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Skeletal injuries after cesarean section - a rare differential diagnosis of child abuse
L Küppers1, C Schaffer2, M Helbig3
1Institute of Legal Medicine, University Clinic Düsseldorf, Düsseldorf, Deutschland. Lisa.kueppers@med.uni-duesseldorf.de.
Insights
Neonatal fractures can occur during cesarean sections, though rare. Medical records are crucial for differentiating birth trauma from abuse in infants with fractures.
Area of Science:
- Pediatrics
- Forensic Medicine
- Obstetrics
Background:
- Birth-related fractures are a key consideration in suspected child abuse cases.
- While vaginal delivery fractures are recognized, cesarean section-related injuries are less commonly known.
- Neonatal fractures have been documented following cesarean deliveries.
Purpose of the Study:
- To review the incidence and common sites of birth-related fractures after cesarean sections.
- To describe symptom presentation and diagnostic timelines for these fractures.
- To provide an overview of neonatal fractures associated with cesarean delivery.
Main Methods:
- A literature search was performed using Google Scholar and PubMed.
- Keywords included "cesarean section" and "fractures" to identify relevant studies.
- The research focused on frequency, fracture locations, symptoms, and diagnosis duration.
Main Results:
- Birth-related fractures following cesarean sections are infrequent but do occur.
- Long bones are the most commonly affected sites in these cases.
- Fractures are typically diagnosed early, though some cases are identified weeks post-birth.
Conclusions:
- Neonatal fractures should be considered in forensic evaluations of infant fractures, even after cesarean birth.
- Thorough review of birth and operative records is essential to distinguish birth trauma from abuse.
- Identifying surgical maneuvers and risk factors aids in differentiating injury origins.
Abstract:
Birth-related fractures are an important differential diagnosis of child abuse in early infancy. While fractures associated to vaginal deliveries are well known, cesarean section is not necessarily known to cause such injuries. Nevertheless neonatal fractures have been described after cesarean sections. To give an overview over the frequency and typical locations of such fractures, the appearance of symptoms and the timespan until diagnosis, a literature research was conducted via Google scholar and Pubmed, using the key words "cesarean section" and "fractures". Birth-related fractures after cesarean sections are rare but can occur, with the long bones being particularly affected. Therefore, birth injuries should always be considered in the forensic medical assessment of fractures in early infancy, even after cesarean section. To enable a differentiation between birth trauma and physical abuse, birth and operation records should be checked for surgical manoeuvres, possible difficulties during the procedure or other risk factors. Birth-related fractures are usually detected early; in rare cases, the diagnosis is made only weeks after birth.
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