BIRTH TRAUMA - A 5-YEAR REVIEW OF INCIDENCE AND ASSOCIATED PERINATAL FACTORS

OBJECTIVE: To determine the current incidence of clavicular fracture ( CF), facial nerve injury (FNI) and brachial plexus injury (BPI) and id entify the existence, if any, of associated perinatal factors with eac h injury. STUDY DESIGN: A case-controlled study design was selected an d the study conducted for births between January 1, 1985 and January 1 , 1990, at Christ Hospital and Medical Center, a tertiary care center with level III perinatal services in suburban Chicago. Among a populat ion of 19,370 consecutive deliveries, we identified the occurrences of CF, FNI and BPI by database search, and maternal and neonatal chart r eviews. A control group was randomly selected. Maternal, labor, delive ry and neonatal variables were then compared between the birth trauma and control groups for each specific injury. RESULTS: The incidence pe r 1,000 live births and per 1,000 live-born cephalic singletons delive red vaginally for CF was 4.5 and 5.7; for FNI, 0.6 and 0.7; and for BP I, 0.9 and 1.1, respectively. To varying degrees, the data demonstrate that the occurrences of these injuries are associated significantly m ore often with prolonged gestation, epidural anesthesia, prolonged sec ond stage of labor, oxytocin use, forceps delivery, shoulder dystocia, macrosomia, low Apgar scores and a previous maternal obstetric histor y of macrosomia when compared to controls. other significantly associa ted variables include the presence of meconium in labor and neonatal h yperbilirubinemia. Despite the presence of multiple perinatal factors that are individually associated statistically with the injured groups , multiple logistic regression analysis predicted 44.2% of CF's, none of the FNIs and only 19% of the BPIs. CONCLUSION: While multiple perin atal variables are statistically associated with the specific birth in juries studied, the use of multiple logistic regression analysis shows that the ability to predict these injuries is markedly limited.