Fetal laceration during caesarean section and its medico-legal sequelae

Abstract

Fetal laceration is a recognized complication of caesarean delivery. The aim of this study was to investigate the incidence, type, location, risk factors and long-term consequences of accidental fetal incised wounds during caesarean delivery. During a five-year period, we observed 25 cases of fetal lacerations caused by the scalpel during hysterotomy. In 20 of these cases, we observed these lesions as consultants for the Neonatologic Care Unit; the other five cases came under our care after an insurance claim for damages against the gynaecologist. All the infants had a lesion located to the head. In only 5 of the 25 cases the lesion was reported in the operative summary, and only 16 of the 25 mothers had signed an informed consent before surgery. With regard to the 20 cases diagnosed at the Neonatologic Care Unit, the lesion was closed using single stitches in nine cases, and with biological glue in 11 cases. Concerning the five cases that underwent legal proceedings against the gynaecologist, a clinical examination was performed by an expert in Public Health and Social Security in collaboration with a paediatric surgeon to evaluate the degree of biological damage. In all five cases, the result of the legal challenge was monetary compensation for the physical and moral damage caused by the gynaecologists to the patients and their parents. Accidental fetal lesions may occur during caesarean delivery; the incidence is significantly higher during emergency caesarean delivery compared to elective procedures. Patients should sign an informed consent in which they should be informed about the risk of the occurrence of fetal lacerations during caesarean delivery in order to avoid legal complications.

Risk factors associated with accidental fetal skin lacerations during cesarean delivery

“…Since the parents tend to refer to AFL as a severe injury due to its iatrogenic cause, AFL can have significant medico-legal consequences. 4,15 Therefore, there is a noteworthy importance of explaining to the bearing woman about the rare possibility of accidental fetal skin laceration injury caused by the surgeon's knife before both elective and urgent CS and noting this in the consent forms. Further large-scale, multicenter studies are warranted to consolidate risk factors associated with AFL and to recommend measures to minimize their occurrence.…”

“…[12][13][14] In addition, AFL is referred as an iatrogenic injury with medico-legal consequences. 4,15 Several approaches have been described in the medical literature to minimize the risk of AFL during CS. These include meticulous suction of blood at the surgical incision, creating a superficial incision by using a scalpel followed by a blunt entry into the uterine cavity, maneuvering the fetus above the designated area of the incision or lifting the edges of the incision away from the advancing part of the fetus by an Allis clamp or a ring forceps.…”

“…However, occasionally, AFL can be much more serious 4,9 causing severe morbidity such as eyelid, canalicular and extensor tendon lacerations 12–14 . In addition, AFL is referred as an iatrogenic injury with medico‐legal consequences 4,15 …”