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Ulici A, Herdea A, Dragomirescu MC, Lungu CN. Obstetric fractures in caesarean delivery and risk factors as evaluated by paediatric surgeons. INTERNATIONAL ORTHOPAEDICS 2022; 46:2611-2617. [PMID: 35982323 PMCID: PMC9556358 DOI: 10.1007/s00264-022-05547-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022]
Abstract
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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Affiliation(s)
- Alexandru Ulici
- 11th Department of Pediatric Orthopedics, "Carol Davila" University of Medicine and Pharmacy, Bd. Eroii sanitari nr. 8, 050474, Bucharest, Romania
- Pediatric Orthopedics Department, "Grigore Alexandrescu" Children's Emergency Hospital, 011743, Bucharest, Romania
| | - Alexandru Herdea
- 11th Department of Pediatric Orthopedics, "Carol Davila" University of Medicine and Pharmacy, Bd. Eroii sanitari nr. 8, 050474, Bucharest, Romania.
- Pediatric Orthopedics Department, "Grigore Alexandrescu" Children's Emergency Hospital, 011743, Bucharest, Romania.
| | - Mihai-Codrut Dragomirescu
- Pediatric Orthopedics Department, "Grigore Alexandrescu" Children's Emergency Hospital, 011743, Bucharest, Romania
| | - Claudiu N Lungu
- Department of Surgery, Clinical Country Emergency Hospital Galati, 800008, Galati, Romania
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Deng H, Qiu X, Su Q, Zeng S, Han S, Li S, Cui Z, Zhu T, Xiong Z, Tang G, Tang S. Epidemiology of skeletal trauma and skull fractures in children younger than 1 year in Shenzhen: a retrospective study of 664 patients. BMC Musculoskelet Disord 2021; 22:593. [PMID: 34174865 PMCID: PMC8236158 DOI: 10.1186/s12891-021-04438-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/04/2021] [Indexed: 11/22/2022] Open
Abstract
Background Unintentional injury is one of the top three causes of death for infants. However, the epidemiological studies of skeletal trauma and skull fractures in infants younger than 1 year were poorly understood in China. Therefore, our study aimed to examine accidental and emergency attendance in infants under 1 year. It also tried to determine the prevalence and severity of accident types in infants. Methods A retrospective analysis was performed on the demographic characteristics of infants younger than 1 year with skeletal trauma and skull fractures who visited the Shenzhen Children’s Hospital from January 1, 2016 to December 31, 2019. Age, gender, fracture site and type, mechanism of injury, length of visit, length of hospital stay, hospitalization cost, and treatment methods were analyzed. Results A total number of 675 fractures in 664 infants were included, the median age was 187days (IQR,90-273days), including 394 males and 270 females. The top three fracture sites were the skull (430 sites, 63.70 %), long bones of the limbs (168 sites, 24.89 %), and clavicle (53 sites, 7.85 %). The top three causes of injury were locomotion injuries (256 cases, 38.55 %), falls or trips from low height (from beds, tables, chairs, etc.) (130 cases, 19.58 %), and birth injuries (97 cases, 14.61 %). The greatest amount of fractures occurred in children 1–28 days of life (d) reached a top of 101 cases, followed by 331–365 days, accounting for 15.21 and 10.24 %, respectively. The number of fractures reached a trough of 29 cases in the 29-60d group (4.37 %). And increased again to 65 cases in the 151-180d group (9.79 %). The proportion remained relatively constant at 9 % in the 181-210d group (9.19 %) and 211-240d group (9.64 %). The interval between injury and visiting our hospital was ≤ 72 h in 554 cases. Conclusions Special attention should be given to the demographic characteristics of fractures in infants under 1 year of age, and appropriate outreach should be implemented. For example, health education should be provided to aid in the prevention especially for frequently occurring locomotion injuries, and prompt access to specialist medical care should be recommended for skull fractures, which are prone to delayed treatment. In addition, multidisciplinary collaboration should be implemented in trauma care, while also promoting the establishment of trauma centers in specialist children’s hospitals with a stronger capacity to treat pediatric trauma, and a regional system for pediatric trauma treatment.
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Affiliation(s)
- Hansheng Deng
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Guangdong Province, Shenzhen, P.R. China.,Zunyi Medical University, Zunyi, Guizhou Province, P.R. China
| | - Xin Qiu
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Guangdong Province, Shenzhen, P.R. China.,Zunyi Medical University, Zunyi, Guizhou Province, P.R. China
| | - Qiru Su
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Guangdong Province, Shenzhen, P.R. China
| | - Shuaidan Zeng
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Guangdong Province, Shenzhen, P.R. China
| | - Shuai Han
- China Medical University, Shenyang, Liaoning Province, P.R. China
| | - Shicheng Li
- China Medical University, Shenyang, Liaoning Province, P.R. China
| | - Zhiwen Cui
- China Medical University, Shenyang, Liaoning Province, P.R. China
| | - Tianfeng Zhu
- China Medical University, Shenyang, Liaoning Province, P.R. China
| | - Zhu Xiong
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Guangdong Province, Shenzhen, P.R. China.
| | - Gen Tang
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Guangdong Province, Shenzhen, P.R. China.
| | - Shengping Tang
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Guangdong Province, Shenzhen, P.R. China. .,Zunyi Medical University, Zunyi, Guizhou Province, P.R. China. .,China Medical University, Shenyang, Liaoning Province, P.R. China.
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Asena M, Akelma H, Ziyadanoğulları MO. The relationship between the location of neonatal clavicular fractures and predisposing factors. J Neonatal Perinatal Med 2020; 13:507-511. [PMID: 31985476 DOI: 10.3233/npm-190321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The aim was to investigate the maternal and fetal predisposing factors of clavicle fracture locations in newborns. METHODS A retrospective evaluation was made of 77 clavicle fractures identified from a total of 33,480 live newborns between September 2016 and September 2018 at a single center in Turkey. Fractures were grouped according to the Allman classification: Group I mid third, Group II lateral distal third, Group III medial proximal third of the clavicle, respectively. Demographic features compared between the groups included maternal age, parity and height and infantile gestational age, gender, birth weight and length. Neonatal clinical features were also compared between the three groups and included mode of delivery, Apgar score, fracture laterality, time to diagnosis, mode of diagnosis, and presence of symptoms of brachial plexus palsy. RESULTS There were no statistically significant differences between the three groups when the demographic characteristics of the mothers and newborns were compared. In terms of clinical characteristics Group 3 contained a higher proportion of patients with symptoms of brachial plexus palsy than Group 1 (61.5% versus 22%, p = 0.017). There was no statistically significant difference between Groups 2 and 3 and Groups 1 and 2. CONCLUSION A significant association was found between the occurrence of brachial plexus palsy and fracture of the medial third of the clavicle (Allman type III).
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Affiliation(s)
- M Asena
- Department of Child Health and Diseases, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - H Akelma
- Department of Anesthesiology and Reanimation, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - M O Ziyadanoğulları
- Department of Orthopedics and Traumatology, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
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Wen Q, Muraca GM, Ting J, Coad S, Lim KI, Lisonkova S. Temporal trends in severe maternal and neonatal trauma during childbirth: a population-based observational study. BMJ Open 2018; 8:e020578. [PMID: 29500215 PMCID: PMC5855201 DOI: 10.1136/bmjopen-2017-020578] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/08/2018] [Accepted: 01/31/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Instrumental vaginal delivery is associated with birth trauma to infant and obstetric trauma to mother. As caesarean delivery rates increased during the past decades, the rate of instrumental vaginal delivery declined. We examined concomitant temporal changes in the rates of severe birth trauma and maternal obstetric trauma. DESIGN A retrospective observational study. SETTINGS AND PARTICIPANTS All hospital singleton live births in Washington State, USA, 2004-2013, excluding breech delivery. Severe birth trauma (brain, nerve injury, fractures and other severe birth trauma) and obstetric trauma (third/fourth degree perineal lacerations, cervical/high vaginal lacerations) were identified from hospitalisation data. Pregnancy and delivery characteristics were obtained from birth certificates. Temporal trends were assessed by the Cochran-Armitage test. Logistic regression was used to obtain adjusted ORs (AORs) and 95% CI. RESULTS Overall, 732 818 live births were included. The rate of severe birth trauma declined from 5.3 in 2004 to 4.5 per 1000 live births in 2013 (P<0.001). The decline was observed only in spontaneous vaginal delivery, the rates of fractures and other severe birth trauma declined by 5% and 4% per year, respectively (AOR: 0.95, 95% CI 0.94 to 0.97 and AOR: 0.96, 95% CI 0.93 to 0.99; respectively). The rate of third/fourth degree lacerations declined in spontaneous vaginal delivery from 3.5% to 2.3% (AOR: 0.95; 95% CI 0.94 to 0.95) and in vacuum delivery from 17.3% to 14.5% (AOR: 0.97, 95% CI 0.96 to 0.98). Among women with forceps delivery, these rates declined from 29.8% to 23.4% (AOR: 0.98, 95% CI 0.96 to 1.00). CONCLUSION While the rates of fractures and other birth trauma declined among infants delivered by spontaneous vaginal delivery, the rate of birth trauma remained unchanged in instrumental vaginal delivery and caesarean delivery. Among mothers, the rates of severe perineal lacerations declined, except for women with forceps delivery.
