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Carvalho M, Barreto MI, Cabral J, Balacó I, Alves C. Neonatal upper limb fractures - a narrative overview of the literature. BMC Pediatr 2024; 24:59. [PMID: 38243191 PMCID: PMC10797735 DOI: 10.1186/s12887-024-04538-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/04/2024] [Indexed: 01/21/2024] Open
Abstract
The aim of this paper is to review the topic of neonatal fractures of the upper limb, describing the different types of fractures focusing on the etiology, epidemiology, risk factors, clinical approach, diagnosis, treatment and prognosis of these injuries. We included all types of research studies, both experimental and observational, published in English, French, Portuguese and Spanish. The information was obtained using the keywords neonatal upper limb fracture, clavicle fracture or humerus fracture from the following resources: MEDLINE database, Embase® database and LILACS database. Other resources such as hand searches of the references of retrieved literature and authoritative texts, personal and hospital libraries searching for texts on upper limb neonatal fractures, discussions with experts in the field of upper limb neonatal fractures and personal experience, were also considered for the completion of the article.Neonatal fractures of the upper limb are consensually considered to have a good prognosis and no long-term sequelae. Conservative treatment is the option in the vast majority of the fractures and is associated with excellent results, with good healing, full range of motion, adequate remodeling without obvious deformity, neurologic impairment or functional implications.
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Affiliation(s)
- Marcos Carvalho
- Department of Pediatric Orthopaedics, Pediatric Hospital of Coimbra - Centro Hospitalar e Universitário de Coimbra (CHUC), EPE; Av Afonso Romão, 3000-602, Coimbra, Portugal.
| | - Maria Inês Barreto
- Department of Pediatric Orthopaedics, Pediatric Hospital of Coimbra - Centro Hospitalar e Universitário de Coimbra (CHUC), EPE; Av Afonso Romão, 3000-602, Coimbra, Portugal
| | - João Cabral
- Department of Pediatric Orthopaedics, Pediatric Hospital of Coimbra - Centro Hospitalar e Universitário de Coimbra (CHUC), EPE; Av Afonso Romão, 3000-602, Coimbra, Portugal
| | - Inês Balacó
- Department of Pediatric Orthopaedics, Pediatric Hospital of Coimbra - Centro Hospitalar e Universitário de Coimbra (CHUC), EPE; Av Afonso Romão, 3000-602, Coimbra, Portugal
| | - Cristina Alves
- Department of Pediatric Orthopaedics, Pediatric Hospital of Coimbra - Centro Hospitalar e Universitário de Coimbra (CHUC), EPE; Av Afonso Romão, 3000-602, Coimbra, Portugal
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Youssefzadeh AC, Tavakoli A, Panchal VR, Mandelbaum RS, Ouzounian JG, Matsuo K. Incidence trends of shoulder dystocia and associated risk factors: A nationwide analysis in the United States. Int J Gynaecol Obstet 2023. [PMID: 36707062 DOI: 10.1002/ijgo.14699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 01/07/2023] [Accepted: 01/26/2023] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To examine recent incidence trends and characteristics of shoulder dystocia. METHODS This is a retrospective cohort study querying the Healthcare Cost and Utilization Project's National Inpatient Sample. The study population included 9 913 838 vaginal deliveries for national estimates from January 2016 to December 2019. The main outcome measure was the diagnosis of shoulder dystocia. A binary logistic regression model was used to identify characteristics of shoulder dystocia in multivariable analysis. RESULTS Shoulder dystocia was reported in 228 120 deliveries (23.0 per 1000). The incidence of shoulder dystocia increased from 21.0 to 24.6 per 1000 deliveries during the 4-year study period (17.1% relative increase, P < 0.001). In a multivariable analysis, the recent year of delivery remained an independent factor for shoulder dystocia: adjusted odds ratio (aOR) compared with 2016, 1.09 (95% confidence interval [CI], 1.08-1.11), 1.13 (95% CI, 1.12-1.14), and 1.18 (95% CI, 1.16-1.19) for 2017, 2018, and 2019, respectively. Large for gestational age (aOR 4.33 [95% CI, 4.25-4.40]), diabetes mellitus (pregestational aOR, 4.78 [95% CI, 4.63-4.94], and gestational aOR, 1.69 [95% CI, 1.66-1.71]), and vacuum-assisted delivery (aOR, 2.18 [95% CI, 2.15-2.21]) exhibited the largest risks for shoulder dystocia. CONCLUSION This national-level analysis identified various risk factors for shoulder dystocia and demonstrated that shouder dystocia cases are increasing gradually in the United States.
