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Obstetrics & Gynecology 2006;108:885-890
© 2006 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Fetal Injury Associated With Cesarean Delivery

James M. Alexander, MD1, Kenneth J. Leveno, MD1, John Hauth, MD2, Mark B. Landon, MD3, Elizabeth Thom, PhD4, Catherine Y. Spong, MD5, Michael W. Varner, MD6, Atef H. Moawad, MD7, Steve N. Caritis, MD8, Margaret Harper, MD9, Ronald J. Wapner, MD10, Yoram Sorokin, MD11, Menachem Miodovnik, MD12, Mary J. O'Sullivan, MD13, Baha M. Sibai, MD14, Oded Langer, MD15, Steven G. Gabbe, MD16 for the National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network*

From the Departments of Obstetrics and Gynecology at the 1 University of Texas Southwestern Medical Center, Dallas, Texas; 2 University of Alabama at Birmingham, Birmingham Alabama; 3 Ohio State University, Columbus, Ohio; 4 The George Washington University Biostatistics Center, Washington, DC; 5 the National Institute of Child Health and Human Development, Bethesda, Maryland; 6 University of Utah, Salt Lake City, Utah; 7 University of Chicago, Chicago, Illinois; 8 University of Pittsburgh, Pittsburgh Pennsylvania; 9 Wake Forest University School of Medicine, Winston-Salem, North Carolina; 10 Thomas Jefferson University, Philadelphia, Pennsylvania; 11 Wayne State University, Detroit, Michigan; 12 University of Cincinnati, Cincinnati, Ohio; 13 University of Miami, Miami, Florida; 14 University of Tennessee, Memphis, Tennessee; 15 University of Texas Health Science Center at San Antonio, San Antonio, Texas; and 16 Vanderbilt University, Nashville, Tennessee.

OBJECTIVE: To describe the incidence and type of fetal injury identified in women undergoing cesarean delivery.

METHODS: Between January 1, 1999, and December 31, 2000, a prospective cohort study of all cesarean deliveries was conducted at 13 university centers. Information regarding maternal and infant outcomes was abstracted directly from hospital charts.

RESULTS: A total of 37,110 cesarean deliveries were included in the registry, and 418 (1.1%) had an identified fetal injury. The most common injury was skin laceration (n=272, 0.7%). Other injuries included cephalohematoma (n=88), clavicular fracture (n=11), brachial plexus (n=9), skull fracture (n=6), and facial nerve palsy (n=11). Among primary cesarean deliveries, deliveries with a failed forceps or vacuum attempt had the highest rate of injuries (6.9%). In women with a prior cesarean delivery, the highest rate of injury also occurred in the unsuccessful trial of forceps or vacuum (1.7%), and the lowest rate occurred in the elective repeat cesarean group (0.5%). The type of uterine incision was associated with fetal injury, 3.4% "T" or "J" incision, 1.4% for vertical incision, and 1.1% for a low transverse (P=.003), as was a skin incision–to–delivery time of 3 minutes or less. Fetal injury did not vary in frequency with the type of skin incision, preterm delivery, maternal body mass index, or infant birth weight greater than 4,000 g.

CONCLUSION: Fetal injuries complicate 1.1% of cesarean deliveries. The frequency of fetal injury at cesarean delivery varies with the indication for surgery as well as with the duration of the skin incision–to–delivery interval and the type of uterine incision.

LEVEL OF EVIDENCE: II-3




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