Incidence of and Risk Factors for Birth Trauma in Iran

Neonatal birth trauma and associated factors in low and middle-income countries: A systematic review and meta-analysis

Neonatal birth trauma, although it has steadily decreased in industrialized nations, constitutes a significant health burden in low-resource settings. Keeping with this, we sought to determine the pooled cumulative incidence (incidence proportion) of birth trauma and identify potential contributing factors in low and middle-income countries. Besides, we aimed to describe the temporal trend, clinical pattern, and immediate adverse neonatal outcomes of birth trauma. We searched articles published in the English language in the Excerpta Medica database, PubMed, Web of Science, Google, African Journals Online, Google Scholar, Scopus, and in the reference list of retrieved articles. Literature search strategies were developed using medical subject headings and text words related to the outcomes of the study. The Joana Briggs Institute quality assessment tool was employed and articles with appraisal scores of seven or more were deemed suitable to be included in the meta-analysis. Data were analyzed using the random-effect Dersimonian-Laird model. The full search identified a total of 827 articles about neonatal birth trauma. Of these, 37 articles involving 365,547 participants met the inclusion criteria. The weighted pooled cumulative incidence of birth trauma was estimated at 34 per 1,000 live births (95% confidence interval (CI) 30.5 to 38.5) with the highest incidence observed in Africa at 52.9 per 1,000 live births (95% CI 46.5 to 59.4). Being born to a mother from rural areas (odds ratio (OR), 1.61; 95% CI1.18 to 2.21); prolonged labor (OR, 5.45; 95% CI 2.30, 9.91); fetal malpresentation at delivery (OR, 4.70; 95% CI1.75 to 12.26); shoulder dystocia (OR, 6.11; 95% CI3.84 to 9.74); operative vaginal delivery (assisted vacuum or forceps extraction) (OR, 3.19; 95% CI 1.92 to 5.31); and macrosomia (OR, 5.06; 95% CI 2.76 to 9.29) were factors associated with neonatal birth trauma. In conclusion, we found a considerably high incidence proportion of neonatal birth trauma in low and middle-income countries. Therefore, early identification of risk factors and prompt decisions on the mode of delivery can potentially contribute to the decreased magnitude and impacts of neonatal birth trauma and promote the newborn's health.

Neonatal Birth Trauma and Its Predisposing Factors Among Newborns Admitted to Public Hospitals in Eastern Ethiopia: A Cross-Sectional Study

Objectives: This study is to investigate the magnitude and predisposing factors for neonatal birth trauma in public hospitals in eastern Ethiopia. It is a major cause of neonatal morbidity and mortality. Despite its higher burden, evidence is limited in eastern Ethiopia. Methods: A cross-sectional study was conducted on 492 newborns selected using systematic random sampling. Data were analyzed using a binary logistic regression model. Statistical significance was set at P < .05. Results: The magnitude of neonatal birth trauma was 16.9% with 95% CI: 13.7-20.5%). In multivariable analysis, instrumental delivery, early preterm (<34 weeks), macrosomia, fetal malpresentation, male sex and, facility-based delivery such as hospital and health center-based delivery were factors associated with neonatal birth trauma. Conclusions: The magnitude of neonatal birth trauma was relatively high. Promoting health facilities-based delivery, prevention of preterm birth, the early decision on the mode, and minimizing instrumental deliveries help reduce neonatal birth trauma.

The Causes and Prevalence of Maxillofacial Fractures in Iran: A Systematic Review

Background

Maxillofacial fractures are a common type of injury that can result in significant morbidity and mortality. We aimed to systematically review the literature on the prevalence and causes of maxillofacial fractures in Iran to estimate the overall prevalence of maxillofacial fractures and the most common causes.

Methods

A systematic search of PubMed, Cochrane Library, Web of Science (WS) and Google Scholar (GS) electronic databases was conducted to identify relevant articles published up to January 2023. Studies reporting the prevalence and causes of maxillofacial fractures in Iran were included in the analysis. MOOSE guidelines were adopted for the current systematic review. No data or language restriction were applied. Risk of bias across the articles was assessed.

