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
- Lacerations hemorrhage
- Subcutaneous fat - Linear fractures
necrosis - Intracranial
hemorrhages
 Face Cranial nerve and
- Subconjunctival spinal cord injuries
hemorrhage - Facial palsy
- Retinal hemorrhage
Musculoskeletal
Peripheral nerve injuries
- Brachial plexus - Clavicular fractures
palsy
- Unilateral vocal - Fractures of long
cord paralysis bones
- Radial nerve palsy - Sternocleido-
- Lumbosacral plexus mastoid injury
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 red-
purple 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.
(і) 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 left-
sided ERB
PARALYSIS.
 The total plexus palsy (Kerer’s
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.