Mollberg Margareta, Hagberg Henrik, Bager Börje, Lilja Håkan, Ladfors Lars
Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, University of Göteborg, Sweden.
Acta Obstet Gynecol Scand. 2005 Jul;84(7):654-9. doi: 10.1111/j.0001-6349.2005.00632.x.
Obstetrical brachial plexus palsy (OBPP) is a serious form of neonatal morbidity.
The aim of this work was to study the incidence of OBPP and to analyze its risk factors.
This is a population-based retrospective case-control study. All deliveries recorded in the Swedish Medical Birth Registry between 1987 and 1997 (n = 1 213 987) were investigated. Cases (n = 2399) with OBPP were compared to all other cases.
The incidence of OBPP increased from 0.17 in 1987 to 0.27% in 1997 (p = 0.002). During the same time period, the mean birthweight increased from 3483 to 3525 g. Birthweight increasing from 4000 g was associated with a progressive rise in OBPP risk. Other significant risk factors associated with the injury were shoulder dystocia, breech presentation in vaginal delivery, operative vaginal delivery, diabetes mellitus, induction of labor, protracted active phase, secondary arrest of dilatation, and epidural anesthesia. Cesarean section was associated with a decreased risk of OBPP. If 5000 g is chosen as cut-off for cesarean section, 85% of the infants in this weight class are underestimated using ultrasonography. Approximately, 331 abdominal deliveries have to be performed to avoid one case of OBPP.
Shoulder dystocia and infant birthweight of 4500 g and more are the strongest risk factors for OBPP in a Swedish population.
产科臂丛神经麻痹（OBPP）是新生儿发病的一种严重形式。
本研究旨在探讨OBPP的发病率并分析其危险因素。
这是一项基于人群的回顾性病例对照研究。对瑞典医学出生登记处1987年至1997年记录的所有分娩情况（n = 1213987）进行调查。将OBPP病例（n = 2399）与所有其他病例进行比较。
OBPP的发病率从1987年的0.17%上升至1997年的0.27%（p = 0.002）。在同一时期，平均出生体重从3483克增加到3525克。出生体重超过4000克与OBPP风险的逐渐上升相关。与该损伤相关的其他显著危险因素包括肩难产、阴道分娩时臀位、阴道助产、糖尿病、引产、活跃期延长、扩张期继发性停滞以及硬膜外麻醉。剖宫产与OBPP风险降低相关。如果选择5000克作为剖宫产的临界值，该体重组中85%的婴儿通过超声检查会被低估体重。大约需要进行331次剖宫产才能避免一例OBPP。
在瑞典人群中，肩难产以及婴儿出生体重达到或超过4500克是OBPP最强的危险因素。
