Birth trauma.

Injuries to the infant that

result from mechanical forces
(i.e., compression, traction)
during the birth process are
categorized as birth trauma.

Even though most women give birth

in modern hospitals surrounded by
medical professionals, seven of
every 1,000 births result in birth
injuries.
Birth injuries account for fewer than
2% of neonatal deaths.
From 1970-1985, rates of infant
mortality resulting from birth
trauma fell from 64.2 to 7.5 deaths
per 100,000 live births

Factors predisposing to injury

include the following:
Prolonged or rapid delivery
Cephalopelvic disproportion, small
maternal stature, maternal pelvic
anomalies
Deep transverse arrest of
presenting part of the fetus
Oligohydramnios
Abnormal presentation (breech)

Use of midcavity forceps or vacuum

extraction
Very low birth weight infant or
extreme prematurity weeks
Large babies birth weight over
about 4,000 grams
Cephalopelvic disproportion
Fetus anomalies

Classification of birth injuries:

Soft tissue
Skull
- Abrasions
- Caput
succedaneum
- Erythema
petechia
- Cephalohematoma
- Ecchymosis
- Subgaleal
hemorrhage
- Lacerations
- Subcutaneous fat - Linear fractures
necrosis
- Intracranial
hemorrhages

Face
Subconjunctival
hemorrhage
Retinal
hemorrhage
Peripheral nerve
Brachial plexus
palsy
Unilateral vocal
cord paralysis
Radial nerve palsy
Lumbosacral
plexus injury

Cranial nerve and

spinal cord
injuries
Facial palsy
Musculoskeletal
injuries
Clavicular
fractures
Fractures of long
bones
Sternocleidomastoid injury

Intra-abdominal injuries
- Liver hematoma
- Splenic hematoma
- Adrenal hemorrhage
- Renal hemorrhage

Abrasions and lacerations

sometimes may occur as scalpel cuts
during cesarean delivery or during
instrumental delivery (i.e, vacuum,
forceps). Infection remains a risk,
but most uneventfully heal.
Management consists of careful
cleaning, application of antibiotic
ointment, and observation.
Lacerations occasionally require
suturing.

Subcutaneous fat necrosis.

Irregular, hard, nonpitting, subcutaneous
induration with overlying dusky redpurple discoloration on the extremities,
face, trunk, or buttocks may be caused
by pressure during delivery.
No treatment is necessary. Subcutaneous
fat necrosis sometimes calcifies.

Caput
succedaneum
is oedema of the
presenting part
caused by pressure
during a vaginal
delivery. This is a
serosanguineous,
subcutaneous,
extraperiosteal
fluid collection
with poorly defined
margins, non
fluctuating

Cephalhematoma is
a subperiosteal
collection of blood
between the skull
and the periosteum.
It may be unilateral
or bilateral, and
appears within
hours of delivery as
a soft, fluctuant
swelling on the side
of the head. A
cephalhaematoma
never extends
beyond the edges
of the bone

Cranial X-ray of the girl with

cephalohematoma

Subgaleal hematoma is bleeding in the

potential space between the skull
periosteum and the scalp galea aponeurosis.
() Shock and pallor: tachycardia, a low blood
pressure,
within
30
minutes
of
the
haemorrhage the haemoglobin and packed
cell volume start to fall rapidly.
(ii) Diffuse swelling of the head. Sutures
usually are not palpable. The amount of
blood under the scalp is far more than is
estimated. Within 48 hours the blood tracks
between the fibres of the occipital and
frontal muscles causing bruising behind the
ears, along the posterior hair line and
around the eyes.

Intracranial hemorrhages.
Extradural (epidural)
Subdural
(i) Shock and/or anaemia due to blood
loss.
(ii) Neurological signs due to brain
compression, e.g. convulsions, apnoea,
a dilated pupil or a depressed level of
consciousness.
(iii) A full fontanelle and splayed sutures
due to raised intracranial pressure.

Subarachnoid hemorrhages
(SAH)
(i) Attacks of secondary asphyxia and
apnoe, irregular breathing, bradycardia.
(ii) Hyperestesia, tremor, seizures, bulging
of
fontanella.
Sunset
and
Grefe
symptoms are positive.
(iii) Changes of spinal fluid in lumbar
puncture: it becomes xanthochromic
or/and contains blood

Intraventricular (IVH)
hemorrhages

Periventricular hemorrhage, intraventricular

hemorrhage. Periventricular hemorrhagic
infarction (PVHI) on MRI.

Periventricular hemorrhage, intraventricular

hemorrhage. Severe or grade III hemorrhage
(subependymal with significant ventricular
enlargement) in ultrasonography.

Subconjunctival

hemorrhage

is
the breakage of small blood vessels in
the eyes of a baby. One or both of the
eyes may have a bright red band
around the iris. This is very common
and does not cause damage to the
eyes. The redness is usually absorbed in
a week to ten days.

Brachial plexus injury

Erb palsy (C5-C6) is most common and is
associated with lack of shoulder motion.
The involved extremity lies adducted,
prone, and internally rotated. Moro,
biceps, and radial reflexes are absent on
the affected side. Grasp reflex is usually
present.
Klumpke paralysis (C 7-8, T1) is rare and
results in weakness of the intrinsic
muscles of the hand; grasp reflex is
absent.
If cervical sympathetic fibers of the Th 1
are involved, Horner syndrome is present.

- This baby

presents with an
asymmetric
posture of the
arms.
- The left arm is not
flexed and hangs
limply.
- The baby
demonstrates the
findings of a leftsided ERB
PARALYSIS.

The total plexus palsy (Kerers

paralyses) is the most disturbing of
all. Its clinical features are:
adynamy
muscle hypotony
positive scarf symptom
Kofferate syndrom (C 3-4) is the
diaphragm paralysis. Because of
irregular breathing, cyanosis
pneumonia can be suggested
mistakenly.

Facial paralysis can be caused by

pressure on the facial nerves
during birth or by the use of
forceps during birth. The affected
side of the face droops and the
infant is unable to close the eye
tightly on that side. When crying
the mouth is pulled across to the
normal side.

Spinal cord injury incurred during

delivery results from excessive
traction or rotation.
failure to establish adequate
respiratory function,
the baby usually is posing as frog,
oscillation symptom is positive
(if to prick leg of the newborn
with needle leg will flex and
extense in all joints several
times).

The clavicle fracture is the most

frequently bone injure in the
neonate during birth and most often
is an unpredictable unavoidable
complication of normal birth. The
infant may present with
pseudoparalysis. Examination may
reveal crepitus, palpable bony
irregularity, and sternocleidomastoid
muscle spasm.
Desault's bandage should be used
for 7-10 days.

Conclusion
Recognition of trauma necessitates a
careful
physical
and
neurologic
evaluation of the infant to establish
whether additional injuries exist.
Occasionally, injury may result from
resuscitation. Symmetry of structure
and function should be assessed as
well as specifics such as cranial
nerve examination, individual joint
range of motion, and scalp/skull
integrity.