Birth trauma 2010

obstetrical condition

1. Birth Injury

2. DEFINITION
Injuries to the infant resulting from
mechanical forces during birth
(compression, traction)

3. INCIDENCE
In 1970 ~ 64 deaths/100 000 births related to
birth trauma
In 1985 ~ 7.5 deaths/100 000 births related to
birth trauma
88% decline
Birth trauma causes < 2% of neonatal deaths
Average ~ 6 - 8 injuries/1000 births

4. PREDISPOSING FACTORS
Primigravida
Cephalopelvic
disproportion
Small maternal stature
maternal pelvic anomalies
Prolonged or rapid labor
Arrest of descent of
presenting fetal part
Oligohydramnios
Resuscitation with CPR
Abnormal presentation
(breech/face)
Use of forceps or vacuum
extraction
VLBW infant or extreme
prematurity
Macrosomia
Large fetal head
Fetal anomalies
Fetal neuromuscular disease

5. BIRTH INJURIES
Soft Tissue Injuries (Abrasions, Bruising, Fat Necrosis,
Lacerations)
Extracranial Bleeding (Caput succedaneum,
Cephalhematoma, Subgaleal Hematoma)
Intracranial Bleeding (Subarachnoid, Epidural, Subdural,
Cerebral, Cerebellar)
Nerve Injuries (Facial and Cervical Nerve Roots, Horner
Syndrome, Recurrent Laryngeal Nerve)
Fractures (Clavicle, Humerus, Femur, Skull)
Dislocations
Torticollis (Sternocleidomastoid injury)
Eye Injuries (Subconjunctival and Retinal Hemorrhage)
Solid Organ Injury (liver, spleen, kidney, adrenal glands)

6. CEPHALHAEMATOMA
It is swelling on infants skull, in which collection of blood
occur between the pericranium & flat bones of skull. It is
usually unilateral. Most of times it occurs over parietal
bone.
Predisposing factors:
-CPD
-Precipitate labour
- forceps delivery

7. Characteristics:
-Never present at birth, gradually develops after 12-
24 hours.
-Limited by suture line, never cross a suture.
-It is soft, circumscribed, fluctuant & in compressible.
-It persists for week.
Treatment :
- No treatment is required, as blood is absorbed in
course of time i.e. 6 to 8 weeks and swelling subside.

8. CAPUT SUCCEDANEUM
It is an oedematous swelling on the fetal skull in
which serosanguinous infilteration occur into scalp
tissue.
Characteristics:
-It is present at birth.
-It can cross suture line.
-It tends to grow less.
-It usually disappear within 36hours.
-It is diffiuse type & pits occur when pressure is given
with finger.

9. CAPUT SUCCEDANEUM

10. SUBAPONEROTIC
HAEMORRHAGE
It is a condition, in which bleeding occurs below the
epicranial aponeurosis. It is usually associated with
vaccum extraction.

11. Characteristics:
-It is present at birth.
-It crosses suture line.
-It increases in size.
-A firm, fluctuent mass is seen.
-It can extend upto subcutaneous tissue of neck &
eyelids.
-It resolve over 2-3 weeks.

12. Treatement:
-It is absorbed, so no treatement but the baby should
be observed for signs of;
 hyperbilirubinemia.
 Aneamia.

13. FRACTURES
skull fracture:
-Fracture of skull are rare.
-Fractures, occasionally associated with intra – cranial
haemorrhages, seizures & death as contusion of the
underlying brain my have occurred.
-X- ray is required to diagnose skull fractures.
Treatement:
. Antibiotic to prevent infection.

14. Clavicle fracture:
-Asymptomatic , associated with brochial plexus
damge.
Diagnosed: a crack heard during delivery, by feeling
the distortion at the break, presence of crepitus and
in late phase callus formation.
Treatement:
. A figure of eight bandage
. Union of brek occur in
7- 10 days.

15. Humerus fracture:
-It occur during bringing down of an extended arm in a
breech presentation.
-A crack may be heard at delivery diagnosis is
confirmed by x- ray.
Treatement :
. Splint the upper arm by applying a crepe bandage.
. A stable union takes place in 2- 3 minutes.

