General Obstetrics and Gynecology: ObstetricsComparison of “instrument-associated” and “spontaneous” obstetric depressed skull fractures in a cohort of 68 neonates
Section snippets
Material and methods
We performed a retrospective, case-control analysis. Because of the study design, the study protocol has received exemption from the Institutional Review Board. This study was conducted in 2 neurosurgery units that are located at Necker and Pierre Wertheimer hospitals. These hospitals are located in Paris and Lyon, France's 2 largest cities, and serve as a catchement area of 11 million people. This study included all neonates who were admitted to 1 of these neurosurgery wards with a DSF between
Results
During the study period, 75 neonates with a DSF were admitted to the neurosurgical units. Births took place in 38 maternity hospitals. Seven cases were excluded (6 files were incomplete, and 1 case was associated with a large [antenatal] porencephalic cyst), which left 68 cases for analysis. The neurosurgical hospitals in Paris and Lyon are referral centers for 183 maternity hospitals. These maternity hospitals delivered 1,994,250 babies between 1990 and 2000.7 Therefore, the incidence of
Comment
The 2 neurosurgery units that were involved in this study act as neurosurgical neonatal referral centers for the 2 largest cities in France. Therefore, it is very unlikely that cases were missed. Moreover, DSF are of the “ping-pong” type and are diagnosed easily clinically, which means that DSF are very unlikely to remain undiagnosed.8 Theoretically, files for neonates who died in the obstetrics ward after an instrumental delivery could have been missed. However, a survey of 2577 forceps
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