Erb's Palsy in Jenin District: Prevalence and Risk Factors

Discussion Committee: 
Dr. Amira shaheen/supervisor
Dr. Khalil Issa/ Co-supervisor
Dr. Alaa Azmi/ Internal examiner
Dr. Sumaya Sayej/ external examiner
Dr. Amira shaheen/supervisor
Dr. Khalil Issa/ Co-supervisor
Laiali Aiosh
Background: Erb's palsy is a physical condition which results from injury to the fifth and sixth cervical vertebra; it causes paralysis or paresis of upper limb (UL) resulting in waiter's tip deformity of that affected limb. Its risk factors vary among individuals. In some cases, Erb's palsy does not have any identifiable risk factor while in other cases it has one or more factors associated with mothers, infants, or obstetric procedures. The most identifiable risk factors of Erb's palsy are shoulder dystocia, macrosomia and breech vaginal delivery. This study aims at determining the prevalence and risk factors of the Erb’s palsy in Jenin district over the period from 2007 to 2011. Methodology: This study is case-control study of all available infants having Erb's palsy condition who were born in Jenin district's hospitals from Jan 1, 2007 to Dec 31, 2011 as cases compared to infants without Erb's palsy having the same age, same sex, and same place of residency as controls. Hospitals (private and governmental), rehabilitation centers, orthopedic doctors, syndicate disabled, key persons in each area, relatives and friends were visited to identify all Erb's palsied cases in the district. Parents of Erb's palsied infants interviewed by phone to fill in the questionnaire. They were asked to give a name of a child -from their area-who had the same age and sex as their child and his or her contact information. The parents of controls filled in the questionnaire by phone, too. Any missed or uncertain information was confirmed by reviewing the medical files of the delivery rooms of hospitals. Results: There was 1.04/1000 live births (38 Erb's palsy cases from 36701 deliveries) prevalence of Erb's palsy in Jenin district during the mentioned period. 36 infants of them were included in the study and were compared to 36 controls of the same age, sex, and place of residency. No significant differences observed between the two groups due to many variables as macrosomia, diabetes mellitus (DM), gestational diabetes mellitus (GDM), obesity, maternal age more than 35 years, parity, previous child with Erb's palsy in the family, mode of delivery, Apgar score at 1 and 5 minutes, delivery specialist, and delivery hospital. Shoulder dystocia (SD) (P-value = 0.008, OR = 5.9, 95% CI) was the most significant associated risk factor with Erb's palsy followed by labour induction (P-value = 0.012, OR = 0.045, 95% CI). Other risk factors identified to be related to Erb's palsy in this study were excessive weight gain during pregnancy (P-value = 0.014, OR = 0.286, 95% CI), short second stage of labour (P-value = 0.014, OR = 2.1, 95% CI), and assisted vaginal delivery (P-value = 0.011, OR = 1.6, 95% CI). The dominant affected UL in our study was the right (Rt.) UL that found to be present in 77.7% of the cases. Conclusion: The prevalence of Erb's palsy found to be within the ranges presented worldwide. SD and labour induction both were the most significant risk factors of Erb's palsy in Jenin and these can be avoided with practice, training and more delivery experiences from both mothers and delivery specialists. Keywords: Erb's palsy, Waiter’s tip deformity, Macrosomia, SD, labour induction.
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