Fetal lacerations occur more often during cesarean section deliveries than vaginal deliveries, often as a result of accidents and negligence on the part of medical staff during delivery. Fetal lacerations occur in as many as three percent of cesarean section deliveries. Infants may be cut by scalpels or other instruments during delivery. Most fetal lacerations are minor and resolve quickly after minimal treatment is provided in the delivery room. In some cases, however, fetal lacerations are deep and require stitches and measures to prevent infection.
Increase in Fetal Lacerations
Studies seem to show a greater prevalence of fetal lacerations in recent years than in the past. However, the statistics may be skewed by the increase in cesarean section deliveries in recent years. Cesarean sections can prevent may other types of birth injuries, so cesarean sections are often ordered as a preventative measure when risk factors are present. This increase in cesarean section delivery is controversial, as many feel than birth injuries such as fetal lacerations could be avoided if proper techniques were used to avoid birth injuries during vaginal deliveries.
Fetal Laceration Risk Factors
Factors that may increase the risk of fetal lacerations during cesarean section deliveries include active labor, low transverse uterine incisions, and the presence of ruptured membranes prior to the cesarean section. When factors dictate an emergency cesarean section, fetal lacerations are also more likely to occur. The experience level of the assisting physician and other medical staff also has bearing on the likelihood of fetal lacerations.
Fetal Laceration Location
About 70 percent of fetal laceration injuries are to the infant’s head, face, and ears. Approximately 20 percent of fetal laceration injuries affect the buttocks, legs and ankles. The remaining 10 percent of laceration injuries affect the infant’s back. The location of the injury depends largely on the fetal positioning in the womb when lacerations occur during cesarean sections.
Fetal Laceration Complications
Injuries affecting the ears, eyes, nose, tendons, and nerves may cause lasting complications. Infants that sustain injuries to the nerves may have sensory and mobility impairments in different areas of the body. Infants that sustain injuries to the eyes may have vision problems, while lacerations around the ears may impair hearing depending on the location of the laceration. Tendon injuries may require specialists and several surgeries to repair, along with physical therapy.
Conditions that may be caused by fetal lacerations include:
- Erb’s palsy
- Klumpke’s palsy
- Paralysis resulting from spinal cord injuries
- Facial nerve paralysis
When fetal lacerations accompany other birth injuries, the effects may be more severe. About eight out of every 1000 children born with lacerations also have bone fractures. This is more likely to occur when surgical tools are used to assist in vaginal deliveries than during cesarean sections. Cranial injuries such as cephalohematoma occur in about 272 out of 1000 births in which children are born with lacerations.
Fetal Laceration Treatment
Treatments for fetal lacerations often include topical adhesives to close wounds and antibiotics to treat or prevent infections. If wounds are deep, suturing may be required. If nerves or tendons are damaged by lacerations, reconstructive surgery may be required to repair the damage. Cosmetic surgery may be necessary if lacerations cause disfigurement of the face or body.
Preventing Fetal Lacerations
The likelihood of fetal lacerations can be minimized by opting for vaginal delivery instead of cesarean delivery. When cesarean delivery is necessary, a tool called CSafe has shown to be effective in helping to prevent fetal lacerations. The tool allows the surgeon to make an incision upwards and away from the fetus.
Physicians may also help to prevent fetal lacerations by using blunt-edged or bandaged scissors that are less likely to nick the infant. The uterine wall can be moved prior to surgery to increase the distance between the infant and surgical tools. Removing abdominal wall retractors prior to the surgery may also help to protect the infant from lacerations.
“Fetal Lacerations Associated with Cesarean Section.” Patient Safety Authority. Patient Safety Authority, 1 Dec. 2004. Web. 3 Feb. 2015. <http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2004/dec1 (4)/Pages/09.aspx>
Kaveh, Mahbod, Fatemeh Tanha, Fereshteh Farzlanpour, and Marzieh Aghaalinejad. “Fetal Laceration Injury at Caesarean Delivery.” Journal of Family and Reproductive Health 4.3 (2010): 115-20. SID. Tehran University of Medical Sciences. Web. 2 Feb. 2015. <http://www.sid.ir/en/VEWSSID/J_pdf/1001420100304.pdf>
Saraf, Sanjay. “Facial Laceration at Caesarean Section: Experience With Tissue Adhesive.” Open Access Journal of Plastic Surgery (2009). National Center for Biotechnology Information. U.S. National Library of Medicine. Web. 2 Feb. 2015. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2627307/>