BIRTH INJURIES

BIRTH INJURIES

Predisposing factors:
macrosomia, prematurity, cephalopelvic disproportion, prolong labor and breach presentation.

Cranial Injuries:

Either extracranial or intracranial.
-Extracranial
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.





Caput Succedaneum

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 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.

cephalhematoma

Subgaleal Hemorrhage:
Blood accumulate between the epicranial aponeurosis of the scalp
and the periosteum. It is usually severe bleeding with a fatality rate of
up to 20% of cases.

Intracranial Injuries:

Intracranial hemorrhage which may result from:
Trauma and it is either epidural, subdural or subarachnoid
hemorrhage, it occur when there is cephalopelvic disproportion,
prolonged labor, breach delivery, or in mechanical intervention.

Fractures of the skull:

linear skull fractures are the most common, causing no symptoms and requires no treatment.

Depressed fractures by the use of forceps in 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.

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.

Visceral Injuries:

The liver is ruptured and there is formation of subcapsular hematoma
which may tamponade furthur bleeding. The infant appears normal in the initial 1-3 days non specific 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:
It is the commonest bone fracture during labor, 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.