Fetal injury associated with cesarean delivery

James M. Alexander, Kenneth J. Leveno, John Hauth, Mark B. Landon, Elizabeth Thom, Catherine Y. Spong, Michael W. Varner, Atef H. Moawad, Steve N. Caritis, Margaret Harper, Ronald J. Wapner, Yoram Sorokin, Menachem Miodovnik, Mary J. O'Sullivan, Baha M. Sibai, Oded Langer, Steven G. Gabbe

Research output: Contribution to journalArticle

111 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)885-890
Number of pages6
JournalObstetrics and Gynecology
Volume108
Issue number4
DOIs
StatePublished - Sep 1 2006
Externally publishedYes

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Wounds and Injuries
Skin
Vacuum
Surgical Instruments
Mothers
Skull Fractures
Brachial Plexus
Lacerations
Facial Paralysis
Facial Nerve
Birth Weight
Registries
Body Mass Index
Cohort Studies
Prospective Studies
Incidence

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Alexander, J. M., Leveno, K. J., Hauth, J., Landon, M. B., Thom, E., Spong, C. Y., ... Gabbe, S. G. (2006). Fetal injury associated with cesarean delivery. Obstetrics and Gynecology, 108(4), 885-890. https://doi.org/10.1097/01.AOG.0000237116.72011.f3

Fetal injury associated with cesarean delivery. / Alexander, James M.; Leveno, Kenneth J.; Hauth, John; Landon, Mark B.; Thom, Elizabeth; Spong, Catherine Y.; Varner, Michael W.; Moawad, Atef H.; Caritis, Steve N.; Harper, Margaret; Wapner, Ronald J.; Sorokin, Yoram; Miodovnik, Menachem; O'Sullivan, Mary J.; Sibai, Baha M.; Langer, Oded; Gabbe, Steven G.

In: Obstetrics and Gynecology, Vol. 108, No. 4, 01.09.2006, p. 885-890.

Research output: Contribution to journalArticle

Alexander, JM, Leveno, KJ, Hauth, J, Landon, MB, Thom, E, Spong, CY, Varner, MW, Moawad, AH, Caritis, SN, Harper, M, Wapner, RJ, Sorokin, Y, Miodovnik, M, O'Sullivan, MJ, Sibai, BM, Langer, O & Gabbe, SG 2006, 'Fetal injury associated with cesarean delivery', Obstetrics and Gynecology, vol. 108, no. 4, pp. 885-890. https://doi.org/10.1097/01.AOG.0000237116.72011.f3
Alexander JM, Leveno KJ, Hauth J, Landon MB, Thom E, Spong CY et al. Fetal injury associated with cesarean delivery. Obstetrics and Gynecology. 2006 Sep 1;108(4):885-890. https://doi.org/10.1097/01.AOG.0000237116.72011.f3
Alexander, James M. ; Leveno, Kenneth J. ; Hauth, John ; Landon, Mark B. ; Thom, Elizabeth ; Spong, Catherine Y. ; Varner, Michael W. ; Moawad, Atef H. ; Caritis, Steve N. ; Harper, Margaret ; Wapner, Ronald J. ; Sorokin, Yoram ; Miodovnik, Menachem ; O'Sullivan, Mary J. ; Sibai, Baha M. ; Langer, Oded ; Gabbe, Steven G. / Fetal injury associated with cesarean delivery. In: Obstetrics and Gynecology. 2006 ; Vol. 108, No. 4. pp. 885-890.
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AU - Leveno, Kenneth J.

AU - Hauth, John

AU - Landon, Mark B.

AU - Thom, Elizabeth

AU - Spong, Catherine Y.

AU - Varner, Michael W.

AU - Moawad, Atef H.

AU - Caritis, Steve N.

AU - Harper, Margaret

AU - Wapner, Ronald J.

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AU - Miodovnik, Menachem

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N2 - 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.

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