Brachial Plexus Birth Injury in Elective Versus Emergent Caesarean Section
1Dr Ayesha Nasir, 2Dr Humera Sharif, 3Dr Zainab Bahadar, 4Dr Sajjad Ali, 5Dr Syed Maaz Shah, 6Dr Asghar Khan
1Consultant, Gynaecologists, Health Department. Kpk
2Consultant, Gynaecologists, Health department kpk.
3Consultant, Gynaecologists, health department kpk
4Resident orthopeadic MTI ATH Abbottabad
5Resident orthopeadic MTI ATH abbottabad.
6Correspondence author), Consultant orthopeadic surgeon MTI ATH abbottabad
Vol: 16/03, 511-526
Submission: 21 December 2025 | Acceptance: 25 December 2025 | Publication: 21 December 2025
Abstract
Background: Brachial plexus birth injury (BPBI) is a serious neonatal morbidity that is traditionally linked to problematic vaginal births. But the postpartum injuries have also been reported after caesarean births especially in an emergency setting. This research paper presents a comparison of the incidence and the related factors of BPBI between an elective and an emergent caesarean section at the Ayub Teaching Hospital. Methods: The study was a retrospective cohort study that took place during a 1-year period (2025) and involved reviewing 1176 caesarean deliveries. The definition of elective caesarean section was given as the delivery on the basis of the non-occurrence of labor and emergent caesarean section was considered as the delivery that occurred after the onset of labor because of acute obstetric complications. Maternal, intrapartum and neonatal data were gathered and the BPBI was diagnosed based on the registered neurological observations. The chi-square test and multivariate logistic regression were used to perform statistical analysis. The institutional Review Committee (IRC No. ) provided the ethical approval. Results: There were 1176 births, 428 (36.4) elective births by the caesarean section and 748 (63.6) emergent. The total rate of BPBI was 0.76% (9/1176) with all nine cases only in the emergent caesarean group and this translates to a rate of 1.20% in the same subgroup. Elective caesarean births had no cases of BPBI. Prolonged labor, low Apgar scores and fetal head impaction were significant predictors of BPBI. The multivariate analysis revealed fetal head impaction as the most significant independent predictor of BPBI ( AOR 4.87, 95% CI 2.118.92). The neuro-outcomes (NICU admission and Apgar scores) of the emergent caesarean section were significantly lower than the elective section. Conclusion: BPBI in a caesarian section is closely related with emergent surgical situations where there are complications in labor and not a planned surgical procedure that is carried out prior to the occurrence of labor. The results highlight the need to intervene in obstetric care in time, better deal with protracted and obstructed labor, and increase the training in the extraction methods of the affected fetal head. Elective caesarean section is very protective in BPBI when it is rightly indicated. Keywords: Brachial plexus birth injury, Caesarean section, Elective caesarean, Emergency caesarean, Neonatal nerve injury, Labor dystocia, Fetal head impaction.