The incidence of fetal injury during cesarean delivery has been reported to be up to 3%. Nearly two-thirds (65%) of these cases are skin lacerations. While mild lacerations may require no or only minimal intervention, moderate to severe lacerations may require extensive repair.¹ Earlier studies have also identified risk factors for fetal lacerations such as emergent surgery, gestational age more than 33 weeks, premature rupture of membranes (PROM), cephalic presentation and low transverse uterine incision. ¹

Adding to this evidence, a new study published in the January 2023 issue of the International Journal of Gynecology & Obstetrics has also identified PROM and meconium-stained amniotic fluid as risk factors for accidental fetal skin lacerations with the risk increasing by 14-15 times. ²

Researchers from Israel retrospectively analysed data of 14,666 cesarean births to identify newborns with accidental fetal skin lacerations during cesarean section between 2014 and 2019. Through this they aimed to define potential risk factors for the same. The control group included newborns who were cesarean deliveries but did not have accidental fetal skin lacerations.

Accidental fetal skin lacerations occurred in 48 (0.33%) newborns; a little over half of them occurred during urgent cesarean section. Premature rupture of membranes was associated with 5-folds increase in the risk of accidental fetal skin lacerations with odds ratio (OR) of 5.38. Presence of meconium-stained amniotic fluid also increased the risk of accidental fetal skin lacerations by 6-folds with OR of 6.50.

In elective cesareans, these factors were non-significant, but remained significant in urgent cesarean sections. The OR for accidental fetal skin lacerations during urgent cesarean deliveries in cases of PROM was 14.23 and for meconium-stained amniotic fluid, the OR was 15.36.

These findings underscore the need for obstetricians to be aware of and exercise great caution during cesarean section, particularly urgent cesareans in cases of premature rupture of membranes or meconium-stained amniotic fluid.

References

1. Shivani Shah-Becker, et al. Scalping of a newborn: Complication during cesarean section. Int J Pediatr Otorhinolaryngol Extra. 2015;10(3): 53-55. https://doi.org/10.1016/j.pedex.2015.04.002.
2. Har-Shai L, et al. Risk factors associated with accidental fetal skin lacerations during cesarean delivery. Int J Gynaecol Obstet. 2023 Jan;160(1):131-135. doi: 10.1002/ijgo.14273.