Neonatal injury at cephalic vaginal delivery: a retrospective analysis of extent of association with shoulder dystocia.

To describe the risk factors and labor characteristics of Clavicular fracture (CF) and brachial plexus injury (BPI); and compare antenatal and labor characteristics and prognosis of obstetrical BPI associated with shoulder dystocia with obstetrical BPI not associated with shoulder dystocia.This retrospective study consisted of women who gave birth to an infant with a fractured clavicle or BPI between January 2009 and June 2013. Antenatal and neonatal data were compared between groups. The control group (1300) was composed of the four singleton vaginal deliveries that immediately followed each birth injury. A multivariable logistic regression model, with backward elimination, was constructed in order to find independent risk factors associated with BPI and CF. A subgroup analysis involved comparison of features of BPI cases with or without associated shoulder dystocia.During the study period, the total number of vaginal deliveries was 44092. The rates of CF, BPI and shoulder dystocia during the study period were 0,6%, 0,16% and 0,29%, respectively. In the logistic regression model, shoulder dystocia, GDM, multiparity, gestational age >42 weeks, protracted labor, short second stage of labor and fetal birth weight greater than 4250 grams increased the risk of CF independently. Shoulder dystocia and protracted labor were independently associated with BPI when controlled for other factors. Among neonates with BPI whose injury was not associated with shoulder dystocia, five (12.2%) sustained permanent injury, whereas one neonate (4.5%) with BPI following shoulder dystocia sustained permanent injury (p = 0.34).BPI not associated with shoulder dystocia might have a higher rate of concomitant CF and permanent sequelae

Maternal Near Miss Morbidity and Maternal Mortality in a Tertiary Referral Center in Turkey

Objective: The objective of the study is to present the maternal near miss and maternal mortality cases from a tertiary hospital and to evaluate the factors associated with the presence of maternal near miss. Study Design: We performed a retrospective study, including all women who fulfilled the WHO criteria for maternal near miss or death between June 2009 and June 2014 at a tertiary referral education hospital. This study was conducted to evaluate the risk factors’ influence on near miss, multivariate logistic regression was used. Before setting logistic regression, univariate analyses were used to select candidate variables. Results: During the 5-year study, there were 82924 deliveries and 81673 live births. We identified 202 maternal near miss events and 11 maternal deaths. The maternal near miss ratio was 2.47 per 1.000 live births and the maternal mortality ratio was 13.46 per 100.000 live births. There were 213 women with a severe maternal outcome ratio (SMOR) (near miss + maternal death), with a ratio of 2.6 cases/1.000 live birth. Near miss events were associated with length of hospital stay (p<0.001), hemoglobin level (p=0.003). Conclusion: By the help of the WHO near miss approach, we identified that near miss events were associated with length of hospital stay, hemoglobin level, cesarean section deliveries and parity

Comparison of maternal, perinatal and neonatal characteristics.

<p>Data expressed as number (%), mean ± SD, CF: Clavicular fracture, BPI: Brachial plexus injury, NS: non significant, min: minutes.</p

The incidence rates of Clavicular fracture, brachial plexus injury and shoulder dystocia.

<p>The incidence rates of Clavicular fracture, brachial plexus injury and shoulder dystocia.</p

Comparison of maternal, perinatal and neonatal characteristics.

<p>Data expressed as number (%), mean ± SD, CF: Clavicular fracture, BPI: Brachial plexus injury, NS: non significant, min: minutes.</p