title: Maternofetal Trauma in Craniosynostosis.
abstract: BACKGROUND
  Premature cranial suture fusion may prevent neonatal skull malleability during birth, increasing the risk of unplanned cesarean delivery and neonatal birth trauma caused by cephalopelvic disproportion. We sought to determine the incidence of perinatal maternofetal complications in cases of craniosynostosis.
  
  
  METHODS
  Records of children presenting with nonsyndromic craniosynostosis to a tertiary pediatric hospital from 1996 to 2012 were reviewed retrospectively with focus on birth history and birth-related complications.
  
  
  RESULTS
  Six hundred eighteen births were reviewed. Rates of cesarean delivery among mothers of children with craniosynostosis [n = 201 (32.5 percent)] exceeded the overall regional rate of 24.5 percent (OR, 1.50; p < 0.0001). Unplanned cesarean delivery occurred in 19.7 percent of births, and were most associated with nulliparous mothers, breech fetal presentations, and lambdoid or multisuture synostosis patterns. Eleven neonates (1.8 percent) exhibited cranial birth trauma, including cephalohematoma and subgaleal hematoma. Neonates with sagittal or multisuture synostosis patterns were more likely to suffer birth trauma and had a higher mean head circumference than those who did not (81st versus 66th percentile, p < 0.05).
  
  
  CONCLUSIONS
  In the setting of craniosynostosis, birth trauma is increased-for mothers in the form of increased cesarean delivery risk, and for fetuses in the form of subgaleal and subperiosteal perinatal bleeding. Difficult maternal labor may be mediated especially by multisuture or lambdoid synostosis, whereas fetal birth trauma may be mediated to a greater extent by large head size. Prenatal diagnosis of craniosynostosis could influence decision-making in the management of labor.
  
  
  METHODS
  Risk, IV.
authors.affiliation: Seattle, Wash. From the Craniofacial Center, Seattle Children's Hospital; and the Division of Plastic Surgery, University of Washington.
authors.forename: Jordan
authors.initials: J
authors.lastname: Swanson
authors.forename: Adam
authors.initials: A
authors.lastname: Oppenheimer
authors.forename: Faisal
authors.initials: F
authors.lastname: Al-Mufarrej
authors.forename: Mitchell
authors.initials: M
authors.lastname: Pet
authors.forename: Chris
authors.initials: C
authors.lastname: Arakawa
authors.forename: Michael
authors.initials: M
authors.lastname: Cunningham
authors.forename: Joseph
authors.initials: J
authors.lastname: Gruss
authors.forename: Richard
authors.initials: R
authors.lastname: Hopper
authors.forename: Craig
authors.initials: C
authors.lastname: Birgfeld
mesh_terms: D001720:Birth Injuries / Q000453:epidemiology* / Q000209:etiology; D015984:Causality; D002508:Cephalometry / Q000379:methods / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data*; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D003398:Craniosynostoses / Q000175:diagnosis / Q000453:epidemiology*; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D008423:Maternal Age; D033261:Maternal-Fetal Relations; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment