| Objective:To identify the risk factors and its degree associated with obstetric brachial plexus palsy (OBPP), and put forward its preventive measures.Methods:A case-control, retrospective study was performed. Neonatal records of thirty-one cases with OBPP and their corresponding maternal records from the department of Gynecology and Obstetrics of eight hospitals in Shanghai city from 1988 to 2002 were reviewed. Four matches ( served as controls) were selected for each patient and every match was born within the same year at the same hospital. The control group included 124 cases without OBPP. According to the uniform medical record data tables and pregnant women health investigation tables, epidemiological investigation was carried out between the case group and control group. The variables analyzed included: 1.the pregnant women: race, age, height, culture grade, annual income, hobbies, family history, occupational history, pre-pregnancy weight, body mass index at the pre-pregnancy (weight/height2), diet during pregnancy, drug intaking, antepartum complications and parity of the mothers; 2.the delivery process: clinic pelvis evaluation, height of uterus, abdomen circumference, antepartum weight, body mass index before the delivery, position of the fetus, mode of delivery, the duration of active phase and 2nd stage of labor, augmentation of labor by oxytocin, shoulder dystocia; 3.the neonates: sex, gestational age, birth weight, affected limb, Apgar scores of 1 and 5 minutes, other birth trauma and resuscitation of infant. The statistical tests applied to these data were Student's t test for continuous variables andχ2 analysis for discrete data. Risk calculation of OBPP was performed by univariable and multivariable conditional logistic regression analysis. Statistical significance was considered at P<0.05.Results:1.Compared to the control group, there were statistically significant increases in the case group in pre-pregnancy weight, pre-pregnancy body mass index, parity, abdomen circumference, dosage of oxytocin for augmentation of labor, birth weight, duration of active phase, and the ratio of occipitoposterior ,occipitotrasverse in fetal position, shoulder dystocia, resuscitation,a combination of other birth trauma; and statistically significant decreases in the case group in Apgar scores of 1 and 5 minutes. There was statistically significant difference between two groups in delivery mode and family incoming. There was no statistically significant difference in race, age, height, culture grade, hobbies, family history, occupational history, diet during pregnancy, drug intaking, antepartum complications, clinic pelvis evaluation, height of uterus, the duration of 2nd stage of labor, the sex and gestational age of the neonates. After the univariable conditional logistic regression model, we found that the variables such as pre-pregnancy weight, pre-pregnancy body mass index, antepartun weight, antepartun body mass index, parity, the duration of active phase and 2nd stage of labor, dose of oxytocin, mode of delivery, shoulder dystocia, macrosomia could enter. When multivariable conditional logistic regression analysis was applied, only mode of delivery, birth weight, and pre-pregnancy body mass index could enter the model. The odds ratio was 40.22,31.25,24.81, respectively. 2.Chi-square for trendsuggested that there was positive linear trend between the mode of delivery (cesarean=0, spontaneous delivery=1, forceps delivery=2 ) and occurrence of brachial plexus injury. Conclusion:1.Forceps delivery, macrosomia, and increase of pre-pregnancy body mass index (≥21) are risk factors of OBPP in the order of risk degree. 2. As far as the delivery mode is concerned, abdominal delivery is a protective factor.Key words:Obstetrical brachial plexus palsy,Case-control study,Risk factors,Protective factors...
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