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Dr. Dilip Walke
Chairman
Ethics & Medicolegal Committee
FOGSI
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.
OBJECTIVE:
o
The purpose of this study was to investigate the incidence,
type, location, and risk factors of accidental fetal lacerations
during cesarean delivery.
STUDY DESIGN:
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.
RESULTS:
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).
CONCLUSION:
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.
OBJECTIVE:
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.
CONCLUSION:
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
METHODS:
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.
CONCLUSIONS:
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.
METHODS:
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.
CONCLUSION:
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. james.alexander@utsouthwestern.edu
METHODS:
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.
o
LEVEL OF EVIDENCE: II-3.
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