{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T06:25:50Z","timestamp":1792304750279,"version":"4.4.0"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T00:00:00Z","timestamp":1665964800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>We compared birth injuries for spontaneous vaginal (VD) and caesarean section (CS) deliveries in preterm and term pregnancies.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>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\u20133.5). When considered all types of birth trauma, incidence of trauma at birth was higher after 28 weeks gestation in VD compared to CS (28\u201331 weeks, aOR 1.7, 95% CI 1.3\u20132.3; 32\u201336 weeks, aOR 4.2, 95% CI 3.6\u20134.9; &gt;37 weeks, aOR 3.3, 95% CI 3.1\u20133.5). 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\u20131.2). 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 &gt; 0.05 for all).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0275726","type":"journal-article","created":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T17:35:41Z","timestamp":1666028141000},"page":"e0275726","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":18,"title":["Birth trauma in preterm spontaneous vaginal and cesarean section deliveries: A 10-years retrospective study"],"prefix":"10.1371","volume":"17","author":[{"given":"Alina","family":"Luca","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2432-2616","authenticated-orcid":true,"given":"Angela","family":"Vinturache","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciprian","family":"Ilea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea","family":"Avasiloaiei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luminita","family":"Paduraru","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru","family":"Carauleanu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioana","family":"Sripcariu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Demetra","family":"Socolov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,10,17]]},"reference":[{"issue":"1","key":"pone.0275726.ref001","first-page":"e22831","article-title":"Incidence of Neonatal Birth Injuries and Related Factors in Kashan","volume":"4","author":"M Abedzadeh-Kalahroudi","year":"2015","journal-title":"Arch Trauma Res"},{"issue":"4","key":"pone.0275726.ref002","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.ajog.2009.11.041","article-title":"Route of delivery and neonatal birth trauma","volume":"202","author":"CK Moczygemba","year":"2010","journal-title":"Am J Obstet Gynecol"},{"issue":"2","key":"pone.0275726.ref003","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/S1028-4559(10)60036-8","article-title":"Incidence of and risk factors for birth trauma in Iran","volume":"49","author":"H Borna","year":"2010","journal-title":"Taiwan J Obstet Gynecol"},{"key":"pone.0275726.ref004","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ejogrb.2013.10.017","article-title":"Vaginal delivery versus caesarean section in preterm breech delivery: a systematic review","volume":"172","author":"L Bergenhenegouwen","year":"2014","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"6","key":"pone.0275726.ref005","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.CD000078.pub2","article-title":"Caesarean section versus vaginal delivery for preterm birth in singletons","author":"Z Alfirevic","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"issue":"3","key":"pone.0275726.ref006","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1097\/AOG.0b013e318265b16c","article-title":"Mode of delivery and neonatal outcomes in preterm, small-for-gestational-age newborns","volume":"120","author":"EF Werner","year":"2012","journal-title":"Obstet Gynecol"},{"issue":"2","key":"pone.0275726.ref007","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.ajog.2012.06.023","article-title":"Neonatal mortality by attempted route of delivery in early preterm birth","volume":"207","author":"UM Reddy","year":"2012","journal-title":"Am J Obstet Gynecol"},{"issue":"3","key":"pone.0275726.ref008","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1097\/01.AOG.0000154156.51578.50","article-title":"The impact of vaginal delivery in premature infants weighing less than 1,251 grams","volume":"105","author":"R Deulofeut","year":"2005","journal-title":"Obstet Gynecol"},{"issue":"3","key":"pone.0275726.ref009","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1080\/14767058.2017.1383980","article-title":"Significant intraventricular hemorrhage is more likely in very preterm infants born by vaginal delivery: a multi-centre retrospective cohort study","volume":"32","author":"I Gamaleldin","year":"2019","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"1","key":"pone.0275726.ref010","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1097\/01.AOG.0000192400.31757.a6","article-title":"Survival advantage associated with cesarean delivery in very low birth weight vertex neonates","volume":"107","author":"HC