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Affiliation(s)
- Qi Wen
- BC Children's Hospital Research Institute, Children's Hospital, Vancouver, Canada
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, Canada
| | - Giulia M Muraca
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
- Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Joseph Ting
- Department of Pediatrics, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada
| | - Sarah Coad
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
- Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada
| | - Kenneth I Lim
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
- Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
- Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Wiśniewski M, Baumgart M, Grzonkowska M, Małkowski B, Flisiński P, Dombek M, Szpinda M. Quantitative anatomy of the growing clavicle in the human fetus: CT, digital image analysis, and statistical study. Surg Radiol Anat 2017; 39:827-835. [PMID: 28188365 PMCID: PMC5569133 DOI: 10.1007/s00276-017-1821-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 01/12/2017] [Indexed: 11/29/2022]
Abstract
Purposes Knowledge of dimensions of fetal long bones is useful in both the assessment of fetal growth and early detection of inherited defects. Measurements of the fetal clavicle may facilitate detection of numerous defects, e.g., cleidocranial dysplasia, Holt–Oram syndrome, Goltz syndrome, and Melnick–Needles syndrome. Methods Using the methods of CT, digital image analysis, and statistics, the size of the growing clavicle in 42 spontaneously aborted human fetuses (21 males and 21 females) at ages of 18–30 weeks was studied. Results Without any male–female and right–left significant differences, the best fit growth models for the growing clavicle with relation to age in weeks were as follows: y = −54.439 + 24.673 × ln(age) ± 0.237 (R2 = 0.86) for length, y = −12.042 + 4.906 × ln(age) ± 0.362 (R2 = 0.82) for width of acromial end, y = −4.210 + 2.028 × ln(age) ± 0.177 (R2 = 0.77) for width of central part, y = −4.687 + 2.364 × ln(age) ± 0.242 (R2 = 0.70) for width of sternal end, y = −51.078 + 4.174 × ln(age) ± 6.943 (R2 = 0.82) for cross-sectional area, and y = −766.948 + 281.774 × ln(age) ± 19.610 (R2 = 0.84) for volume. Conclusions With no sex and laterality differences, the clavicle grows logarithmically with respect to its length, width, and volume, and linearly with respect to its projection surface area. The obtained morphometric data of the growing clavicle are considered normative for their respective weeks of gestation and may be of relevance in the diagnosis of congenital defects.
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Affiliation(s)
- Marcin Wiśniewski
- Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, 1 Łukasiewicza Street, Bydgoszcz, 85-821, Poland
| | - Mariusz Baumgart
- Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, 1 Łukasiewicza Street, Bydgoszcz, 85-821, Poland
| | - Magdalena Grzonkowska
- Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, 1 Łukasiewicza Street, Bydgoszcz, 85-821, Poland
| | - Bogdan Małkowski
- Department of Positron Emission Tomography and Molecular Imaging, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University in Toruń, 1 Łukasiewicza Street, 85-821, Bydgoszcz, Poland
| | - Piotr Flisiński
- Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, 1 Łukasiewicza Street, Bydgoszcz, 85-821, Poland
| | - Małgorzata Dombek
- Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, 1 Łukasiewicza Street, Bydgoszcz, 85-821, Poland
| | - Michał Szpinda
- Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, 1 Łukasiewicza Street, Bydgoszcz, 85-821, Poland.
