PP-028 Obstetric brachial plexus paralysis: a case-control study on risk factors, epidemiological and clinical perspectives

brachial plexus palsy is a redoubtable neonatal complication that can compromise the functional prognosis of the upper limb. This study aims to investigate the epidemiological and clinical aspects of obstetric brachial plexus palsy and to identify the risk factors involved.

This is a retrospective case-control study conducted in the Department of resuscitation and neonatal medicine of Sousse in Tunisia. It includes a sample of newborns who presented with OBPP lesions over a seven-year period from 01/01/2013 to 31/12/2019. A control group of the same size was randomly selected from the department's records for the analytical study.

Our study, conducted in the maternity ward of CHU Farhat Hached in Sousse, revealed an overall average incidence of Brachial Plexus Palsy (BPP) of 1.05‰ live births from January 1, 2016, to December 31, 2019. The parturients had a mean age of 30.66 years, with 41.1% being primiparous. However, only 37% of cases had adequate pregnancy monitoring. The primary pregnancy pathologies observed were gestational diabetes (23.3%), prolonged rupture of membranes (15.1%), and preeclampsia (5.5%). In terms of paralysis, 50.7% of cases were right-sided, 47.9% were left-sided, and 1.4% were bilateral. BPP was proximal (C5-C6+/-C7) in 82.4% of cases, complete in 16.2% of cases, and distal (C8-T1) in 1.4% of cases. The most frequently associated traumatic lesion with OBPP was a clavicle fracture, occurring in 17.8% of cases. Other associated lesions included sero-sanguineous bump (26%), diaphragmatic paralysis (5.6%), pneumothorax (2.8%), skull bone embarrures (2.8%), and humerus fracture (1.4%). Statistically significant differences were found for gestational diabetes (p=0.01), premature delivery (p=0.007), and term >40 weeks of gestation (p=0.019). Regarding delivery characteristics, statistically significant differences were found for shoulder dystocia (p<0.0001) and cesarean delivery (p<0.0001). In the multivariate analysis, the risk factors independently associated with OBPP were shoulder dystocia, forceps, and macrosomia. cesarean section emerged as a protective factor.

Because of its unpredictable occurrence, the potential disability it can cause and the medico-legal implications arising from it, OBPP constitutes a major health challenge in Tunisia. This requires the implementation of preventive measures to limit the occurrence of these complications.