Results

A total of 32 studies comprising 35,720 patients were included in the analysis. The most common cause of maxillofacial fractures was road traffic accidents (RTAs), accounting for 68.97% of all cases, followed by falls (12.62%) and interpersonal violence (9.03%). The prevalence of maxillofacial fractures was higher in males (81.04%) and in the age group of 21-30 years (43.23%). Risk of bias across studies was considered low.

Conclusion

Maxillofacial fractures are a significant public health problem in Iran, with a high prevalence and RTAs being the leading cause. These results highlight the need for increased efforts to prevent maxillofacial fractures in Iran, especially through measures to reduce the incidence of RTAs.

Birth trauma in preterm spontaneous vaginal and cesarean section deliveries: A 10-years retrospective study

OBJECTIVE

We compared birth injuries for spontaneous vaginal (VD) and caesarean section (CS) deliveries in preterm and term pregnancies.

METHODS

A retrospective cohort study was conducted in a single tertiary center, between January 1st, 2007, and December 31st, 2017. The study included 62330 singleton pregnancies delivered after 24 0/7 weeks gestation. Multivariable analyses compared trauma at birth, birth hypoxia and birth asphyxia in term and preterm deliveries, stratified by mode of birth, VD versus CS. Main outcome measure was trauma at birth including intracranial laceration and haemorrhage, injuries to scalp, injuries to central and peripheral nervous system, fractures to skeleton, facial and eye injury.

RESULTS

The incidence of preterm deliveries was 10.9%. Delivery of preterm babies by CS increased from 37.0% in 2007 to 60.0% in 2017. The overall incidence of all birth trauma was 16.2%. When stratified by mode of delivery, birth trauma was recorded in 23.4% of spontaneous vaginal deliveries and 7.5% of CS deliveries (aOR 3.3, 95%CI 3.1-3.5). When considered all types of birth trauma, incidence of trauma at birth was higher after 28 weeks gestation in VD compared to CS (28-31 weeks, aOR 1.7, 95% CI 1.3-2.3; 32-36 weeks, aOR 4.2, 95% CI 3.6-4.9; >37 weeks, aOR 3.3, 95% CI 3.1-3.5). There was no difference in the incidence of birth trauma before 28 weeks gestation between VD and CS (aOR 0.8, 95% CI 0.5-1.2). Regarding overall life-threatening birth trauma or injuries at birth with severe consequences such as cerebral and intraventricular haemorrhage, cranial and brachial nerve injury, fractures of long bones and clavicle, eye and facial injury, there was no difference in vaginal preterm deliveries compared to CS deliveries (p > 0.05 for all).

CONCLUSION

CS is not protective of injury at birth. When all types of birth trauma are considered, these are more common in spontaneous VD, thus favoring CS as preferred method of delivery to avoid trauma at birth. However, when stratified by severity of birth trauma, preterm babies delivered vaginally are not at higher risk of major birth trauma than those delivered by CS.

Childbirth-Related Psychological Trauma

Traumatic childbirth is an international public health problem because it is supposed that currently up to 45% of new mothers have reported such an experience. International rates of PTSD due to birth trauma range between 1.5 and 9 percent of all births. Birth trauma is defined as an event occurring during the labour and delivery process that involves actual or threatened serious injury or death of the mother or her infant. A traumatic event or situation creates psychological trauma when it overwhelms the individual's ability to cope, and leaves that person fearing death, annihilation, mutilation, or psychosis. The individual may feel emotionally, cognitively, and physically overwhelmed. The aim of this article is to present a review of published data for childbirth trauma over various periods of time, as well as in different regions of the world. Studies were identified through a comprehensive search of PubMed, PsycInfo, ProQuest and PILOTS (Published International Literature of Traumatic Stress) over the last 20 years. More than 8000 articles were found. In this article we present and discuss some important findings.