Lee","year":"2006","journal-title":"Obstet Gynecol"},{"key":"pone.0275726.ref011","unstructured":"For a healthy Belgium. https:\/\/www.healthybelgium.be\/en\/health-system-performance-assessment\/specific-domains\/mother-and-newborn. Accessed April 2022"},{"key":"pone.0275726.ref012","unstructured":"WHO. Caesarean section rates continue to rise, amid growing inequalities in access. https:\/\/www.who.int\/news\/item\/16-06-2021-caesarean-section-rates-continue-to-rise-amid-growing-inequalities-in-access-who. Accessed April 2022"},{"issue":"12","key":"pone.0275726.ref013","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1080\/08035250600711066","article-title":"Comparative analysis of neonatal morbidity for vaginal and caesarean section deliveries using hospital charge","volume":"95","author":"CHANG J","year":"2006","journal-title":"Acta P\u00e6diatrica"},{"issue":"6","key":"pone.0275726.ref014","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1097\/AOG.0b013e3182918a7e","article-title":"Health outcomes for vaginal compared with cesarean delivery of appropriately grown preterm neonates","volume":"121","author":"EF Werner","year":"2013","journal-title":"Obstet Gynecol"},{"issue":"9525","key":"pone.0275726.ref015","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1016\/S0140-6736(06)68704-7","article-title":"Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America","volume":"367","author":"J Villar","year":"2006","journal-title":"The Lancet"},{"issue":"4","key":"pone.0275726.ref016","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/BF02390387","article-title":"Delivery of very premature infants: does the caesarean section rate relate to mortality, morbidity, or long-term outcome?","volume":"249","author":"J Dietl","year":"1991","journal-title":"Arch Gynecol Obstet"},{"issue":"1","key":"pone.0275726.ref017","doi-asserted-by":"crossref","DOI":"10.5812\/atr.22831","article-title":"Incidence of neonatal birth injuries and related factors in Kashan, Iran","volume":"4","author":"M Abedzadeh-Kalahroudi","year":"2015","journal-title":"Arch Trauma Res"},{"issue":"5","key":"pone.0275726.ref018","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.ajog.2007.03.065","article-title":"Fetal trauma in term pregnancy","volume":"197","author":"TF Baskett","year":"2007","journal-title":"Am J Obstet Gynecol"},{"issue":"2","key":"pone.0275726.ref019","first-page":"202","article-title":"Birth injuries-A review of incidence, perinatal risk factors and outcome","volume":"54","author":"C Warke","year":"2012","journal-title":"Bombay Hosp J"},{"issue":"1","key":"pone.0275726.ref020","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.ajog.2016.01.004","article-title":"Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort","volume":"215","author":"TA Manuck","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"4","key":"pone.0275726.ref021","first-page":"328","article-title":"Intraventricular hemorrhage in premature infants with Respiratory Distress Syndrome treated with surfactant: incidence and risk factors in the prospective cohort study","volume":"21","author":"E Helwich","year":"2017","journal-title":"DevPeriod Med"},{"issue":"1\u20133","key":"pone.0275726.ref022","doi-asserted-by":"crossref","first-page":"e34","DOI":"10.1016\/j.forsciint.2011.07.044","article-title":"Serious head injury in young children: Birth trauma versus non-accidental head injury","volume":"214","author":"S Bode-J\u00e4nisch","year":"2012","journal-title":"Forensic Sci Int"},{"issue":"1","key":"pone.0275726.ref023","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1053\/j.nainr.2015.12.003","article-title":"Birth injuries resulting in neurologic insult","volume":"16","author":"P. Scheans","year":"2016","journal-title":"Newborn Infant Nurs Rev"},{"issue":"2","key":"pone.0275726.ref024","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1542\/peds.2007-2620","article-title":"Impact of cesarean section on neonatal mortality rates among very preterm infants in the United States, 2000\u20132003","volume":"122","author":"MH Malloy","year":"2008","journal-title":"Pediatrics"},{"issue":"4","key":"pone.0275726.ref025","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1016\/j.ajog.2006.06.047","article-title":"The Maternal-Fetal Medicine Units Cesarean Registry: safety and efficacy of a trial of labor in preterm pregnancy after a prior cesarean delivery","volume":"195","author":"CP Durnwald","year":"2006","journal-title":"Am J Obstet Gynecol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0275726","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T17:36:13Z","timestamp":1666028173000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0275726"}},"subtitle":[],"editor":[{"given":"Claudine","family":"Irles","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,10,17]]},"references-count":25,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0275726","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,17]]}}}