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Obstetric fractures in caesarean delivery and risk factors as evaluated by paediatric surgeons
Alexandru Ulici1,2, Alexandru Herdea3,4, Mihai-Codrut Dragomirescu2
111th Department of Pediatric Orthopedics, "Carol Davila" University of Medicine and Pharmacy, Bd. Eroii sanitari nr. 8, 050474, Bucharest, Romania.
Insights
Obstetric clavicle fractures are common birth injuries. Pelvic presentation during natural birth significantly increases the risk of associated pathologies compared to cranial presentation.
Area of Science:
- Orthopaedic Surgery
- Neonatal Care
- Obstetrics
Background:
- Obstetric fractures, particularly clavicle fractures, are common birth injuries, affecting 0.2-3.5% of births.
- These injuries often require paediatric orthopaedic intervention.
- The aetiology of obstetric fractures may be linked to delivery method and presentation.
Purpose of the Study:
- To identify risk factors for obstetric fractures.
- To improve prediction and management of birth-related fractures.
- To analyze the correlation between delivery type, presentation, and associated pathologies.
Main Methods:
- Retrospective study design.
- Inclusion of 136 patients with Allman type I clavicle fracture.
- Data collection on parity, gestity, delivery type, presentation, shoulder dystocia, fracture type, birth weight, and APGAR score.
Main Results:
- Pelvic presentation during natural birth increased the risk of associated pathology by 6.2 times compared to cranial presentation.
- Caesarean delivery and cranial presentation increased the risk of related pathology by 5.04 times compared to natural birth.
- Pelvic presentation was 5.54 times more likely to develop associated pathology than cranial presentation, indicating a correlation between delivery type/presentation and associated pathologies.
Conclusions:
- Caesarean delivery should be reserved for necessary cases due to associated newborn risks.
- Predictive modeling in late-stage pregnancy can help anticipate birth complications like fractures and brachial plexus birth palsy (BPBP).
- Delivery method and fetal presentation are significant factors in obstetric fracture-related complications.
Introduction:
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.
Hypotheses:
Caesarean delivery, elective or necessary, along with the type of presentation, may play a determinant role in the aetiology of obstetric fractures.
Materials And Methods:
We chose to do a retrospective study to determine possible risk factors for this type of injury that may manifest in either delivery. Our aim was to deepen our knowledge in order to have a better prediction and a better management of this condition. Data gathered included parity, gestity, type of delivery, presentation, shoulder dystocia, type of fracture, birth weight, and APGAR score.
Results:
We 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. Type of delivery and presentation correlate with associated pathology of clavicle fractures.
Discussion And Conclusion:
Caesarean delivery brings risks for the newborn and should be practiced only when necessary. Predictive modeling in obstetrics in third-trimester evaluations may statistically predict risks of birth complications like fracture and BPBP.
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