Neonatal humeral fracture and scalp laceration following difficult cesarean delivery for transverse lie: a case report.

Abstract

Objectives: Transverse lie in advanced labor presents significant obstetric challenges and may complicate fetal extraction during cesarean delivery. Although cesarean delivery is generally considered protective against birth trauma, neonatal injuries may still occur during technically difficult extractions.

Case presentation: A 41-year-old gravida 6 para 5 woman with gestational diabetes mellitus, polyhydramnios, and an unstable transverse lie underwent external cephalic version at 37+3 weeks' gestation. Although cephalic presentation was initially achieved, the fetus reverted to a transverse lie within 3 h. With cervical dilatation of 8 cm and no presenting part, emergency cesarean delivery was performed under general anaesthesia. A poorly formed lower uterine segment intraoperatively necessitated the use of an inverted T uterine incision, and the neonate sustained a 2 cm scalp laceration and a minimally displaced right humeral shaft fracture. The scalp laceration was repaired immediately, while the humeral fracture was diagnosed on postnatal day 3 following the development of upper limb weakness and an absent Moro reflex. Both injuries were managed successfully with favourable outcomes.

Conclusions: This case highlights the challenges of cesarean delivery for transverse lie in advanced labor and demonstrates that neonatal trauma may occur despite operative delivery. Careful surgical planning, experienced obstetric involvement, and thorough neonatal assessment following difficult extraction are essential.