Prevalence and associated factors of birth injury among neonates admitted at neonatal intensive care unit (NICU) in governmental hospitals of Southwest Ethiopian people regional state, Ethiopia: A multicenteric cross-sectional study

INTRODUCTION

Neonatal birth injury is the functional or structural damage of the new-born during child birth. Fetal related factors such as macrosomia, fetal height, fetal weight, and prematurity; maternal related factors such as overly young and old maternal age, parity, poor maternal health, and pelvic anomalies contribute to neonatal birth injury. Labor and delivery related factors including prolonged labor, fetal mal-presentation and mal-position, cesarean and instrumental deliveries also predispose the neonate to birth injury. This study was conducted to assess the prevalence and associated factors of birth injury among neonates admitted to the neonatal intensive care unit (NICU) in Governmental Hospitals of Southwest Ethiopia.

OBJECTIVE

To assess the prevalence and associated factors of birth injury among neonates admitted to the neonatal intensive care unit (NICU) in governmental hospitals in Southwest Ethiopia.

METHOD

Hospital-based cross-sectional study design was implemented at Mizan-Tepi University Teaching Hospital, Bonga Gebretsadik Shawo General Hospital, and Tepi General Hospital. A total of 1,315 neonates were included in the study using systematic random sampling techniques. Data was entered using Epi-Data version 4.2 and exported to SPSS version 21 for analysis. Logistic regression analysis was conducted to see the association between the dependent and independent variable.

RESULTS

The prevalence of neonatal birth injury was 16.7%. Predictors such as primipara, no formal education, mothers with no antenatal care, and mothers whose occupational status were unemployed were 12.27, 2.52, 2.40, and 4.26 times more likely to develop neonatal birth injuries than their counterparts, respectively. Whereas, maternal age within the age range of 25-34 years, and neonates delivered via instrumental delivery were 6.68, and 2.81 times more likely to develop neonatal birth injury compared to those whose age was greater than 34 years and neonates delivered through Cesarean section, respectively.

CONCLUSION

The magnitude of birth injury in the current study was significantly high. Primiparity, mothers with no history of antenatal care follow up, uneducated women, unemployed women, mode of delivery, and maternal age between 25 and 34 years were strong predictors associated with neonatal birth injury. Therefore, comprehensive maternal health care such as antenatal care follow up and health institution delivery should be promoted and well addressed to all reproductive age women and special attention should be given particularly to pregnant women in order to mitigate problems related to childbirth.

Traumatic Decapitation of the Fetus During Birth: Criminalistic and Forensic Aspects

Serious intrapartum fetal injuries are unfortunate events that confer severe consequences on medical personnel. Most birth traumas are noncritical and resolve for a few days. Permanent effects or fatal outcomes occur infrequently. We report an unusual case of intrapartum complete fetal decapitation. The labor was complicated by shoulder dystocia, with resultant repeated mechanical trauma to the fetal neck and, finally, decapitation. The tragic results of biological processes in human organisms do not automatically confirm medical malpractice. However, there may be grave ethical and forensic outcomes.

A case-control study about foetal trauma during caesarean delivery

OBJECTIVE

The caesarean section rate is gradually increasing in most countries. The frequency of occurrence of foetal injury per birth is estimated to 1%. The majority of these injuries presents a low functional impact, but remains responsible for a significant neonatal morbidity. Even though the foetal risk factors are well documented in cases of vaginal birth, they have not been accurately identified for caesarean section. The aim of this study is to identify the risk factors for neonatal fracture during caesarean section.

METHODS

We conducted a retrospective case-control study comparing complicated caesarean sections foetal fracture with uncomplicated caesarean sections in a tertiary teaching hospital. We collected all the caesarean sections carried out between 1st January 2003 and 1st September 2015 and selected those the medical files of which presented a foetal fracture diagnosis.