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Choi HA, Lee YK, Ko SY, Shin SM. Neonatal clavicle fracture in cesarean delivery: incidence and risk factors. J Matern Fetal Neonatal Med 2016; 30:1689-1692. [PMID: 27549685 DOI: 10.1080/14767058.2016.1222368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Neonatal clavicle fracture in cesarean delivery is rare and has not been extensively studied. METHODS We performed a retrospective review of cesarean deliveries with neonatal clavicle fracture during a 12-year period. Maternal and neonatal factors as well as surgical factors related to cesarean delivery for the fracture were determined and compared to the control group to analyze their significance. RESULTS Among a total 89 367 deliveries during the study period, 36 286 babies were born via cesarean section. Nineteen cases of clavicle fractures in cesarean section were identified (0.05% of total live births via cesarean section). In the analysis of maternal and neonatal risk factors, birthweight, birthweight ≥ 4000 g and maternal age were significantly associated with clavicle fracture in cesarean section. However, clavicle fractures were not correlated with the selected surgical factors such as indication for cesarean section, skin incision to delivery time and incision type of skin and uterus. Logistic regression analysis showed that birthweight was the major risk factor for clavicle fracture. CONCLUSION Clavicle fractures complicated 0.05% of cesarean deliveries. The main risk factor related to a clavicle fracture in cesarean section was the birthweight of an infant. As reported in previous studies associated with vaginal delivery, clavicle fracture is considered to be an unavoidable event and may not be eliminated, even in cesarean delivery.
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Affiliation(s)
- Hyun Ah Choi
- a Department of Pediatrics , Cheil General Hospital and Women's Health Care Center, Dankook University College of Medicine , Seoul , Korea
| | - Yeon Kyung Lee
- a Department of Pediatrics , Cheil General Hospital and Women's Health Care Center, Dankook University College of Medicine , Seoul , Korea
| | - Sun Young Ko
- a Department of Pediatrics , Cheil General Hospital and Women's Health Care Center, Dankook University College of Medicine , Seoul , Korea
| | - Son Moon Shin
- a Department of Pediatrics , Cheil General Hospital and Women's Health Care Center, Dankook University College of Medicine , Seoul , Korea
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Ahn ES, Jung MS, Lee YK, Ko SY, Shin SM, Hahn MH. Neonatal clavicular fracture: recent 10 year study. Pediatr Int 2015; 57:60-3. [PMID: 25203556 DOI: 10.1111/ped.12497] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 06/07/2014] [Accepted: 06/13/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The clavicle is the bone most frequently fractured during the delivery process. METHODS A retrospective review was performed of all births with clavicular fractures from January 2003 to December 2012. Risk factors for fracture were determined and then compared to the control group. The data were compared and analyzed with previous studies. RESULTS Three hundred and nineteen cases of clavicular fracture (0.41% of total live births, n = 77 543) were identified. Prior to discharge, 275 cases (86.2%) were detected, and 44 cases (13.8%) were not detected until after discharge. Physical examination identified 144 cases (45.1%), while 175 cases (54.9%) were identified on chest X-ray incidentally. All babies with fracture, including five (1.6%) with brachial plexus palsy, recovered without treatment. Vacuum delivery was associated with a significantly higher incidence of clavicular fracture, as were mothers of advanced age with relatively shorter height. High birthweight, low head to chest circumference ratio and low Apgar score were other variables also significantly associated with clavicular fracture. On logistic regression analysis vacuum delivery and birthweight were significant risk factors. When analyzing and comparing findings from previous studies, only birthweight was identified as common to the risk factors affecting clavicular fracture. CONCLUSION Major risk factors for clavicular fracture were vacuum delivery and birthweight. Considering the previous studies together, neonatal clavicular fracture appears to be a transient event without sequelae and most probably not preventable during birth.
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Affiliation(s)
- Eun Sub Ahn
- Department of Pediatrics, Cheil General Hospital and Women's Health Care Center, Kwandong University College of Medicine, Seoul, Korea
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Iskender C, Kaymak O, Erkenekli K, Ustunyurt E, Uygur D, Yakut HI, Danisman N. Neonatal injury at cephalic vaginal delivery: a retrospective analysis of extent of association with shoulder dystocia. PLoS One 2014; 9:e104765. [PMID: 25144234 PMCID: PMC4140686 DOI: 10.1371/journal.pone.0104765] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/16/2014] [Indexed: 11/19/2022] Open
Abstract
Purpose To describe the risk factors and labor characteristics of Clavicular fracture (CF) and brachial plexus injury (BPI); and compare antenatal and labor characteristics and prognosis of obstetrical BPI associated with shoulder dystocia with obstetrical BPI not associated with shoulder dystocia. Methods This retrospective study consisted of women who gave birth to an infant with a fractured clavicle or BPI between January 2009 and June 2013. Antenatal and neonatal data were compared between groups. The control group (1300) was composed of the four singleton vaginal deliveries that immediately followed each birth injury. A multivariable logistic regression model, with backward elimination, was constructed in order to find independent risk factors associated with BPI and CF. A subgroup analysis involved comparison of features of BPI cases with or without associated shoulder dystocia. Results During the study period, the total number of vaginal deliveries was 44092. The rates of CF, BPI and shoulder dystocia during the study period were 0,6%, 0,16% and 0,29%, respectively. In the logistic regression model, shoulder dystocia, GDM, multiparity, gestational age >42 weeks, protracted labor, short second stage of labor and fetal birth weight greater than 4250 grams increased the risk of CF independently. Shoulder dystocia and protracted labor were independently associated with BPI when controlled for other factors. Among neonates with BPI whose injury was not associated with shoulder dystocia, five (12.2%) sustained permanent injury, whereas one neonate (4.5%) with BPI following shoulder dystocia sustained permanent injury (p = 0.34). Conclusion BPI not associated with shoulder dystocia might have a higher rate of concomitant CF and permanent sequelae.
