Risk Factors Associated with Major Neonatal Birth Injuries During Caesarean Section in a Tertiary Care Hospital in Southern India

Abstract

Introduction: Neonatal birth injuries are commonly associated with instrumental vaginal deliveries, but have also been known to occur at uncomplicated vaginal or caesarean deliveries. Caesarean section confers some amount of protection against injuries at birth, but these can still occur with an incidence of 1.1%. Most common injury noted has been scalp lacerations followed by cephalohaematoma; others are fractures, brachial plexus injury, etc. Aim: This study was carried out to find the incidence of and risk factors associated with major neonatal injuries sustained during Lower Segment Caesarean Section (LSCS) done in the Department of Obstetrics and Gynecology, Christian Medical College, Vellore, a tertiary level hospital in Southern India, over a period of one year. Materials and Methods: The hospital numbers of babies who had sustained major birth injuries during LSCS from June 1st 2015 to May 31st 2016 were retrieved from the sentinel events register, being maintained by the charge nurse in the operation theatre. The details of the mothers, including details of LSCS, intraoperative findings, and their babies were then retrieved from the medical records. Major birth injuries were defined as lacerations or cuts requiring suturing; fracture of bones; intracranial haemorrhage; skull fracture, facial nerve injury and intra-abdominal injury. The data was entered into clinical proforma and analysed using SPSS software (IBM, version 23). Descriptive measures like mean, median and standard deviation were computed for all continuous variables. Results: There were a total of 12,430 deliveries in the period from June 1st 2015 to May 31st 2016, out of which 35% (4,375) were caesarean deliveries. Out of 4,375 caesarean deliveries, there were six cases of major neonatal birth injuries, incidence being 0.13%. Of the six birth injuries, 66.6% were lacerations and remaining were femoral fractures (33.3%). We found that primiparous women carrying singleton pregnancies in cephalic presentation, undergoing LSCS following onset of labour were at increased risk of having major neonatal birth injuries. Presence of oligohydramnios intraoperatively, incision to delivery interval <5 minutes and surgery carried out by surgeons with mid-level expertise during “risk hours” (12am8am) were also at risk. We did not find an increased risk with J or U shaped uterotomy incisions. Neonatal risk factors included prematurity and female gender. We did not find any correlation with very low birth weight and/or macrosomia. The average birth weight in this cohort was 2.35 kg. Conclusion: Presence of risk factors like foetal prematurity, presence of oligohydramnios intraoperatively; incision to delivery interval <5 minutes and delivery during the “risk hours” increases the risk of major birth trauma at LSCS. However, our numbers are small to measure the exact correlation. Hence, prospective studies with larger sample size are needed to study the risk factors.

Keywords

• birth trauma
• childbirth
• lower segment caesarean section