Karakteristik dan Faktor Risiko Obstetrical Brachial Plexus Palsy pada Bayi Baru Lahir

Abstract

Obstetrical brachial plexus palsy (OBPP) merupakan cedera sebagian/seluruh plexus brachialis akibat proses kelahiran. Insidensi di negara berkembang berkisar 0,15%. Faktor risiko meliputi intrapartum dan intrauterin. Dibedakan tiga jenis OBPP yaitu Duchenne Erb, Klumpke, dan whole arm palsy. Penelitian bersifat retrospektif, melihat karakteristik dan faktor risiko terjadinya OBPP di RS. Hasan Sadikin, Bandung, periode Januari 2002-April 2007. Data diperoleh dari catatan medik bagian perinatologi, kemudian dilakukan analisis binary logistic regression. Hasil penelitian menunjukkan insidensi OBPP 0,141%, seluruhnya Erb palsy dan kehamilan tunggal. Sebanyak 68,75% presentasi belakang kepala, 50% lahir spontan, 18,75% disertai meconeal staining, 62,5% berat lahir ≥3.500 g, 56,25% laki-laki, 68,75% asfiksia, 12,5% distosia bahu, dan 6,25% fraktur klavikula. Faktor risiko yang bermakna adalah presentasi kaki (OR 9,357; 95%CI), letak lintang (OR 5,136; 95%CI), ekstraksi vakum (OR 5,240;95%CI), ekstraksi forseps (OR 4,320; 95%CI), ekstraksi bokong/kaki (OR 14,411; 95%CI), berat lahir 3.500- 3.999 g (OR 4,571; 95%CI), berat lahir ≥ 4.500 g (OR 57,759; 95%CI), asfiksia (OR 5,992; 95%CI) dan asfiksia berat (OR 6,094; 95%CI). Sectio Cesarea cenderung protektif {OR 0,244; 95%CI; p=0,062 (>0,05)}. Pada penelitian ini dapat disimpulkan bahwa faktor risiko yang terutama berperan adalah presentasi kaki, ekstraksi bokong, dan berat lahir >4.500 g.

Characteristics and Risk Factors of Obstetrical Brachial Plexus Palsy in Newborn Baby

Obstetrical brachial plexus palsy (OBPP) is an injury of entire or part of brachial plexus correlated with delivery process. Incidence in developing countries is around 0.15%. Risk factors include intrapartum and intrauterine. Three types of OBPP are Duchenne Erb, Klumpke, and whole arm palsy. This was a retrospective study of characteristic and risk factors of OBPP in Hasan Sadikin Hospital, Bandung, period January 2002-April 2007. Data were collected from perinatology ward medical records, and analyzed using binary logistic regression. OBPP incidence was 0.141%. All were Erb palsy and single pregnancy, 68.75% were head-occiput posterior presentation, 50% were spontaneous birth, 18.75% had meconeal staining, 62.5% had birth weight ≥3,500 g, 56.25% were male, 68.75% asphyxia, 12.5% shoulder dystocia, and 6.25% clavicle fracture. Risk factors significantly correlated were foot presentation (OR 9.357; 95%CI), transverse fetal position (OR 5.136; 95%CI), vacuum, forceps, breech/foot extraction (OR 5.240;95%CI, 4.320; 95%CI, 14.411; 95%CI, respectively), birth weight 3,500-3,999 g (OR 4.571;95%CI), birth weight ≥4,500 g (OR 57.759; 95%CI), asphyxia (ORs 5.992; 95%CI), and severe asphyxia (OR 6.094; 95%CI). Sectio cesarea tend to have protective effect {OR 0.244; 95%CI; p=0.062 (>0.05)}. The important risk factors of OBPP are foot presentation, breech/foot extraction, and birth weight >4,500 g.

DOI: http://dx.doi.org/10.15395/mkb.v42n2.9