Increased incidence of shoulder dystocia but a declining incidence of obstetric brachial plexus palsy in vaginally delivered infants
Abstract Introduction Obstetric brachial plexus palsy (OBPP) is a serious form of neonatal morbidity. The primary aim of this population‐based registry study was to examine temporal trends, 1997–2019, of OBPP in infants delivered vaginally in a cephalic presentation. The secondary aim was to examine...
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Wiley
2023-01-01
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| Series: | Acta Obstetricia et Gynecologica Scandinavica |
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| Online Access: | https://doi.org/10.1111/aogs.14481 |
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| author | Margareta Mollberg Linnea V. Ladfors Christina Strömbeck Helen Elden Lars Ladfors |
| author_facet | Margareta Mollberg Linnea V. Ladfors Christina Strömbeck Helen Elden Lars Ladfors |
| author_sort | Margareta Mollberg |
| collection | DOAJ |
| description | Abstract Introduction Obstetric brachial plexus palsy (OBPP) is a serious form of neonatal morbidity. The primary aim of this population‐based registry study was to examine temporal trends, 1997–2019, of OBPP in infants delivered vaginally in a cephalic presentation. The secondary aim was to examine temporal changes in the incidence of associated risk factors. Material and Methods This was a population‐based registry study including singleton, cephalic, vaginally delivered infants, 1997–2019, in Sweden. To compare changes in the incidence rates of OBPP and associated risk factors over time, univariate logistic regression was used and odds ratios (OR) with 95% confidence intervals (CI) were calculated. Results The incidence of OBPP in infants delivered vaginally in a cephalic presentation decreased from 3.1 per 1000 births in 1997 to 1.0 per 1000 births in 2019 (OR 0.31, 95% CI 0.24–0.40). Conversely, the incidence of shoulder dystocia increased from 2.0 per 1000 in 1997 to 3.3 per 1000 in 2019 (OR 1.64, 95% CI 1.34–2.01). Over time, the proportion of women with body mass index of 30 kg/m2 or greater increased (14.5% in 2019 compared with 8.0% in year 1997, OR 1.96, 95% CI 1.89–2.03), more women had induction of labor (20.5% in 2019 compared with 8.6% in 1997, OR 2.74, 95% CI 2.66–2.83) and epidural analgesia (41.2% in 2019 compared with 29.0% in 1997, OR 1.72, 95% CI 1.68–1.75). In contrast, there was a decrease in the rate of operative vaginal delivery (6.0% in 2019, compared with 8.1% in 1997, OR 0.72, 95% CI 0.69, 0.75) and in the proportion of infants with a birthweight greater than 4500 g (2.7% in 2019 compared with 3.8% in 1997, OR 0.70, 95% CI 0.66–0.74). The decline in the incidence of these two risk factors explained only a small fraction of the overall decrease in OBPP between 1997–2002 and 2015–219. Conclusions The incidence of OBPP in vaginally delivered infants in a cephalic presentation at birth decreased during the period 1997–2019 despite an increase in important risk factors including shoulder dystocia. |
| format | Article |
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| institution | DOAJ |
| issn | 0001-6349 1600-0412 |
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| publishDate | 2023-01-01 |
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| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-4be33fba3d334f46b2289e2a5c083e562025-08-20T03:22:14ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122023-01-011021768110.1111/aogs.14481Increased incidence of shoulder dystocia but a declining incidence of obstetric brachial plexus palsy in vaginally delivered infantsMargareta Mollberg0Linnea V. Ladfors1Christina Strömbeck2Helen Elden3Lars Ladfors4Institute of Health and Care Sciences, Sahlgrenska Academy Gothenburg University Gothenburg SwedenClinical Epidemiology Division, Department of Medicine—Solna Karolinska Institutet Stockholm SwedenDepartment of Woman and Child Health, Neuropediatric