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A systematic review of brachial plexus injuries after caesarean birth: challenging delivery?

Jaufuraully, S; Lakshmi Narasimhan, A; Stott, D; Attilakos, G; Siassakos, D; (2023) A systematic review of brachial plexus injuries after caesarean birth: challenging delivery? BMC Pregnancy and Childbirth , 23 (1) , Article 361. 10.1186/s12884-023-05696-1. Green open access

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Abstract

BACKGROUND: Caesarean section (CS) is widely perceived as protective against obstetric brachial plexus injury (BPI), but few studies acknowledge the factors associated with such injury. The objectives of this study were therefore to aggregate cases of BPI after CS, and to illuminate risk factors for BPI. METHODS: Pubmed Central, EMBASE and MEDLINE databases were searched using free text: (“brachial plexus injury” or “brachial plexus injuries” or “brachial plexus palsy” or “brachial plexus palsies” or “Erb’s palsy” or “Erb’s palsies” or “brachial plexus birth injury” or “brachial plexus birth palsy”) and (“caesarean” or “cesarean” or “Zavanelli” or “cesarian” or “caesarian” or “shoulder dystocia”). Studies with clinical details of BPI after CS were included. Studies were assessed using the National Institutes for Healthy Study Quality Assessment Tool for Case Series, Cohort and Case-Control Studies. MAIN RESULTS: 39 studies were eligible. 299 infants sustained BPI after CS. 53% of cases with BPI after CS had risk factors for likely challenging handling/manipulation of the fetus prior to delivery, in the presence of considerable maternal or fetal concerns, and/or in the presence of poor access due to obesity or adhesions. CONCLUSIONS: In the presence of factors that would predispose to a challenging delivery, it is difficult to justify that BPI could occur due to in-utero, antepartum events alone. Surgeons should exercise care when operating on women with these risk factors.

Type: Article
Title: A systematic review of brachial plexus injuries after caesarean birth: challenging delivery?
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1186/s12884-023-05696-1
Publisher version: https://doi.org/10.1186/s12884-023-05696-1
Language: English
Additional information: © 2023 BioMed Central Ltd. This article is licensed under a Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).
Keywords: Birth injury, Brachial plexus injury, Caesarean section, erb’s palsy, Neonatal injury, Operative birth, Zavanelli
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health > Maternal and Fetal Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10171420
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