Accidental fetal lacerations during cesarean delivery: experience in an Italian level III university hospital.
OBJECTIVE
The purpose of this study was to investigate the incidence, type, location, and risk factors of accidental fetal lacerations during cesarean delivery.


METHODS
Total deliveries, cesarean deliveries, and neonatal records for documented accidental fetal lacerations were reviewed retrospectively in our level III university hospital. 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. Cesarean deliveries were divided into scheduled, unscheduled, and emergency procedures. Fetal lacerations were divided into mild, moderate, and severe. Neonatal follow-up examinations regarding laceration sequelae were available for 6 months.


RESULTS
Of 14926 deliveries, 3108 women were delivered by cesarean birth (20.82%). Neonatal records documented 97 accidental fetal lacerations. Of these accidental lacerations, 94 were mild; 2 were moderate, and 1 was severe. The overall rate of accidental fetal laceration per cesarean delivery was 3.12%; the accidental laceration rate in the cohort of fetuses was 2.46%. The crude odds ratios were 0.34 for scheduled procedures, 0.57 for unscheduled procedures, and 1.7 for emergency procedures. 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).


CONCLUSIONS
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.
Dessole
Salvatore
S
Department of Obstetrics and Gynecology, University of Sassari, Sassari, Italy. dessole@uniss.it
Cosmi
Erich
E
Balata
Antonio
A
Uras
Luisa
L
Caserta
Donatella
D
Capobianco
Giampiero
G
Ambrosini
Guido
G
D002585:Cesarean Section / Q000009:adverse effects*; D004638:Emergency Treatment; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D007558:Italy / Q000453:epidemiology; D022125:Lacerations / Q000453:epidemiology* / Q000209:etiology; D008499:Medical Records; D011247:Pregnancy; D049188:Prenatal Injuries; D012189:Retrospective Studies