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Affiliation(s)
- Cantekin Iskender
- Department of Perinatology, Dr Zekai Tahir Burak Research and Training Hospital, Ankara, Turkey
- * E-mail:
| | - Oktay Kaymak
- Department of Perinatology, Dr Zekai Tahir Burak Research and Training Hospital, Ankara, Turkey
| | - Kudret Erkenekli
- Department of Perinatology, Dr Zekai Tahir Burak Research and Training Hospital, Ankara, Turkey
| | - Emin Ustunyurt
- Department of Obstetrics and Gynecology, Bursa Şevket Yılmaz Research and Education Hospital, Bursa, Turkey
| | - Dilek Uygur
- Department of Perinatology, Dr Zekai Tahir Burak Research and Training Hospital, Ankara, Turkey
| | - Halil Ibrahim Yakut
- Department of Neonatology, Dr Zekai Tahir Burak Research and Training Hospital, Ankara, Turkey
| | - Nuri Danisman
- Department of Perinatology, Dr Zekai Tahir Burak Research and Training Hospital, Ankara, Turkey
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Lurie S, Wand S, Golan A, Sadan O. Risk factors for fractured clavicle in the newborn. J Obstet Gynaecol Res 2011; 37:1572-4. [PMID: 21790882 DOI: 10.1111/j.1447-0756.2011.01576.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To disclose potential risk factors for sustaining a fractured clavicle in the newborn. METHOD A retrospective case-control analysis of women who gave birth to an infant with a fractured clavicle during a four-year period (2003-2006) was performed. A control group of newborns who did not sustain a fractured clavicle was formed (2:1) matched for maternal age, parity and gestational age at delivery. RESULTS The rate of fractured clavicle was 0.35%. Heavier newborns' birth weight (3632.9 ± 376.1 g vs. 3429.5 ± 513.0 g, P < 0.05) and the use of oxytocin (91.3% vs. 69.5%, P < 0.05) were associated with the occurrence of fractured clavicle during birth. Fractured clavicle was not well correlated with maternal height, maternal pregestational body mass index, maternal body mass index at delivery, maternal weight gain during pregnancy, induction of labor, duration of the second stage of labor, instrumental delivery or newborn birth weight of more than 4000 g. CONCLUSION We could not identify significant risk factors that could be dealt with in order to avoid a fractured clavicle being sustained during birth. Most fractured clavicles occur in normal newborns following normal labor and delivery.
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Affiliation(s)
- Samuel Lurie
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.
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Sandmire H, Morrison J, Racinet C, Hankins G, Pecorari D, Gherman R. Newborn brachial plexus injuries: The twisting and extension of the fetal head as contributing causes. J OBSTET GYNAECOL 2009; 28:170-2. [DOI: 10.1080/01443610801913053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- H. Sandmire
- Associates of Green Bay Ltd, Kewaunee, WI, USA
| | - J. Morrison
- Mississippi Medical Center, Jackson, MS, USA
| | | | | | | | - R. Gherman
- Prince George Hospital Center, Cheverly, MD, USA
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11
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Abstract
Understanding the causation of newborn brachial plexus injuries and why they are not decreasing in frequency.
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Affiliation(s)
- H F Sandmire
- Obstetric and Gynecologic Associates of Green Bay Ltd, Green Bay, Wisconsin 54301, USA.
