Caesarean delivery brings risk of fractures & birth palsy for newborn: study

Obstetric fractures usually occur after complicated births and are sent to paediatric orthopaedics for treatment and follow-up. Clavicle fractures represent the most common orthopaedic birth injury, involving approximately 0.2 to 3.5% of births.

The authors chose to do a retrospective study to determine possible risk factors for this type of injury that may manifest in either delivery. The aim was to deepen the knowledge in order to have a better prediction and a better management of this condition.

The study was conducted with patients presented to Paediatric Orthopaedic ward of "Grigore Alexandrescu" Children's Emergency Clinical Hospital of Bucharest, Romania.

The following variables were analyzed in search for statistical significance: maternal age, height, antepartum weight, weight gain after pregnancy, urban/rural environment, parity, gestity, place of birth, public/private hospital, type of delivery, gestational age, presentation, shoulder dystocia, type of fracture, birth weight, gender, duration of labour and expulsion, APGAR score, and complicated/ straightforward fracture. A p-value less than 0.05 was considered statistically significant, with a corresponding confidence level of 95%.

• The authors followed 136 patients that were diagnosed with Allman type I clavicle fracture, 32 of them also having brachial plexus birth palsy (BPBP) type 1 (Duchenne-Erb).

• Natural birth with a pelvic presentation imposes a relative risk of 6.2 of associated pathology compared to cranial presentation.

• Caesarean delivery and cranial presentation increase the risk of related pathology by 5.04 compared to natural birth.

• Statistically, pelvic presentation is 5.54 times more likely to develop related pathology than cranial presentation.

The authors concluded that – "Caesarean delivery brings risks for the newborn and should be practiced only when necessary. It is possible to use predictive modeling in obstetrics in third-trimester evaluations. One may statistically predict risks of birth complications like fracture and BPBP. More data is needed, from larger study samples, to find new risk factors and validate our logistic regression models."

Further reading:

Obstetric fractures in caesarean delivery and risk factors as evaluated by paediatric surgeons

Alexandru Ulici,Alexandru Herdea et al

International Orthopaedics (2022) 46:2611–2617

https://doi.org/10.1007/s00264-022-05547-2