(243) Declining incidence of obstetric brachial plexus palsy in vaginally delivered infants.

A population-based registry study including singleton, cephalic, vaginally delivered infants 1997-2019 in Sweden. To compare changes in the incidence rates of OBPP and associated risk factors over time, univariate logistic regression was used and odds ratios (OR) with 95% confidence intervals (CI) were calculated.

Results:

The incidence of OBPP in infants delivered vaginally in a cephalic presentation decreased from 3.1 per 1000 births in 1997 to 1.0 per 1000 births in 2019 (OR 0.31, 95% CI 0.24, 0.40).  Conversely, the incidence of shoulder dystocia increased from 2.0 per 1000 in 1997 to 3.3 per 1000 in 2019 (OR 1.64, 95%, CI 1.34, 2.01). Over time, the proportion of women with body mass index ≥30 increased (14.5% in 2019 compared to 8.0% in year 1997, OR: 1.96, 95%, CI:1.89-2.03), more women had induction of labour (20.5% in 2019 compared to 8.6% in 1997, OR: 2.74, 95% CI: 2.66-2.83) and epidural analgesia (41.2% in 2019 compared to 29.0% in 1997, OR: 1.72, 95% CI: 1.68-1.75). In contrast, there was a decrease in the rate of operative vaginal delivery (6.0% in 2019, compared to 8.1% in 1997, OR: 0.72, 95% CI: 0.69, 0.75) and in the proportion of infants with a birth weight > 4500 g (2.7% in 2019 compared to 3.8% in 1997, OR: 0.70, 95% CI: 0.66-0.74). The decline in the incidence of these two risk factors explained only a small fraction of the overall decrease in OBPP between 1997-2002 and 2015-219.

Conclusion: The incidence of OBPP in vaginally delivered infants in cephalic presentation at birth decreased during the period 1997-2019 despite an increase in important risk factors including shoulder dystocia.