clinicians who were enrolled in the program and in 11,958 patients of clinicians with no access to the program. RESULTS Key risk factors were identified in 1071 of 8767 mothers (12.2%), of whom 40 of 8767 women (0.46%) had results in the high-risk category. The rate of primary cesarean delivery rate was stable (21.2-20.8%; P = .57). Shoulder dystocia rates fell by 56.8% (1.74-0.75%; P = .002). The rates of shoulder dystocia and cesarean birth showed no changes in the group with no access to the program. CONCLUSION With the introduction of this program, overall shoulder dystocia rates fell by more than one-half with no increase in the primary cesarean delivery rate.
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Bonneau C, Nizard J. [Management of pregnancies with a previous cesarean]. ACTA ACUST UNITED AC 2012; 41:497-511. [PMID: 22609031 DOI: 10.1016/j.jgyn.2012.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Revised: 04/04/2012] [Accepted: 04/10/2012] [Indexed: 11/29/2022]
Abstract
The cesarean rate in France has reached 21% in 2010. With a maintained fertility rate, management of a pregnant woman with a previous caesarean scar is becoming a daily situation for most obstetrical teams. Considering the small rate of vaginal birth after cesarean (VBAC), we will try to establish an up-to-date review of the benefits and risks of encouraging trial of VBAC. This information can help professionals provide adequate counselling women or couples.
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Affiliation(s)
- C Bonneau
- Service de gynécologie obstétrique, UPMC Paris-6, hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 83, boulevard de l'Hôpital, 75013 Paris, France
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Hoffman MK, Bailit JL, Branch DW, Burkman RT, Van Veldhusien P, Lu L, Kominiarek MA, Hibbard JU, Landy HJ, Haberman S, Wilkins I, Gonzalez-Quintero VH, Gregory KD, Hatjis CG, Ramirez MM, Reddy UM, Troendle J, Zhang J. A comparison of obstetric maneuvers for the acute management of shoulder dystocia. Obstet Gynecol 2011; 117:1272-1278. [PMID: 21555962 PMCID: PMC3101300 DOI: 10.1097/aog.0b013e31821a12c9] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the efficacy of obstetric maneuvers for resolving shoulder dystocia and the effect that these maneuvers have on neonatal injury when shoulder dystocia occurs. METHODS Using an electronic database encompassing 206,969 deliveries, we identified all women with a vertex fetus beyond 34 0/7 weeks of gestation who incurred a shoulder dystocia during the process of delivery. Women whose fetuses had a congenital anomaly and women with an antepartum stillbirth were excluded. Medical records of all cases were reviewed by trained abstractors. Cases involving neonatal injury (defined as brachial plexus injury, clavicular or humerus fracture, or hypoxic-ischemic encephalopathy or intrapartum neonatal death attributed to the shoulder dystocia) were compared with those without injury. RESULTS Among 132,098 women who delivered a term cephalic liveborn fetus vaginally, 2,018 incurred a shoulder dystocia (1.5%), and 101 (5.2%) of these incurred a neonatal injury. Delivery of the posterior shoulder was associated with the highest rate of delivery when compared with other maneuvers (84.4% compared with 24.3-72.0% for other maneuvers; P<.005 to P<.001) and similar rates of neonatal injury (8.4% compared with 6.1-14.0%; P=.23 to P=.7). The total number of maneuvers performed significantly correlated with the rate of neonatal injury (P<.001). CONCLUSION Delivery of the posterior shoulder should be considered following the McRoberts maneuver and suprapubic pressure in the management of shoulder dystocia. The need for additional maneuvers was associated with higher rates of neonatal injury.
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Affiliation(s)
- Matthew K Hoffman
- From Christiana Care Health System, Newark, Delaware; MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio; Intermountain Healthcare and the University of Utah, Salt Lake City, Utah; Tufts University, Baystate Medical Center, Springfield, Massachusetts; the EMMES Corporation, Rockville, Maryland; Indiana University Clarian Health, Indianapolis, Indiana; the University of Illinois at Chicago, Chicago, Illinois; Georgetown University Hospital, MedStar Health, Washington, DC; Maimonides Medical Center, Brooklyn, New York; the University of Miami, Miami, Florida; Cedars-Sinai Medical Center, Los Angeles, California; Summa Health Systems Akron City Hospital, Akron, Ohio; the University of Texas Health Science Center at Houston, Houston, Texas; and the Pregnancy and Perinatology Branch and the Division of Epidemiology, Statistics and Prevention Research, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Abstract
In subsequent pregnancies after a cesarean delivery, women must choose between attempting to deliver vaginally or undergoing another cesarean delivery. Information relevant to this choice includes the long-term benefits and harms to the baby. In this article we discuss the relationship of mode of delivery (planned trial of labor, either with or without vaginal delivery, or elective repeat cesarean delivery) and long-term outcomes, including brachial plexus palsy, neurodevelopmental impairment, and asthma. No randomized trials are available that relate directly to the choice of delivery method after previous cesarean. Observational studies suggest that cesarean delivery might be associated with a greater risk of asthma, caused perhaps by altered gut colonization, increased risk of neonatal respiratory disease, decreased gestational age at birth or decreased likelihood of breastfeeding. By contrast, vaginal delivery after a previous cesarean delivery is associated with greater risks of neurodevelopmental impairment and upper-extremity motor impairment, caused, respectively, by greater risks of perinatal hypoxic-ischemic encephalopathy and brachial plexus injury. Available information does not provide a precise estimate of the relative risks for infants delivered after a trial of labor versus elective cesarean delivery.
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Affiliation(s)
- T Michael O'Shea
- Department of Pediatrics (Neonatology), Wake Forest University, Health Sciences, Winston-Salem, NC 27157, USA.
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Lima S, Chauleur C, Varlet MN, Guillibert F, Patural H, Collet F, Seffert P, Chêne G. [Shoulder dystocia: a ten-year descriptive study in a level-III maternity unit]. ACTA ACUST UNITED AC 2009; 37:300-6. [PMID: 19375371 DOI: 10.1016/j.gyobfe.2009.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Accepted: 02/20/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Shoulder dystocia is one of the most dreadful complications of vaginal deliveries. The aim of this observational study was to evaluate risk factors of dystocia, maternal and neonatal complications and recurrent risk factors. PATIENTS AND METHODS Sixty-six cases of shoulder dystocia occurring between January 1998 and August 2008 in our university hospital were identified. Demographic data, labor management, management of the shoulder dystocia and neonatal outcome were recorded. RESULTS The incidence of shoulder dystocia was 0.3%. Multiparity, weight gain greater than 12 kg, and post-term delivery were more present in our study group. McRoberts' manoeuver and symphyseal pressure were first realised. Brachial plexus injuries affected 9% of neonates with skeletal fractures in 7.5% of cases. Maternal morbidity was evaluated at about 8%. Twenty per cent had a recurrent shoulder dystocia. DISCUSSION AND CONCLUSION Shoulder dystocia is an obstetric emergency which requires a prompt management of trained personnel. Despite the difficulty of being able to prevent shoulder dystocia, training the obstetric staff could probably improve management of shoulder dystocia.
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Affiliation(s)
- S Lima
- Service de gynécologie-obstétrique, hôpital Nord, CHU de Saint-Etienne, avenue Albert-Raimond, 42270 Saint-Priest, Jarez, France
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