Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2018 Mar 2;8(3):e020578.
doi: 10.1136/bmjopen-2017-020578.

Temporal trends in severe maternal and neonatal trauma during childbirth: a population-based observational study

Qi Wen  1   2 , Giulia M Muraca  3   4   5 , Joseph Ting  6 , Sarah Coad  3   4 , Kenneth I Lim  3   4 , Sarka Lisonkova  3   4   5
Affiliations
Observational Study

Temporal trends in severe maternal and neonatal trauma during childbirth: a population-based observational study

Qi Wen et al. BMJ 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.

Keywords: birth trauma; mode of delivery; obstetric trauma; trend.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Temporal trends in mode of delivery in singleton infants, Washington State, USA, 2004–2013.
Figure 2
Figure 2
Temporal trends in severe birth trauma among singleton infants, Washington State, USA, 2004–2013.
See this image and copyright information in PMC

References

    1. Parker LA. Part 1: early recognition and treatment of birth trauma: injuries to the head and face. Adv Neonatal Care 2005;5:288–97. 10.1016/j.adnc.2005.09.001 - DOI - PubMed
    1. Sauber-Schatz EK, Markovic N, Weiss HB, et al. . Descriptive epidemiology of birth trauma in the United States in 2003. Paediatr Perinat Epidemiol 2010;24:116–24. 10.1111/j.1365-3016.2009.01077.x - DOI - PubMed
    1. Towner D, Castro MA, Eby-Wilkens E, et al. . Effect of mode of delivery in nulliparous women on neonatal intracranial injury. N Engl J Med 1999;341:1709–14. 10.1056/NEJM199912023412301 - DOI - PubMed
    1. Baskett TF, Allen VM, O’Connell CM, et al. . Fetal trauma in term pregnancy. Am J Obstet Gynecol 2007;197:e1–7. 10.1016/j.ajog.2007.03.065 - DOI - PubMed
    1. Moczygemba CK, Paramsothy P, Meikle S, et al. . Route of delivery and neonatal birth trauma. Am J Obstet Gynecol 2010;202:e1–6. 10.1016/j.ajog.2009.11.041 - DOI - PubMed

Publication types

MeSH terms