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Affiliation(s)
- Ariane C Youssefzadeh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Amin Tavakoli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Viraj R Panchal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Rachel S Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA.,Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Joseph G Ouzounian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
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Kekki M, Salonen A, Koukkula T, Laivuori H, Tihtonen K, Huttunen TT. Incidence changes in risk factors associated with the decreasing number of birth-related clavicle fractures in Finland: A nationwide retrospective birth cohort from 2004 to 2017. Birth 2022; 50:428-437. [PMID: 35735132 DOI: 10.1111/birt.12662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND A clavicle fracture is one of the most common birth injuries. The objective of this study was to examine whether the decreased incidence of birth-related clavicle fractures in Finland is because of temporal changes in their predisposing factors. METHODS For this nationwide population-based study, we used the Finnish Medical Birth Register and the Care Register for Health Care databases. The study population included all singleton, live-born newborn born spontaneously or by vacuum-assisted delivery, in cephalic presentation ≥37+0 weeks of gestation. The incidences of clavicle fractures, pregnancy characteristics, and risk assessments for fracture were calculated and compared between two time periods: 2004-2010 and 2011-2017. RESULTS A total of 629 457 newborn were born vaginally between 2004 and 2017. The clavicle fracture incidence decreased from 17.6/1000 to 6.2/1000 live births. Shoulder dystocia, diabetes, and birthweight ≥4000 g were the strongest predisposing factors. The incidence of birthweight ≥4000 g decreased, meanwhile type 1 diabetes and shoulder dystocia remained stable and gestational diabetes, type 2 diabetes, and maternal obesity increased in the later study period. The incidence of clavicle fractures without known predisposing factors declined. Simultaneously, the cesarean birth rate remained stable (13.2%-13.1%), although the rate of vacuum-assisted deliveries increased (8.5%-9.5%). DISCUSSION The incidence of clavicle fractures decreased, even though the incidence of most risk factors remained stable or increased, and the cesarean birth rate remained stable. This decline may be related to the reduction of fracture incidence among deliveries without known risk factors, and the decrease in birthweight ≥4000 g.
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Affiliation(s)
- Maiju Kekki
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.,Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Anne Salonen
- Department of Pediatric and Adolescent Surgery, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Topias Koukkula
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Hannele Laivuori
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.,Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Kati Tihtonen
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.,Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tuomas T Huttunen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tampere University Heart Hospital, Tampere University Hospital, Tampere, Finland
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Clapp MA, James KE, McCoy TH Jr, Perlis RH, Kaimal AJ. The value of intrapartum factors in predicting maternal morbidity. Am J Obstet Gynecol MFM 2021; 4:100485. [PMID: 34517146 DOI: 10.1016/j.ajogmf.2021.100485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/20/2021] [Accepted: 09/03/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The rates of severe maternal morbidity and mortality in the United States exceed those in other high-income nations. To aid providers and hospitals in recognizing the risk factors, there have been multiple attempts to develop stratification systems for morbidity based on maternal comorbidities. However, most women giving birth are healthy and do not have comorbidities to suggest that they are at an increased risk for severe maternal morbidity. There are small but inherent maternal risks to labor, and the events after admission may further influence a woman's risk for morbidity even for those initially at a low risk. OBJECTIVE To determine if the incorporation of intrapartum factors known at the start of the second stage of labor improves the predictive performance of a comorbidity-based risk tool for severe maternal morbidity. STUDY DESIGN This is a retrospective cohort study of women at 8 hospitals in a single health system between July 1, 2016, and June 30, 2020. The women had term, singleton gestations and were admitted in labor and reached the second stage. The primary outcome was severe maternal morbidity. We compared logistic regression models using a validated risk-scoring tool (the Expanded Obstetric Comorbidity Score, which uses diagnosis codes for maternal comorbidities and pregnancy characteristics to predict maternal morbidity) with a model that included the Expanded Obstetric Comorbidity Score combined with parity and intrapartum factors. The intrapartum factors included labor induction or augmentation, length of labor, prolonged rupture of membranes, the presence of meconium-stained amniotic fluid, and gestational age. The hospitals were divided into a training (n=4) and testing (n=4) set to evaluate the predictive model performance. Discrimination was assessed by calculating the area under the receiver operating curve and calibration via calibration plots. Similar model comparisons were performed in a subgroup of women, who the Expanded Obstetric Comorbidity Score predicted to be at low risk for morbidity. RESULTS This analysis included 33,770 deliveries from the 8 hospitals; severe maternal morbidity occurred in 498 (1.5%) deliveries. The model performance is reported among the testing set (n=15,350). Using the Expanded Obstetric Comorbidity Score alone, the area under the receiver operating curve was 0.676 (95% confidence interval, 0.636-0.716) and 155 (71%) events occurred among individuals above the median predicted risk. When combining intrapartum factors, the area under the receiver operating curve increased to 0.729, (95% confidence interval, 0.693-0.764) and 171 (78%) events occurred among individuals above the median predicted risk. The significant factors that were associated with severe maternal morbidity in this combined model included the Expanded Obstetric Comorbidity Score, length of labor, and the presence of meconium-stained amniotic fluid. The area under the receiver operating curve for the model with intrapartum factors was significantly higher than the models using the Expanded Obstetric Comorbidity Score alone (P<.001). CONCLUSION The incorporation of intrapartum factors along with a validated risk tool (Expanded Obstetric Comorbidity Score) improved the ability to predict severe maternal morbidity at the start of the second stage. These findings emphasize the evolution of a woman's risk during her labor course and suggests that the prediction of maternal risk can be improved by considering intrapartum factors.
