This study analyzed 33 cases of brachial plexus injury (BPI) that occurred during or after delivery at a single institution over time. The study found that 58% of BPI cases were associated with shoulder dystocia, while 42% occurred without shoulder dystocia. BPI without shoulder dystocia was associated with longer second stage of labor, low birth weight, and absence of gestational diabetes. The study concluded that both BPI and shoulder dystocia represent complications of uterine forces during delivery when there is disproportion between the fetal shoulders and birth canal, but they are not always causally related. Proper labor management and treatment of complications can help reduce the risk of BPI.

1. Pathophysiologic Origin
of Brachial Plexus Injury
By :- Meet Soni

2. ● Author :- Grace J. Johnson, MD
● Co- Author :- Stacie Denning, MS
Steven L. Clark, MD
Christiana Davidson, MD
● Received Date:- March 15, 2020
● Published Date:- May 21, 2020
● Published On :- WK Health Journal, Vol.136,No.4

3. ● Objective :-
- To analyze the origins and consequences of cases of
brachial plexus injuries and their relationship to shoulder
dystocia

4. ● Methodology :-
● Retrospective Cohort Study
● Within institution, Identified all women with shoulder
dystocia & all neonates with brachial plexus injury
● Collected all medical data of the mother & neonates from
medical records
● All cases of brachial plexus injury were then stratified in
two ways :

5. Brachial Plexus Injury
● With Shoulders
Dystocia
● Without Shoulder
Dystocia
● Trancient BPI
● Persistent BPI
- And lastly For comparisons statistical test are
performed ex., Chi-Square test

6. ● Introduction :-
1. Roots :- C5- C8 , T1
2. Trunks :-
Superior (C5,C6),
Middle (C7),
Inferior (C8,T1)
1. Division :- Anterior , Posterior
2. Cords :-
Lateral - Ant. Of Superior & Middle
Medial - Ant. Of Inferior
Posterior - Post. Of All 3
1. Branches

7. Brachial Plexus Injury
● Uncommon complication of delivery
● Occurs only In 1.5 of 1000 total births
● Occurs as a result of strech or tearing of the
C5-T1 Nerve root
● May or may not be associated with shoulder
dystocia
● Beleived that injuries occur as sequelae of
forces applied By the delivering clinicians
● Can occur in both Vaginal & Cesarean
delivery

8. Shoulder Dystocia
● Complication faced during
delivery
● Mechanical Problem occuring
during a vaginal delivery
● Characterized By failure to
deliver the fetal shoulders using
solely gentle downward traction
● Requires additional maneuvars
to deliver baby successfully

9. ● Management of Shoulder Dystocia
● Initial Maneuveres :-
1) McRoberts Maneuver
2) Suprapubic Presure
● Additional Maneuvers :-
1. Posterior Arm Release
2. Woods Maneuver
3. Episiotomy

10. McRoberts Maneuver :-
1. Legs fixed on the abdomen
causes rotation of pelvis ,
alignment Of sacrum , &
opening of birth canal
2. Suprapubic pressure helps
anterior shoulder to pass out
of passage Easily

11. ● Results :-
● Total Deliveries :- 41525
1. Vaginal Deliveries :- 26163(63%)
2. Cesarean Section :- 15362 (37%)
● Shoulder dystocia :- 547 (1.3%)
● Vaginal delivery With SD :- 2.1%
● C-section with SD :- 0.06%
● Total BPI case :- 33
● Vaginal delivery with BPI :- 30
● C-section delivery with BPI :- 3
● BPI with shoulder dystocia: -
19 (58%)
● BPI without Shoulder
dystocia :- 14 (42%)

13. ● Brachial Plexus injuries
without Shoulder Dystocia
:-
- commonly seen in
- Absence of Gestational
Diabetes
- Increase Time period of
second stage of labour
- Low birth weight

14. ● Discussion :-
● Compared our result with two other review which included more than 4000
cases of Brachial Plexus injury fromb 25 institutes
● 46-54% cases of Brachial plexus injury were not associated with shoulder
dystocia
● Finding of this study is similar to other researches
● Data derive from a new, level IV academic facilities in which multiple layers of
oversight were purposfully Integrated into operations to ensure quality, safety
& completness Of reporting any Adverse event
● Co-occurence Of BPI and SD when compared with isolated cases of BPI
occurence of both are somewhat similar

15. ● That suggest that both Brachial plexus injury & Shoulder Dystocia are not
related to each Other but are complication of of uterine forces driving fetus
through birth canal in the presence of disproportion between the passage &
the shoulder girdle of the fetus
● Other than that findings like Brachial plexus injury without shoulder dystocia
in longer second stage of labour suggest that injury occurs Due to
maladaptation between shoulder girdle & birth canal
● Transient BPI :- more commonly Occurs due to endogenous uterine forces
● Permenant BPI :- more commonly occurs due to excessive external forces

16. ● Conclusion : -
● BPI & SD both represents as a complication Of uterine forces driving fetus
through the maternal pelvis in the presence of disproportion between the
passage & shoulder girdle
● Either or both complication can occur at the time of delivery
● But often both are not often causally related
● Better delivery practice & treatment of the complication faced during
delivery reduces chances of Brachial plexus injury
● Brachial plexus injury can occur in neonate due to various other reasons
also Like malposition of fetus , overstreching during delivery , high Maternal
age , narrow passage
● Proper labour management can reduce the frequencies of injuries

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18. Thank you