B. Kaplan et al., FRACTURE OF THE CLAVICLE IN THE NEWBORN FOLLOWING NORMAL LABOR AND DELIVERY, International journal of gynaecology and obstetrics, 63(1), 1998, pp. 15-20
Objective: Earlier works have associated neonatal clavicular fracture
(0.2-3.5% of all deliveries) with a range of procedural, fetal and mat
ernal risk factors; more recent studies, however, have failed to firml
y identify any one or a combination of them. In the present work we so
ught to determine possible ante/intra-partum risk factors for this con
dition. Study design: Using a retrospective case-controlled approach,
we examined a series of maternal, fetal and pregnancy or delivery-rela
ted variables in 87 cases (out of 403) of fractured clavicle of the ne
wborn diagnosed in our department from 1986 to 1994. All infants were
delivered vaginally (in the occipito-anterior position) at term by a s
pecialist obstetrician and underwent peripartum sonographic fetal weig
ht estimation. All variables were compared with those of an equal numb
er of infants born immediately before or after each affected infant an
d delivered by the same obstetrical team. Results: Fractured clavicles
were found in 1.65% of the total number of deliveries during the stud
y period. Neonatal clavicular fracture was significantly and directly
related to the duration of the second stage of labor, peripartum sonog
raphic fetal weight estimation, and neonatal length, and inversely rel
ated to maternal height; nevertheless, all values in both the study an
d control groups were within normal range. Logistic regression analysi
s showed that these antenatal variables significantly affect the chanc
es of clavicular fracture, but due to the high false-positive rate the
y cannot serve clinically as a comprehensive antenatal prediction inde
x. Conclusions: The majority of clavicular fractures occur in normal n
ewborns following normal labor and delivery. The risk factors we ident
ified statistically do not offer a method for clinical prenatal predic
tion. This work provides statistical evidence of the nature of this co
mplication of early newborn life. (C) 1998 International Federation of
Gynecology and Obstetrics.