Brachial plexus impairment: Incidence and predisposing factors

OBJECTIVE: To study brachial plexus impairment, incidence and predisposing factors.

METHODS: A retrospective study of cases of brachial plexus palsy diagnosed post delivery at Al-Jamahiria Maternity Teaching Hospital, Benghazi, Libya from 1st January 1993 to 1st December 1993.

RESULTS: Out of a total of 17,288 deliveries in 1993, there were 20 cases of brachial plexus impairment (0.115% or 1.15/1000 births). The predisposing factors were maternal age >24 years (85%), increased parity (100%), obesity (35%), diabetes mellitus (20%), term infant (100%), birth weight of >/= 4 kg, attending juniors and midwives (75%).

CONCLUSION: Maternal age >24 years, increased parity, obesity, diabetes mellitus, term infants, birth weight >/= 4 kg and an attendant of little experience were the most valuable risk factors predisposing to brachial plexus palsy at birth. We conclude that birth control and glucose controls are very important for prevention, though cesarean delivery can be performed for at risk mothers. Serial training programs on the management of obstetric emergencies, such as shoulder dystocia, are essential for the junior doctors and midwives.