title: Long bone fractures in extreme low birth weight infants at birth: obstetrical considerations.
abstract: BACKGROUND
  Cesarean section is a common delivery route for breech fetuses < 1000 gm to prevent trauma. However, abdominal and vaginal delivery maneuvers are similar. Cesarean section avoids the risk of head entrapment but long bone trauma can still occur.
  
  
  METHODS
  We identified three neonates with femoral fractures during a one year period. All mothers were in active labor. All were premature newborns less than 32 weeks gestation, in breech presentation and delivered by a low vertical cesarean section. Review of all cesarean sections done due to mal presentation (n = 26) during that time showed 11 classic and 15 lower segment vertical incisions (both vertical and transverse).
  
  
  CONCLUSIONS
  The interest to reduce maternal morbidity may prompt physicians to perform a low segment vertical incision for delivery of a preterm breech. This decision may increase the chances of trauma by providing less area for the required obstetric maneuvers.
authors.affiliation: Department of Pediatrics, Neonatology Section, Medical Sciences Campus, PO Box 365067, San Juan, Puerto Rico 00936-5067. nicu@coqui.net
authors.forename: Inés E
authors.initials: IE
authors.lastname: García García
authors.forename: Alberto
authors.initials: A
authors.lastname: de la Vega
authors.forename: Lourdes
authors.initials: L
authors.lastname: García Fragoso
mesh_terms: D000293:Adolescent; D000328:Adult; D001946:Breech Presentation; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D009321:Natural Childbirth / Q000379:methods; D011247:Pregnancy; D011859:Radiography