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12
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Sherer DM, Sokolovski M, Dalloul M, Khoury-Collado F, Osho JA, Lamarque MD, Abulafia O. Fetal clavicle length throughout gestation: a nomogram. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 27:306-10. [PMID: 16450360 DOI: 10.1002/uog.2706] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To create a nomogram of fetal clavicle length (CL) throughout gestation. METHODS Cross-sectional study of patients between 14 and 42 weeks' gestation. Inclusion criteria consisted of well-established dates (consistent with early ultrasound), singleton, non-anomalous fetuses, and intact amniotic membranes. Sonographic measurements included biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), humerus length (HL) and sonographically estimated fetal weight (SEFW). For every case, the average of three separate measurements of the CL was used. The 5th, 50th and 95th centiles were obtained by least squares regression. Pearson's correlation coefficient and associated P-values for the relationships between CL and other biometric measurements were calculated. The data were compared to a nomogram of the CL generated in 1985 from the measurement of 85 fetuses. RESULTS A total of 623 consecutive patients were studied. In all but three cases, CL was successfully measured. Mean maternal age was 27.7 +/- 6.2 years, median gravidity 3 (range, 1-14) and median parity 1 (range, 0-9). Mean CL (mm) = -75.30 + 32.70*ln(GA) and SD = -0.41 + 0.08328*GA, where ln represents the natural logarithm and GA the gestational age in weeks. Fetal CL correlated significantly and strongly with BPD, HC, AC, HL, FL and the logarithm of SEFW, with Pearson correlation values of 0.973, 0.977, 0.976, 0.979, 0.977 and 0.979, respectively (all P < 0.001). Measurements according to comparable 1985 data were consistently substantially below the present data (smaller CL for any given GA except below 17 weeks' gestation). CONCLUSIONS We propose a new nomogram of CL, which differs significantly from the previously published nomogram. We suggest that the present data reflect the use of high-resolution ultrasound technology and propose that these data, based on a large number of fetuses, replace the previous nomogram. We also suggest that the '1 mm = 1 week' rule of thumb should no longer be used, since it can be erroneous by as much as 6 weeks.
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Affiliation(s)
- D M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, Brooklyn, NY 11203, USA.
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Parker LA. Part 2: Birth trauma: injuries to the intraabdominal organs, peripheral nerves, and skeletal system. Adv Neonatal Care 2006; 6:7-14. [PMID: 16458246 DOI: 10.1016/j.adnc.2005.11.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Part 1 of this 2-part article, "Early Recognition and Treatment of Birth Trauma: Injuries to the Head and Face" provided readers with basic concepts related to birth trauma to the head and face. Part 2 focuses on the pathophysiology, etiology, diagnosis, treatment, and prognosis of birth injuries to the intraabdominal organs, the peripheral nerves, the spinal cord, and the skeletal system. Risk factors for birth injury to these areas are discussed along with key issues related to the nursing care of affected infants.
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Affiliation(s)
- Leslie A Parker
- College of Nursing, University of Florida, Gainesville, FL 32610, USA.
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Nield LS, Kamat D. Refracture of the clavicle in an infant: case report and review of clavicle fractures in children. Clin Pediatr (Phila) 2005; 44:77-83. [PMID: 15678235 DOI: 10.1177/000992280504400110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Perinatal clavicle fractures typically heal without complication, and subsequent refracture of the same clavicle during infancy or toddlerhood has not been reported. This is a case report of a fracture of the clavicle in a 9-month-old child who had previously suffered a fracture of the same clavicle at birth. A review of the evaluation and management of neonatal and post-neonatal clavicle fractures is also presented.
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Affiliation(s)
- Linda S Nield
- Associate Professor of Pediatrics, West Virginia University, Morgantown, West Virginia, USA
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Abstract
OBJECTIVE Birth-related fractures of the long bones are not rare. METHODS This study presents a retrospective analysis of birth-related fractures of long bones seen at the King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. RESULTS There were 21 fractures (clavicle 11, femur 6, humerus 3 and radius 1) during the 10-year period, with an overall incidence of 0.67 per 1000 live births. Neonates with fractures had higher birth-weight (p<0.001) as compared to the control group and other parameters like gestational age and mode of delivery were not significant. CONCLUSION It is recommended that neonates with fractures must have quicker appointments in the outpatient clinics to prevent deformities and secondly those with fracture clavicles should be thoroughly evaluated to rule out damage to brachial plexas as well.
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Affiliation(s)
- Ibrahim Al-Habdan
- College of Medicine, King Faisal University, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia.
