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Fifth stage
Pediatric
Lec. 4
د. بسام
7/12/2016
BIRTH INJURIES
Predisposing factors
macrosomia, prematurity, cephalopelvic disproportion, prolong labor and breach
presentation.
Cranial Injuries
Caput succedaneum:
Is a diffuse sometimes ecchymotic edematous swelling of the soft tissues of the scalp
involving the portion presenting during labor. It appear during the first hours or
immediately after birth.
It may extent across the midline & across the suture lines.
The edema disappear during the 1st few days of life. No specific treatment is needed.
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Cephalhematoma:
Is a subperiosteal hemorrhage, it is always limited to the surface of one cranial bone, it
does not cross the suture lines. No discoloration of the overlying scalp. the swelling starts
after several hours after birth. Occasionally an underlying linear skull fracture is associated
with cephalhematoma.
It takes 2wks to 3 mo to be resorbed.
No treatment is needed but may be phototherapy to ameliorate hyperbilirubinemia.
A massive cephalhematoma may rarely result in blood loss severe enough to require
transfusion.
Fractures of the skull:
linear skull fractures are the most common cause no symptoms and requires no treatment.
Depressed fractures by the use of forceps delivery, it is advisable to elevate severe
compression to prevent cortical injury from sustained pressure.
Eye Injuries
Subconjunctival and retinal hemorrhage are frequent.
Skin:
petechiae of the skin of the head and neck are common.
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Peripheral Nerves Injuries:
Erb’s palsy: is an injury to C 5,6, there is failure of abduction of the arm from the shoulder
inability for external rotation of the arm and to supinate the forearm. The characteristic
position is adduction and
internal rotation of the arm and pronation of the forearm.
The biceps reflex is absent. The Moro reflex is absent on the affected side.
Klumpks paralysis
It is rare injury to C 7, 8 and T1. It produce a paralyzed hand and ipsilateral ptosis and
meiosis if the sympathetic fibers of T1 are injured.
Phrenic nerve paralysis
C 3, 4, 5 injury result in dyspnea, cyanosis and irregular breathing.
Facial nerve injury:
results from pressure over the facial nerve in utero, from efforts during labor, or from
forceps during delivery,rarely it is due to nuclear agenesis of facial nuclei.
When the infant cry:
there is movement only on the non paralized side of the face, and the mouth is drawn to
that side. On the affected side the forehead is smooth, the eye cannot be closed, the
nasolabial fold is absent.
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Visceral Injuries:
The liver is ruptured and there is formation of sub capsular hematoma which may
tamponade further bleeding. The infant appears normal in the initial 1-3 days nonspecific
signs related to loss of blood in the hematoma may appear as poor feeding irritability,
pallor, jaundice, tacchypnea, and tacchycardia.
A mass may be palpable in the right hypochondrium and abdomen may appear blue, the
hematoma may be large enough to cause anemia.
Shock and death may occur if the hematoma breaks into through the capsule into the
peritoneal cavity.
Rupture of the spleen may also occur alone or in association with the liver.
Fractures
Clavicles: usually results when there is difficulty in the delivery of the shoulder in vertex
presentation and of the extended arms in breach deliveries. The baby is unable to move the
arm freely on the affected side, bony irregularity may be palpated, occasionally
discoloration may be visible over the fracture side. The Moro reflex is absent on the
affected side.
Extremities: fracture of the humerus and the femur, spontaneous movement and Moro
reflex is absent on the affected extremity.
Intracranial hemorrhage
Intracranial hemorrhage may result from :
Trauma and it is usually epidural, subdural or subarachnoid hemorrhage, it occur when
there is cephalopelvic disproportion ,prolonged labor, breach delivery, or in mechanical
intervention .