Objective: The purpose of this study was to analyze the data on brachial plexus injury and its relationship with Shoulder dystocia from a tertiary center for a 23-year period.Study design: A review of the logbooks on labor and delivery and the nursery and the International Classification of Diseases codes identified all newborn infants with brachial Plexus injury who were delivered at our center.Results: During the 23 years (1980-2002), there were 89,978 deliveries, of which there were 85 cases of brachial plexus injury (1/1000 births) with vaginal delivery. The injury was permanent (1 year) in 12% of the cases, and only 2 cases have been litigated. Newborn infants that weighed >= 4 kg were significantly more common among those infants who had shoulder dystocia and brachial plexus injury than those infants Without injury (odds ratio, 6.55; 95% CI, 2.30 18.63). The rate of permanent brachial plexus injury was similar between the 2 groups.Conclusion: A case of brachial Plexus injury occurs I time in every 1000 births, is permanent in 1 of every 10,000 deliveries, and is litigated 1 time for every 45,000 deliveries. The infrequent nature Of injury may preclude prevention.