Risk factors for brachial plexus injury with and without shoulder dystocia

Edith D. Gurewitsch, Elizabeth Johnson, Sayeh Hamzehzadeh, Robert H. Allen

Research output: Contribution to journalArticlepeer-review

65 Scopus citations


Objective: To ascertain whether brachial plexus palsy (BPP) that occurs without shoulder dystocia (SD) represents a traction injury during unrecognized SD or a natural phenomenon with a different mechanism of injury, we compared risk factors and outcomes between SD-associated and non-SD-associated BPP. Study design: Neonates with BPP after cephalic vaginal delivery were pooled from all deliveries at Johns Hopkins (June, 1993-December, 2004) and a dataset of litigated permanent BPP from multiple institutions (1986-2003), grouped by SD association based on clinician documentation and compared by using Fisher exact and t tests. Results: Thirty percent of 49 non-SD-BPP and 11% of 280 SD-BPP lacked all risk factors for SD (P = .002). Compared with SD-BPP infants, non-SD-BPP infants were average weight (P < .001) and had cord pH less than 7.10 (P = .01) more commonly and exhibited a trend toward posterior shoulder involvement (P = .06). Nearly all non-SD-BPP were temporary, whereas more than 90% of permanent BPP were associated with SD (odds ratio 17, 7.3-39.6). Conclusion: Non-SD-BPP is uncommon and likely mechanistically distinct from SD-BPP. Risk factors, birth weight, fetal acidosis, posterior arm involvement, and injury severity distinguish between shoulder dystocia-related brachial plexus injuries and those not recorded as such.

Original languageEnglish (US)
Pages (from-to)486-492
Number of pages7
JournalAmerican journal of obstetrics and gynecology
Issue number2
StatePublished - Feb 2006
Externally publishedYes


  • Complete injury
  • Erb-Duchenne palsy
  • Fetal acidosis
  • Klumpke palsy
  • Mechanism of injury
  • Neurapraxia
  • Permanent
  • Posterior shoulder
  • Spontaneous injury
  • Temporary
  • Vaginal delivery

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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