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Reiners CH, Souid AK, Oliphant M, Newman N. Palpable spongy mass over the clavicle, an underutilized sign of clavicular fracture in the newborn. Clin Pediatr (Phila) 2000; 39:695-8. [PMID: 11156066 DOI: 10.1177/000992280003901202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This prospective study emphasizes the importance of an early physical finding of neonatal clavicular fracture, termed "the palpable spongy mass sign." Of the 1,661 term neonates examined at our tertiary center over a 20-month period, 24 had clinical signs of a clavicular fracture. In 22 of the 24 neonates, the fractures were documented by positive radiographs or callus formation. None of the fractures was recognized because of an asymmetric Moro reflex, visible swelling, or bruising. The palpable spongy mass was present in 18 of the 22 fractures (82%), crepitus in 10 (45%), angulation deformity in two (9%), and localized tenderness in one (5%). Any combination of crepitus, deformity, and localized tenderness was detected in 11 of the 22 (50%) fractures. When the palpable spongy mass sign was added to these three signs, all but one fracture was clinically detected (95%), emphasizing the importance of using all physical findings. We conclude that "the clavicular spongy mass sign" is highly sensitive and predictive of neonatal clavicular fractures.
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Affiliation(s)
- C H Reiners
- Department of Pediatrics, State University of New York, Upstate Medical University, Syracuse 13210, USA
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Kaplan B, Rabinerson D, Avrech OM, Carmi N, Steinberg DM, Merlob P. Fracture of the clavicle in the newborn following normal labor and delivery. Int J Gynaecol Obstet 1998; 63:15-20. [PMID: 9849706 DOI: 10.1016/s0020-7292(98)00127-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Earlier works have associated neonatal clavicular fracture (0.2-3.5% of all deliveries) with a range of procedural, fetal and maternal risk factors; more recent studies, however, have failed to firmly identify any one or a combination of them. In the present work we sought to determine possible ante/intra-partum risk factors for this condition. STUDY DESIGN Using a retrospective case-controlled approach, we examined a series of maternal, fetal and pregnancy or delivery-related variables in 87 cases (out of 403) of fractured clavicle of the newborn diagnosed in our department from 1986 to 1994. All infants were delivered vaginally (in the occipito-anterior position) at term by a specialist obstetrician and underwent peripartum sonographic fetal weight estimation. All variables were compared with those of an equal number of infants born immediately before or after each affected infant and delivered by the same obstetrical team. RESULTS Fractured clavicles were found in 1.65% of the total number of deliveries during the study period. Neonatal clavicular fracture was significantly and directly related to the duration of the second stage of labor, peripartum sonographic fetal weight estimation, and neonatal length, and inversely related to maternal height; nevertheless, all values in both the study and control groups were within normal range. Logistic regression analysis showed that these antenatal variables significantly affect the chances of clavicular fracture, but due to the high false-positive rate they cannot serve clinically as a comprehensive antenatal prediction index. CONCLUSIONS The majority of clavicular fractures occur in normal newborns following normal labor and delivery. The risk factors we identified statistically do not offer a method for clinical prenatal prediction. This work provides statistical evidence of the nature of this complication of early newborn life.
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Affiliation(s)
- B Kaplan
- Department of Obstetrics and Gynecology, Rabin Medical Center, Petah Tiqva, Israel
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Adams KM, Li H, Nelson RL, Ogburn PL, Danilenko-Dixon DR. Sequelae of unrecognized gestational diabetes. Am J Obstet Gynecol 1998; 178:1321-32. [PMID: 9662318 DOI: 10.1016/s0002-9378(98)70339-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Prior studies have suggested that macrosomia is the only morbid condition associated with gestational diabetes and that this association is the result of confounding by maternal obesity rather than a result of gestational diabetes itself. We sought to determine whether unrecognized gestational diabetes is an independent predictor of macrosomia and other perinatal morbid conditions after controlling for confounding variables. STUDY DESIGN A retrospective analysis of 472 consecutive cases of gestational diabetes diagnosed between 24 and 30 weeks' gestation was undertaken including 16 prospectively identified but clinically unrecognized cases, 297 cases treated with diet alone, and 76 treated with diet plus insulin. Unrecognized cases were matched to 64 nondiabetic controls for race, age, body mass index, parity, pregnancy weight gain, and gestational age at delivery. RESULTS In the unrecognized gestational diabetes group versus the nondiabetic control versus gestational diabetes diet groups rates of large for gestational age infants (44% vs 5% vs 9%, p < 0.0005), macrosomia (44% vs 8% vs 15%, p < 0.01), shoulder dystocia (19% vs 3% vs 3%, p < 0.05), and birth trauma (25% vs 0% vs 0.3%, p < 0.001) were all significantly increased. These differences remained significant after controlling for maternal age, race, parity, body mass index, pregnancy weight gain, and gestational age at delivery. CONCLUSIONS This study suggests that unrecognized gestational diabetes increases risks of large for gestational age infants, macrosomia, shoulder dystocia, and birth trauma independent of maternal obesity and other confounding variables. Clinical recognition and dietary control of gestational diabetes are associated with a reduction in these perinatal morbid conditions.
