Our objective was to determine the frequency, severity, and documentation of fetal laceration during cesarean delivery (CD) in patients receiving intrapartum low-risk (LRC) vs high-risk (HRC) care.
This is a retrospective cohort study of patients delivered at a single, academic medical center from January 2014 to December 2016. Medical records were reviewed for infants with a laceration after CD, and maternal, fetal, and obstetric variables were extracted. Lacerations were classified as mild, moderate, or severe. Patients assigned to LRC were compared to those assigned to HRC using appropriate bivariate analyses with an alpha of 0.05.
Over the study period, there were 8,454 (62.7%) vaginal deliveries and 5,036 (37.3%) CDs. Of the CDs, 3,104 (61.6%) were performed on patients assigned to LRC and 1,932 (38.4%) to HRC. There were 14 total lacerations: 12 (85.7%) were classified as mild, 1 (7.1%) as moderate, and 1 (7.1%) as severe. There were more lacerations in patients assigned to HRC (71.4% vs 28.6%; p=0.01), with a fetal laceration rate of 1.3 per 1000 LRC CDs and 5.2 per 1000 HRC CDs. Of note, 42.9% of fetal injuries were associated with emergency CDs, and the risk of emergency delivery was higher in the HRC group, although this did not reach statistical significance (50.0% vs 25.0%, P=0.68). Documentation of fetal laceration was poor, recorded in only 42.8% of the maternal medical records.
There was a four-fold increase in fetal injury associated with CD and HRC. Documentation of fetal injury at the time of CD needs improvement.