Fetal lacerations are birth injuries that occur during a caesarian-section (C-section) delivery, usually as a result of improper procedures performed by medical personnel during childbirth. The lacerations are caused by nicks and cuts from scalpels, forceps, and other instruments used by physicians while performing a surgically-assisted delivery. These lacerations are mostly minor and easily treated in the delivery room, but in some cases they can be deep and require stitches or reconstructive surgery
Background on Fetal Lacerations
Per the Patient Safety Authorty (PSA), a recent study of close to 900 women who underwent C-sections showed that between 1.5% to 1.9% of the infants experienced fetal lacerations. However, another similar study showed that the rate of fetal lacerations is 6%. In yet another study, the National Institutes of Health (NIH) states that fetal lacerations occur in at least 3% of all pregnancies. One reason that the results may varies is due to the increase of C-sections. Regardless, fetal lacerations still remain a problem, sometimes leading to lifelong, severe injuries.
Risk Factors Associated With Fetal Lacerations
Per PSA, there are several risk factors that increase the chances for fetal lacerations during a C-section delivery. The principal risk factors include:
- Ruptured membranes before the C-section
- Low transverse uterine incisions
- Active labor
- Emergency C-section
- Inexperienced surgeons or residents
Long-Term Problems Associated with Fetal Lacerations
According to PSA, in a study of over 20 hospitals and medical facilities, fetal lacerations were common during C-section deliveries. Close to 20% of the lacerations were made to infants’ faces, ears, and head, while 10% of the lacerations were made to infants’ backs. The American Journal of Gynecology and Obstetrics, these types of birth injuries can cause long-term and sometimes permanent health issues. For example, in one instance, a newborn infant was cut with scalpel, leaving a 2cm-long cut. Twelve years later, the cut extended to 10 cm.
Other long-term problems include bone fractures, facial nerve palsy, and more. Although these injuries may clear up within a few months for some infants, others may live with the effects of the injury for a lifetime. For example, brachial plexus injuries have been associated with IUGR, including:
- Fracture humerus and clavicle
- Cervical cord injuries
- Erb’s palsy
- Klumpke’s palsy
Bone fractures occur in 8 out every 1,000 births of infants who experience fetal lacerations, according to the National Institute of Child Health and Human Development. Cranial injuries, specifically cephalohematoma, occurs in at least 272 out of 1,000 births of babies who had fetal laceration injuries. Although this condition typically goes away within three months, there are other instances in which jaundice develops, which can lead to long-term brain damage if not treated immediately.
Fetal Laceration Treatment
Treatment will depend on how deep and long the cut is, as well as any other additional birth injuries that occurred due to the laceration.
For minor cuts, many physicians prefer to apply topical tissue adhesives to the cut. In other instances, physician may perform suturing, meaning the cut is stitched up by using a suture medical device. Suturing is almost always used for deep cuts as well.
Oral antibiotics may be prescribed to treat the infection,which typically needs to given to the baby anywhere from a month to several months, depending upon the physician’s orders.
Prevention of Fetal Lacerations
There is ongoing in-depth research in ways to prevent fetal lacerations. Although research continues, a device called CSafe, has proven to an effective way to help prevent fetal lacerations. The CSafe, a small surgical tool, offers added protection during the C-section process by allowing physicians to cut upwards and away from the infant.
Other prevention strategies include:
- Moving the uterine wall prior to incision
- Blunt entry into the uterine cavity prior to incision
- Using bandaged scissors
- Removing abdominal wall retractors prior to incision