title: Fetal injury associated with cesarean delivery.
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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  II-3.
authors.affiliation: Department of Obstetrics at the University of Texas Southwestern Medical Center, Dallas, Texas 75235-9032, USA. james.alexander@utsouthwestern.edu
authors.forename: James M
authors.initials: JM
authors.lastname: Alexander
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Leveno
authors.forename: John
authors.initials: J
authors.lastname: Hauth
authors.forename: Mark B
authors.initials: MB
authors.lastname: Landon
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Thom
authors.forename: Catherine Y
authors.initials: CY
authors.lastname: Spong
authors.forename: Michael W
authors.initials: MW
authors.lastname: Varner
authors.forename: Atef H
authors.initials: AH
authors.lastname: Moawad
authors.forename: Steve N
authors.initials: SN
authors.lastname: Caritis
authors.forename: Margaret
authors.initials: M
authors.lastname: Harper
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wapner
authors.forename: Yoram
authors.initials: Y
authors.lastname: Sorokin
authors.forename: Menachem
authors.initials: M
authors.lastname: Miodovnik
authors.forename: Mary J
authors.initials: MJ
authors.lastname: O'Sullivan
authors.forename: Baha M
authors.initials: BM
authors.lastname: Sibai
authors.forename: Oded
authors.initials: O
authors.lastname: Langer
authors.forename: Steven G
authors.initials: SG
authors.lastname: Gabbe
mesh_terms: D000328:Adult; D001720:Birth Injuries / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology*; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007743:Labor, Obstetric; D010298:Parity; D011247:Pregnancy; D011446:Prospective Studies; D044465:White People