Birth trauma
Objectives
At the end of this session all students able to:
Define birth trauma
Diagnose different types of birth trauma
Investigate
Manage properly
Birth injuries: harm that can happen to a baby during the
birthing process
They may be avoidable or unavoidable.
It is a common problem with significant neonatal morbidity
and mortality
Risk Factors
Prematurity
Small maternal stature (CPD)
Prolonged or precipitated labour
Mal presentation and malposition
Instrumental delivery
Versions and extraction
Fetal macrosomia or large fetal head.
chronic and acute maternal illness
Risk factors
Maternal factors
Fetal factors
Delivery factors
Evaluation
Detailed neurologic evaluation
Examine the neonate for asymmetry of structure and
function, cranial nerves, range of motion of individual
joints, and integrity of the scalp and skin
Types of injury
Head and neck injury
Nerve injury
Facial injury
Fracture
Intra abdominal injury
Soft tissue injury
Extra cranial injury
Caputsuccedaneum
Cephalhematoma
Subgaleal hemmorage
[Link] succedaneum
It is a commonly occurring subcutaneous
extra periosteal fluid collection that is occasionally hemorrhagic
It has poorly defined margins and can extend over the midline
and across suture lines
Con….
Itextends over the presenting portion of the scalp and is
usually associated with molding
The lesion usually resolves spontaneously without
sequelae over first several days after birth
It rarely causes significant blood loss or jaundice
[Link]
It is a subperiosteal collection of blood resulting from
rupture of the superficial veins between the skull and
periostum
Cannot cross the suture lines
Con….
An Extensive cephalohematoma can result in significant
hyperbilirubinemia and rarely serious enough to
necessitate blood transfusion
The risk of infection is very rare
Skull fractures have been associated with 5 – 20% of cases
Cephalohematoma
Management
Observation in most cases
Incision and aspiration is contraindicated
Anemia and jaundice should be treated as needed
3. Subgaleal hemorrhage
It is hemorrhage under the aponeurosis of the scalp
Because subaponeurotic space extends from the orbital
ridges to the nap of the neck and laterally to the ears
The hemorrhage can spread across the entire calvarium
Con…
The initial presentation typically includes pallor, poor tone,
and a fluctuant swelling on the scalp which cross the suture
lines
The hematoma may grow slowly or increase rapidly and
result in shock
With progressive spread the ears may be displaced
anteriorly and peirorbital swelling can occur
Con…
Ecchymosis of the scalp may develop and it is very
painful on manipulation
The blood is desorbed slowly and swelling resolves
gradually
A Subgaleal hemorrhage associated with skin
abrasions may become infected, it should be treated
with antibiotics and may need drainage
Management and follow up
New born with this lesion should be admitted
Assess and treat shock
Daily HC measurement and Head-CT follow-up
Minimize manipulation because it is painful
Manage anemia and jaundice if needed
Fluid and blood product given if shock and anemia
Cervical nerve root injuries
Brachial plexus injury
paralysis of upper arm muscles following trauma to spinal roots
C5 to T1
The cause is excessive traction on the head, neck, and arm during
birth
Risk factors include macrosomia, shoulder dystocia, breech
presentation
Injury usually involves the nerve root, specially where the roots
come together to form the nerve trunk of the plexus
1 .Duchenne/Erb’s palsy
Involves the upper trunks (C5,C6 and occasionally
C7)
The most common type of brachial plexus injury
The clinical presentation includes partial or full paralysis
of the arm and often accompanied by loss of sensation
The deltoid muscle is paralyzed, which prevents the arm
from being raised.
Clinical presentation
The arm is typically adducted and internally rotated at the
shoulder
There is extension and pronation at the elbow and flexion at
the wrist and fingers in the characteristic “waiter’s tip”
posture
Moro is absent on the affected side
The grasp reflex is intact and sensation is variably affected
Fig-
[Link]’s palsy
involves injury C7/C8 to T1 and is the least common injury
In this case the grasp reflex is absent because of damage of
lower nerve root that control wrist and hand muscle .
There is sensory impairment on the ulnar side of the forearm
and hand
Management of brachial plexus injury
physical therapy and passive range of motion exercises
prevent contractures
It should be started at 7 -10 days when the post injury
neuritis recovered
Splinting should be avoided as contractures in the
shoulder girdle may develop
Wrist and digits splints may be useful
Prognosis
Full recovery varies with the extent of injury.
If the nerve roots are intact and not avulsed, prognosis
for full recovery is excellent
Notable clinical improvement in the first two weeks
indicates that normal or near normal function will return
Most infants recover fully by three months of age
In case with slow recovery, electromyography and nerve
conduction studies are indicated
Phrenic nerve injury (C3, 4 or 5 )
Phrenic nerve injury leading to paralysis of the ipsilateral
diaphragm may result from stretch injury due to lateral
hyperextension of the neck at birth
Risk factors include breech and difficult forceps deliveries
At least 75%of patients also have brachial plexus injury
Clinical features
Respiratory distress and cyanosis
Some infants present with persistent tachypnea and
decreased breath sounds at the lung base
There may be decreased movement of the affected hemi
thorax
Diagnosis
U/S
C-X-ray
RX
the initial treatment is supportive
CPAP or mechanical ventilation may be needed
Careful air way care to avoid atelectasis and pneumonia
Summery
Birth injuries are common problem in neonate
The common ones are as follow:
cephalohematoma
subgalialhemorrage
Erb’s palsy
Clavicular fractures
skull fracture
subgalialhemorrage is the most sever form and needs
strict follow up for shock and severe anemia and need
proper management
References
Nelson text book of pediatrics
19th ed.
WHO. managing new born
problems: a guide for doctors,
nurses, and mid wives. WHO
2003
FANAROFF
Manual of neonatal care,7th edk.