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Affiliation(s)
- K M Adams
- Mayo Medical School, and Division of Maternal-Fetal Medicine, Mayo Medical Center, Rochester, Minnesota, USA
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Kolderup LB, Laros RK, Musci TJ. Incidence of persistent birth injury in macrosomic infants: association with mode of delivery. Am J Obstet Gynecol 1997; 177:37-41. [PMID: 9240580 DOI: 10.1016/s0002-9378(97)70435-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Our purpose was to determine the incidence of birth injury in a cohort of macrosomic infants (birth weight >4000 gm) and analyze the association between persistent injury and delivery method. STUDY DESIGN Deliveries of 2924 macrosomic infants were reviewed. Outcomes were compared with those of 16,711 infants with birth weights between 3000 and 3999 gm. RESULTS Macrosomic infants had a sixfold increase in significant injury relative to controls (relative risk 6.7,95% confidence interval 6.5 to 6.9). Risk of trauma correlated with delivery mode: forceps were associated with a fourfold risk of clinically persistent findings compared with spontaneous vaginal delivery or cesarean section. However, the overall incidence of persistent cases remained low (0.3%); a policy of elective cesarean section for macrosomia would necessitate 148 to 258 cesarean sections to prevent a single persistent injury. Avoidance of operative vaginal delivery would require 50 to 99 cesarean sections per injury prevented. CONCLUSIONS These findings support a trial of labor and judicious operative vaginal delivery for macrosomic infants.
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Affiliation(s)
- L B Kolderup
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 94143-0556, USA
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Gherman RB, Goodwin TM, Souter I, Neumann K, Ouzounian JG, Paul RH. The McRoberts' maneuver for the alleviation of shoulder dystocia: how successful is it? Am J Obstet Gynecol 1997; 176:656-61. [PMID: 9077624 DOI: 10.1016/s0002-9378(97)70565-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Our purpose was to determine the rate of success of the McRoberts' maneuver as the initial treatment for shoulder dystocia and to compare the rate of maternal and neonatal morbidity with those cases of shoulder dystocia requiring additional obstetric maneuvers. A secondary goal was to assess those factors associated with successful McRoberts' maneuvers. STUDY DESIGN A retrospective review of shoulder dystocia cases occurring between 1991 and 1994 was performed. The identified cases were divided into two groups on the basis of the maneuvers used to relieve the shoulder dystocia. The first group comprised cases in which the McRoberts' maneuver was used as the sole treatment and the second group consisted of cases in which additional maneuvers were subsequently used. Exclusion criteria included lack of documentation concerning the maneuvers used or cases in which the McRoberts' maneuver was not the initial technique used. The two groups were compared with respect to various antepartum, intrapartum, and neonatal characteristics. RESULTS During the study period we identified 250 cases of shoulder dystocia among 44,072 vaginal deliveries, for an incidence of 0.57%. Of these, 236 cases (94%) fulfilled entry criteria. The McRoberts' position alone successfully alleviated the shoulder dystocia in 98 cases (42%). In the group of cases where the McRoberts' maneuver was the sole maneuver used, there were significantly lower mean birth weights (p = 0.008), shorter durations of the active phase of labor (p = 0.009), and shorter second stages (p < 0.0001). In the group of cases that required additional maneuvers to relieve the shoulder dystocia, there was a trend toward an increased incidence of postpartum hemorrhage and brachial plexus injury (p = 0.07). CONCLUSIONS These data suggest that the McRoberts' maneuver is associated with a significant degree of success in relieving shoulder dystocia and may be associated with decreased morbidity compared with other maneuvers. On the basis of these findings, we recommend the McRoberts' maneuver as the initial technique for disimpaction of the anterior shoulder.
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Affiliation(s)
- R B Gherman
- Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles 90033, USA
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