Birth Injury

DEFINITION

 Injuries to the infant resulting from

mechanical forces during birth
(compression, traction)
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
PREDISPOSING FACTORS
 Primigravida  Abnormal presentation
(breech/face)
 Cephalopelvic
disproportion  Use of forceps or vacuum
extraction
 Small maternal stature
 VLBW infant or extreme
 maternal pelvic anomalies
prematurity
 Prolonged or rapid labor  Macrosomia
 Arrest of descent of  Large fetal head
presenting fetal part
 Fetal anomalies
 Oligohydramnios
 Fetal neuromuscular disease
 Resuscitation with CPR
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)
 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
 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.
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.
CAPUT SUCCEDANEUM
SUBAPONEROTIC
HAEMORRHAGE
 It is a condition, in which bleeding occurs below the
epicranial aponeurosis. It is usually associated with
vaccum extraction.
 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.
 Treatement:

- It is absorbed, so no treatement but the baby should

be observed for signs of;

 hyperbilirubinemia.
 Aneamia.
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.
 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.
 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.
 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.
NERVE INJURY

 Facial nerve injury.

 Brachial plexus injury.
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.

 Treatement :
- No treatment is required.
- Only cellulose eye drops in case eyelids open.

- Spontaneous improvement occur in 7- 10 days.

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

- simple oxygen therapy to intermittent positive

pressure ventilation.

Complication:
- Hypostatic pneumonia.
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.
SOFT TISSUE INJURY
 Injury to superficial tissues:
- Bruising & excoriation.
- Eyelids & lips oedematous.

Treatment:
. No treatment unless complications.
. Reassurance to mother complications.
 Injury to liver & spleen:
injury to liver

subscapular haematoma

decreased hematocrit & haemaglobulin

Treatment :
- Immediate resuscitative measures.
- Restoration of circulatory volume.
 Renal injury:
- It leads to massive haemorrhage – lead to circulatory
collapse.
Diagnosed: by ultrsound

Treatement :
- Supportive treatement.
- If required blood transfusion.
 Intestinal injury:
- Result in coagulopathy.
- Bleeding per rectum.
- Anaemia & feeding difficulties.
Treatement :
. I / V fluids.
. Nasogastric suction.

. Hematoma usually resolves.

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.
TYPES :

1. Tearing of muscle.
2. Impaired blood supply.

Treatment :
. Swelling resolves over several weeks.
. Muscle stretching exercises.
. Sleep on opposite side of injury.
SKIN INJURY

 Bruising or subcutaneous fat necrosis-

usually on face.
 In case of abscess – incision &
antibiotics.
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.
 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.