16. Femur fracture:
-It can occur during delivery of extende leg in a breech
presentation.
-A crack is heard or felt at time delivery.
Diagnosed : It is confirmed by x- ray.
Treatment :
. Simple splinting , a crepe bandage being firmly
applied to upper leg for 2- 3 weeks.

17. NERVE INJURY
Facial nerve injury.
Brachial plexus injury.

18. Facial nerve injury
It is associated with forceps delivery.
Facial nerve is compressed against ramus of
mandible.
It results in;
. Unilateral facial weakness.
. Eyelid of affected side remain open.

19. Treatement :
-No treatment is required.
-Only cellulose eye drops in case eyelids open.
-
Spontaneous improvement occur in 7- 10 days.

20. BRACHIAL PLEXUS
INJURIES
It result from stretching or disruption of nerve of
brachial plexus.
Injuries result from;
-Excessive lateral flexion of head & neck in case of
shoulder dystocia or breech presentation.
Diagnosed: x- ray of clavicle, arm, cervical spine &
chest.

21. TYPES
Erb’s palsy.
Klumpk’s palsy.
Erb’s palsy:
. Arm rotated inwardly.
. Arm lies limply by his side.
. Unable to flex his elbow & lift his arm.
. Half closed hand outwardly turned.
Klumpk’s palsy:
. Wrist drop and limb fingers.
. Involves lower arm, wrist and hand.

22. Diagnosed:
x- ray of clavicle, arm, cervical spine & chest.
Treatement :
. Resting of arm for 7- 10 days.
. Full range of passive movements for shoulder, elbow
& wrist.

23. PHRENIC NERVE INJURY
It occurs with brachial plexus injury.

It can affect one or both sides of diaphargm.

24. Treatement:
- simple oxygen therapy to intermittent positive
pressure ventilation.
Complication:
- Hypostatic pneumonia.

25. HORNER’S SYNDROME
It is associated with klumpke’s paralysis.
It results form damage to cervical sympathetic
nerves.
Symptoms;
-ptosis.
-Exophthalmus.
-Abesence of sweating from affected side.

26. SOFT TISSUE INJURY
Injury to superficial tissues:
-Bruising & excoriation.
-Eyelids & lips oedematous.
Treatment:
. No treatment unless complications.
. Reassurance to mother complications.

27. Injury to liver & spleen:
injury to liver
subscapular haematoma
decreased hematocrit & haemaglobulin
Treatment :
-Immediate resuscitative measures.
-Restoration of circulatory volume.

28. Renal injury:
-It leads to massive haemorrhage – lead to circulatory
collapse.
Diagnosed: by ultrsound
Treatement :
-Supportive treatement.
-If required blood transfusion.

29. Intestinal injury:
-Result in coagulopathy.
-Bleeding per rectum.
-Anaemia & feeding difficulties.
Treatement :
. I / V fluids.
. Nasogastric suction.
. Hematoma usually resolves.

30. MUSCLE INJURY
Injury to sternomastoid muscle
-Results in torticollis.
It occurs during delivery of anterior shoulder in a vertex
presentation or while rotating the shoulder in breech
presentation.

31. TYPES :
1.Tearing of muscle.
2.Impaired blood supply.
Treatment :
. Swelling resolves over several weeks.
. Muscle stretching exercises.
. Sleep on opposite side of injury.

32. SKIN INJURY
Bruising or subcutaneous fat necrosis-
usually on face.
In case of abscess – incision &
antibiotics.

33. Prevention of injury in newborn
Provide comprehensive antenatal &
intrnatal care.
Screen out high risk babies who are
likely to get injury during delivery.
Continuously do fetal monitoring to find
out cerebral anoxia.
Give episiotomy carefully.
Do not unduly stretch the neck.

34. Administer vitamin k .
Prefer caserean, if difficult delivery by
forceps.
Never apply traction, till the blades are
over biparietal plane.
Avoid ventouse delivery for preterm
babies.
Take precautions while delivering after
coming head in breech delivery.