RESULTS

We identified 10 fractures during the study period, including four skull fractures, three long bone fractures, three clavicle fractures. In all these cases there were no complications with a median perspective of six years (median=6, IQR=4). The push method, which is performed during a caesarean section at the second stage of labour, is identified as a risk factor for foetal trauma in our study (OR: 20.2 [2.8-116.85], p<0.01). A significant correlation was found between transverse lie and foetal trauma (OR: 16.67, CI [1.39; 123.18], p=0.0137).

CONCLUSION

Foetal trauma during caesarean delivery is a rare event for which the prognosis is most often favourable. Data in the literature on the subject are minimal. This study highlighted transverse lie and the push method as risks factors for foetal fractures during caesarean sections. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Psychotropic drug use as indicator of mental health in adolescents affected by a plexus injury at birth: A large population-based study in Sweden

Chronic handicap in early life may have a long-term impact on children’s psychosocial well-being. Here, we investigated whether Brachialis Plexus Birth Injury (BPBI)—an unpredictable injury at birth—is associated with worse mental health later on, as indicated by prescription and use of psychotropic drugs in adolescence. We explored further whether this association is different depending on socioeconomic characteristics of the child’s family, as well as sex. Of the 641 151 children born to native parents in Sweden 1987–1993 (alive and still living in Sweden at the end of 2008), identified in the Swedish Medical Birth Registry, 1587 had suffered a BPBI. Logistic regression analysis was performed to assess the impact of socioeconomic characteristics and associations with later psychosocial health. Results show that beyond the known increased risks for females as compared to males, BPBI, but also lower family income, further increased the risk of burdened mental health requiring psychotropic drug use in adolescence. The effects were additive. Thus, compared to unaffected peers, teenagers who suffered a BPBI at birth are at higher risk of suffering poor mental health during adolescence, independently of surgical intervention and its outcome. Girls growing up in families with lower socioeconomic status have this risk added to their already increased risk of poor mental health during adolescence.

Incidence of Neonatal Birth Injuries and Related Factors in Kashan, Iran

Background:

Birth injuries are defined as the impairment of neonatal body function due to adverse events that occur at birth and can be avoidable or inevitable. Despite exact prenatal care, birth trauma usually occurs, particularly in long and difficult labor or fetal malpresentations.

Objectives:

This study aimed to investigate the incidence of birth injuries and their related factors in Kashan, Iran, during 2012-2013.

Patients and Methods:

In this cross-sectional study, all live-born neonates in the hospitals of Kashan City were assessed prospectively by a checklist included demographic variables (maternal age, weight, and nationality), reproductive and labor variables (prenatal care, parity, gestational age, premature rupture of membrane (PROM), fetal heart rate (FHR) pattern, duration of PROM, induction of labor, fundal pressure, shoulder dystocia, fetal presentation, duration of second stage, type of delivery, and delivery attendance), and neonatal variables (sex, birth weight, height, head circumference, Apgar score, and neonatal trauma). Birth trauma was diagnosed based on pediatrician or resident examination and in some cases confirmed by paraclinic methods. Statistical analyses were performed by chi-square, student’s t-test, and multiple logistic regression analyses using SPSS version 17. P ≤ 0.05 was considered statistically significant.

Results:

In this study, the incidence of birth trauma was 2.2%. Incidence of trauma was 3.6% in vaginal deliveries and 1.2% in cesarean sections (P < 0.0001). The most common trauma was cephalohematoma (57.2%) and then asphyxia (16.8%). In multiple logistic regression analyses, decreased fetal heart rate (FHR), fundal pressure, shoulder dystocia, vaginal delivery, male sex, neonatal weight, delivery by resident, induction of labor, and delivery in a teaching hospital were predictors of birth trauma.

Conclusions:

Overall, incidence of birth trauma in Kashan City was lower in comparison with most studies. Considering existing risk factors, further monitoring on labor, and delivery management in teaching hospitals are recommended to prevent birth injuries. In addition, careful supervision on students and residents' training should be applied in teaching hospitals.