INVITATION ARTICLES - Handling Accidental cut on the baby during LSCS By Dr. Dilip Walke

Dr. Dilip Walke

Chairman Ethics & Medicolegal Committee



This article is a compilation of reference from various journals to defend a case of cut on the face of the baby during LSCS. This is a very common birth injury during LSCS and if it lands up in litigation there are not enough references to prove that the injury is possible in spite of careful surgery. I must thank Dr Vaishali Korde from Dinanath Hospital Pune for helping me in the compilation of these references


Reference No 1


Accidental fetal lacerations during cesarean delivery: experience in an Italian level III university hospital. Dessole S, Cosmi E, Balata A, Uras L, Caserta D, Capobianco G, Ambrosini G.




o    The purpose of this study was to investigate the incidence, type, location, and risk factors of accidental fetal lacerations during cesarean delivery.




o    Retrospective analysis of delivery and neonatal records

o    The gestational age, the presenting part of the fetus, the cesarean delivery indication, the type of incision, and the surgeon who performed the procedure were recorded.

o    Cesarean deliveries were divided into scheduled, unscheduled, and emergency procedures.

o    Fetal lacerations were divided into mild, moderate, and severe. Neonatal follow-up examinations regarding laceration sequelae were available for 6 months.




o    14926 deliveries, 3108 women were delivered by cesarean birth (20.82%).

o    97 accidental fetal lacerations– 94 were mild/2 were moderate and 1 was severe

o    The overall rate of accidental fetal laceration per cesarean delivery was 3.12%;

o    The crude odds ratios were 0.34 for scheduled procedures, 0.57 for unscheduled procedures, and 1.7 for emergency procedures.

o    The risk for fetal accidental lacerations was higher in fetuses who underwent emergency cesarean birth and lower for unscheduled and scheduled cesarean births (P < .001).




o    Fetal accidental laceration may occur during cesarean delivery; the incidence is significantly higher during emergency cesarean delivery compared with elective procedures. The patient should be counseled about the occurrence of fetal laceration during cesarean delivery to avoid litigation.


Reference No 2

Fetal laceration injury at cesarean delivery. Smith JF, Hernandez C, Wax JR.
Department of Obstetrics and Gynecology, St. Joseph Hospital, Denver, Colorado, USA.



o   To investigate the incidence of fetal laceration injury in cesarean delivery.

·         METHODS:

o   A retrospective review 

·         RESULTS:

o   Of the 904 LSCS cases, 17 laceration injuries were recorded (1.9%).

o   The incidence of laceration was higher in non-vertex cases appeared higher when the indication for cesarean was non-vertex cases

o   Only one of the 17 Obstetricians recorded the lacerations in the notes.




o   Fetal laceration injury at cesarean delivery is not rare, especially when it is performed for non-vertex presentation. The minority of obstetric records show documentation of such lacerations, suggesting that this complication often may not be recognized by obstetricians.


Reference No 3

Laceration injury at cesarean section. Haas DM, Ayres AW.
Department of Obstetrics and Gynecology, Naval Medical Center, San Diego, California 92134-5000, USA



o   Retrospective study of two years

o   Control group ( LSCS- no lacerations) also studied

·         RESULTS:

o   LSCS rate 16.7%

o   No difference in operative indication, type of Cesarean section, or any demographic information between the two groups.

o   Male infant gender (p = 0.027) and ruptured membranes (p = 0.019) showed a statistically significant difference between the two groups.




o   Laceration injury to the infant during Cesarean section is associated with a laboring uterus. This is an important complication that should be part of preoperative counseling and should be documented appropriately when it occurs.


Reference No 4

Accidental incision of the fetus at caesarian section. Okaro JM, Anya SE.
Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital Enugu, Nigeria.



o   Retrospective review of seven years

·         RESULTS:

o   Incidence- 0.55% of live caesarian section births.

o   Associated with emergency caesarian section, ruptured membranes and relative inexperience of the operating surgeon.

o   Documentation of injury was poor and there was no evidence that parents were counseled.




o   Laceration of the fetus is an occasional complication of caesarian section. Proper documentation and counseling of parents are required especially as there are potential medicolegal implications. Careful attention to the technique of uterine entry at caesarian section should reduce the risk of injury to the fetus.



Reference No 5


Fetal injury associated with cesarean delivery. 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; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Department of Obstetrics at the University of Texas Southwestern Medical Center, Dallas, Texas 75235-9032, USA.



o   One year prospective study Between January 1, 1999, and December 31, 2000

·         RESULTS:

o   37,110 cesarean

o   418 (1.1%) had an identified fetal injury.

o   Skin laceration (n = 272, 0.7%).

o   Other injuries

§  cephalhaematoma (n = 88),

§  clavicular fracture (n = 11),

§  brachial plexus (n = 9),

§  skull fracture (n = 6), and

§  Facial nerve palsy (n = 11).

o   Among primary cesarean deliveries, deliveries with failed instrumentations had the highest rate of injuries (6.9%).

o   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%).

o   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),

o   Skin incision-to-delivery time of 3 minutes or less—more injuries.

o   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.





Click here to view other articles in this section