OBSTETRIC BRACHIAL PLEXUS INJURIES IN CHILDREN: ANALYSIS OF 60 CASES

Abstract

The present study was conducted to see various risk factors related with obstetric brachial plexus injury in children in relation to home and hospital conducted deliveries. This represents case-review control study on hospital based data. The study was conducted in Armed Forces Institute of Rehabilitation Medicine Rawalpindi from Jan 1998-Feb 2002.

     60 cases of Obstetric Brachial Plexus Injury diagnosed on electrophysiological studies were reviewed. Relevant obstetric history and data was taken through self- administered questionnaire from patient’s electrodiagnostic evaluation files at the institute. To compare the population of the response, Z test of population was used as appropriate statistical test at P<.05 level of significance. This is first local study where association of disease was studied in reference to home and hospital conducted deliveries.

     Palsy was more common in deliveries conducted at home 43 patients (71.9%) while it was less common in deliveries conducted at hospitals 17 patients (P <.001). Obstructed labour was very common associated risk factor (P<.008) in 37 patients (61.6%) whereas 23 deliveries showed no signs of obstruction. Study of other risk factors revealed breech deliveries in 6 cases (10%) and vertex presentation in 54(90%) cases. Upper root lesions C5,6,7 were much more common in 45 patients (75%) as compared to isolated lower root lesions C8, T1 2 cases (3.33%), whereas complete paralysis was seen in 13 out of 60(21.5%) cases. Root avulsion in 12 (20%) cases out which 10 were home delivered. 13 cases (21.6%) showed evidence of instrumentation. No associated injury was seen.    It is concluded that obstetric brachial plexus injury was more common (P<.001) in deliveries conducted at home. Association of birth palsy and breech presentation was seen in small number of cases but all had more severe lesions.