Neonatal clavicular fracture: Can induction of labor be a risk factor?

Abstract

Perinatal clavicular fracture is the most common birth injury that may cause neonatal morbidities such as obstetric brachial palsy (OBP) ranging from 0.2 to 3.5%. We aimed to compare the relationship between perinatal clavicular fracture and induced vaginal delivery. All the live births and the neonatal outpatient clinic admissions between June 2016 and December 2022 have been investigated retrospectively. A total of 185 newborn infants with a mean gestational age of 38.3±1.6 weeks and a mean birth weight of 3,451±430.10 grams were enrolled. When compared to all in-born live births, the overall incidence of clavicular fracture was 0.78%. One hundred eighty-one (97.8%) infants were born vaginally and 4 (2.2%) were born by cesarean sections (C-sections). The incidence of clavicular fracture among in-born vaginally delivered infants was 1.26% (n=153) and among C-section deliveries was 0.04% (n=3). In vaginal deliveries, 54.7% (n=99) had prolonged labor, 71.8% (n=130) had received labor induction and 7.7% (n=14) had a history of instrumental intervention. A statistically significant relationship was found between clavicular fracture and prolonged labor, labor induction, increased birth weight, and low Apgar scores (p<0.001). While 21 infants (11.4%) had cephalohematoma, 8 infants (4.3%) presented with symptoms of OBP. Although high birth weight, prolonged labor, and ventouse delivery are the already known major risk factors for neonatal clavicular fractures, induced vaginal delivery has been defined as a new and important risk factor. Induction of labor should be decided when the benefits of immediate delivery outweigh the risks of continuing the pregnancy for fetal and maternal health.