BIRTH-WEIGHT AS A PREDICTOR OF BRACHIAL-PLEXUS INJURY

Objective: To examine the relationship between birth weight and brachi al plexus injury and estimate the number of cesareans needed to reduce such injuries. Methods: All 80 neonatal records coded for brachial pl exus injury from October 1985 to September 1993 at the Brigham and Wom en's Hospital in Boston, Massachusetts, were studied along with linked maternal files. Birth weight, method of delivery, presence or absence of shoulder dystocia, and any diagnosis of maternal gestational or no ngestational diabetes were abstracted. Data for the group with brachia l plexus injury were compared with data for live-born infants without this injury during the same period. The sensitivity and specificity of birth weight as a predictor of brachial plexus injury were calculated . Further, the number of cesarean deliveries necessary to prevent a si ngle brachial plexus injury was estimated using various weight cutoffs (4000, 4500, and 5000 g) for elective cesarean delivery. Results: Amo ng 77,616 consecutive deliveries, there were 80 brachial plexus injuri es identified, for an incidence of 1.03 per 1000 live births. The inci dence of brachial plexus injury increased with increasing birth weight , operative vaginal delivery, and the presence of glucose intolerance. In the group of women without diabetes, between 19 and 162 cesarean d eliveries would have been necessary to prevent a single immediate brac hial plexus injury. Among women with diabetes, between five and 48 add itional cesareans would have been required. Conclusion: Although birth weight is a predictor of brachial plexus injury, the number of cesare an deliveries necessary to prevent a single injury is high at most bir th weights. Because of the large number of cesarean deliveries needed to prevent a single brachial plexus injury in infants born to women wi thout diabetes, it is difficult to recommend routine cesarean delivery for suspected macrosomia in these women. (C) 1997 by The American Col lege of Obstetricians and Gynecologists.