The study uses a retrospective case-note review to assess the incidence of fetal scalpel injuries at Cesarean section. Indications for the 896 cesareans in which neonatal records were available are listed in Table 1. Location of laceration injury and presentation are shown in Table 2. The authors demonstrate that fetal laceration injury at cesarean delivery is not rare, especially when it is performed for nonvertex presentation. The minority of obstetric records show documentation of such lacerations, suggesting that this complication often may not be recognized by obstetricians.
Advice is given by the authors on methods to avoid fetal scalpel injuries.
General surgical methods to reduce the risk of fetal laceration injury have included meticulous suctioning at the time of uterine entry3 and removal of retractors of the abdominal wall, if used, before delivery of the fetus to minimize trauma risk and to create more room for the delivery. Methods of uterine entry advocated to reduce fetal trauma have included scoring the uterus along the entire length of the proposed uterine incision with the scalpel and bluntly entering the uterine cavity by inserting a finger into the central portion of the uterine incision. The uterine incision is then extended in both lateral directions by retraction with index fingers. In the UK I am very aware of the fact that such injuries are increasingly becoming a cause for medical negligence litigation. I have recently acted as an expert in one such case and have recently been instructed in a second.