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Vetterlein J, Doehmen CAE, Voss H, Dittkrist L, Klapp C, Henrich W, Ramsauer B, Schlembach D, Abou-Dakn M, Maresh MJA, Schaefer-Graf UM. Antenatal risk prediction of shoulder dystocia: influence of diabetes and obesity: a multicenter study. Arch Gynecol Obstet 2021; 304:1169-1177. [PMID: 34389888 DOI: 10.1007/s00404-021-06041-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/17/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To estimate the risk of shoulder dystocia (SD) in pregnancies with/without maternal diabetes or obesity; to identify antenatal maternal and fetal ultrasound-derived risk factors and calculate their contributions. METHODS A multicenter retrospective analysis of 13,428 deliveries in three tertiary hospitals (2014-2017) with fetal ultrasound data ≤ 14 days prior to delivery (n = 7396). INCLUSION CRITERIA singleton pregnancies in women ≥ 18 years old; vertex presentation; vaginal delivery at ≥ 37 weeks of gestation. Estimated fetal weight (EFW) and birth weight (BW) were categorized by steps of 250 g. To evaluate risk factors, a model was performed using ultrasound data with SD as the dependent variable. RESULTS Diabetes was present in 9.3%; BMI ≥ 30 kg/m2 in 10.4% and excessive weight gain in 39.8%. The total SD rate was 0.9%, with diabetes 2.0% and with obesity 1.9%. These increased with BW 4250-4499 g compared to 4000-4249 g in women with diabetes (12.1% vs 1.9%, P = 0.010) and without (6.1% vs 1.6%, P < 0.001) and at the same BW threshold for women with obesity (9.6% vs 0.6%, P = 0.002) or without (6.4% vs 1.8%, P < 0.001). Rates increased similarly for EFW at 4250 g and for AC-HC at 2.5 cm. Independent risk factors for SD were EFW ≥ 4250 g (OR 3.8, 95% CI 1.5-9.4), AC-HC ≥ 2.5 cm (OR 3.1, 95% CI 1.3-7.5) and diabetes (OR 2.2, 95% CI 1.2-4.0). HC/AC ratio, obesity, excessive weight gain and labor induction were not significant. CONCLUSION Independent of diabetes, which remains a risk factor for SD, a significant increase may be expected if the EFW is ≥ 4250 g and AC-HC is ≥ 2.5 cm.
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Affiliation(s)
- Julia Vetterlein
- Department for Obstetrics and Gynecology, Berlin Center for Diabetes and Pregnancy, St. Joseph Hospital, Wuesthoffstr. 15, 12101, Berlin, Germany
| | - Cornelius A E Doehmen
- Department for Obstetrics and Gynecology, Berlin Center for Diabetes and Pregnancy, St. Joseph Hospital, Wuesthoffstr. 15, 12101, Berlin, Germany
| | - Holger Voss
- Department for Obstetrics and Gynecology, Berlin Center for Diabetes and Pregnancy, St. Joseph Hospital, Wuesthoffstr. 15, 12101, Berlin, Germany
| | - Luisa Dittkrist
- Department for Obstetrics and Gynecology, Berlin Center for Diabetes and Pregnancy, St. Joseph Hospital, Wuesthoffstr. 15, 12101, Berlin, Germany
| | - Christine Klapp
- Department for Obstetrics, Charité-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Wolfgang Henrich
- Department for Obstetrics, Charité-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Babett Ramsauer
- Clinic of Obstetric Medicine, Vivantes Clinicum Neukoelln, Berlin, Germany
| | - Dietmar Schlembach
- Clinic of Obstetric Medicine, Vivantes Clinicum Neukoelln, Berlin, Germany
| | - Michael Abou-Dakn
- Department for Obstetrics and Gynecology, Berlin Center for Diabetes and Pregnancy, St. Joseph Hospital, Wuesthoffstr. 15, 12101, Berlin, Germany
| | - Michael J A Maresh
- Department of Obstetrics, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center, Manchester, UK
| | - Ute M Schaefer-Graf
- Department for Obstetrics and Gynecology, Berlin Center for Diabetes and Pregnancy, St. Joseph Hospital, Wuesthoffstr. 15, 12101, Berlin, Germany. .,Department for Obstetrics, Charité-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.
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