Unit, Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm SwedenInstitute of Health and Care Sciences, Sahlgrenska Academy Gothenburg University Gothenburg SwedenDepartment of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University Sahlgrenska University Hospital Gothenburg SwedenAbstract Introduction Obstetric brachial plexus palsy (OBPP) is a serious form of neonatal morbidity. The primary aim of this population‐based registry study was to examine temporal trends, 1997–2019, of OBPP in infants delivered vaginally in a cephalic presentation. The secondary aim was to examine temporal changes in the incidence of associated risk factors. Material and Methods This was a population‐based registry study including singleton, cephalic, vaginally delivered infants, 1997–2019, in Sweden. To compare changes in the incidence rates of OBPP and associated risk factors over time, univariate logistic regression was used and odds ratios (OR) with 95% confidence intervals (CI) were calculated. Results The incidence of OBPP in infants delivered vaginally in a cephalic presentation decreased from 3.1 per 1000 births in 1997 to 1.0 per 1000 births in 2019 (OR 0.31, 95% CI 0.24–0.40). Conversely, the incidence of shoulder dystocia increased from 2.0 per 1000 in 1997 to 3.3 per 1000 in 2019 (OR 1.64, 95% CI 1.34–2.01). Over time, the proportion of women with body mass index of 30 kg/m2 or greater increased (14.5% in 2019 compared with 8.0% in year 1997, OR 1.96, 95% CI 1.89–2.03), more women had induction of labor (20.5% in 2019 compared with 8.6% in 1997, OR 2.74, 95% CI 2.66–2.83) and epidural analgesia (41.2% in 2019 compared with 29.0% in 1997, OR 1.72, 95% CI 1.68–1.75). In contrast, there was a decrease in the rate of operative vaginal delivery (6.0% in 2019, compared with 8.1% in 1997, OR 0.72, 95% CI 0.69, 0.75) and in the proportion of infants with a birthweight greater than 4500 g (2.7% in 2019 compared with 3.8% in 1997, OR 0.70, 95% CI 0.66–0.74). The decline in the incidence of these two risk factors explained only a small fraction of the overall decrease in OBPP between 1997–2002 and 2015–219. Conclusions The incidence of OBPP in vaginally delivered infants in a cephalic presentation at birth decreased during the period 1997–2019 despite an increase in important risk factors including shoulder dystocia.https://doi.org/10.1111/aogs.14481delivery, obstetriclogistic modelsmode of deliveryneonatal brachial plexus palsyobstetric brachial plexus palsyrisk factors |
| spellingShingle | Margareta Mollberg Linnea V. Ladfors Christina Strömbeck Helen Elden Lars Ladfors Increased incidence of shoulder dystocia but a declining incidence of obstetric brachial plexus palsy in vaginally delivered infants Acta Obstetricia et Gynecologica Scandinavica delivery, obstetric logistic models mode of delivery neonatal brachial plexus palsy obstetric brachial plexus palsy risk factors |
| title | Increased incidence of shoulder dystocia but a declining incidence of obstetric brachial plexus palsy in vaginally delivered infants |
| title_full | Increased incidence of shoulder dystocia but a declining incidence of obstetric brachial plexus palsy in vaginally delivered infants |
| title_fullStr | Increased incidence of shoulder dystocia but a declining incidence of obstetric brachial plexus palsy in vaginally delivered infants |
| title_full_unstemmed | Increased incidence of shoulder dystocia but a declining incidence of obstetric brachial plexus palsy in vaginally delivered infants |
| title_short | Increased incidence of shoulder dystocia but a declining incidence of obstetric brachial plexus palsy in vaginally delivered infants |
| title_sort | increased incidence of shoulder dystocia but a declining incidence of obstetric brachial plexus palsy in vaginally delivered infants |
| topic | delivery, obstetric logistic models mode of delivery neonatal brachial plexus palsy obstetric brachial plexus palsy risk factors |
| url | https://doi.org/10.1111/aogs.14481 |
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