BIRTH

INJURIES

1
 DEFINITION

‹ Avoidable and unavoidable

mechanical
and anoxic trauma incurred by the
infant during
labour and delivery.
Injury may occur from inappropriate
or deficient
medical skill or attention, or may
occur despite
skilled and competent obstetric care,
independently
of any acts or omissions.

2
 PREDISPOSING
FACTORS.
• Macrosomia
‹ Prematurity/primiparity

‹ CPD/small mother
‹ Dystocia

‹ Prolonged labour
‹ Abnormal presentation
eg.breech, face
‹ Instrumentation

3
 SOFT TISSUE

‹ Bruising, petechiae/
ecchymoses
‹ Lacerations, abrasions

‹ Subcutaneous fat necrosis

Risks:forceps, C/S deliveries

‹ Subconjunctival and retinal
haemorrages:
Probably secondary to sudden
increase in intra-thoracic
pressure;
Requires no treatment.

4
 Scalp swellings

‹ Caput succedaneum
‹ Cephalhaematoma

‹ Subaponeurotic/subgaleal
haemorrhage

5
 CAPUT
SUCCEDANEUM
‹ A diffuse, oedematous swelling
of the soft tissues of the scalp
of the presenting part during
vertex delivery.
‹ May extend across the midline
and across suture lines.
‹ Oedema resolves in a few days
‹ When vacuum is used in
delivery, caput may become
haemorrhagic (haemorrhagic
caput or vacuum haematoma)-
round, reddish-purple, raised
swelling. Excoriation or blister
may be present.

6
CEPHALHAEMATOMA

‹ Haemorrhage situated between

skull bone and overlying
periosteum
‹ Always limited to 1 cranial
bone ie. does not cross suture
lines.
‹ Parietal bone is usually
involved
‹ No discolouration of surface
skin; visible some hours after
birth.
‹ Most are resorbed within 2 wks
-3months depending on size;
some may calcify and remain
as bony protuberances
‹ Occasionally, linear skull
7
fracture is present
‹ TREATMENT: NONE-
phototherapy may be
required in some cases to
reduce
hyperbilirubinaemia.
Incision and drainage is
contraindicated- risk of
introducing infection.
A massive cephalhaematoma
may require transfusion.

8
 Subaponeurotic/
subgaleal haemorrhage
‹ Extensive haemorrhage
below the epicranial
aponeurosis
‹ Risk factors: vacuum,
forceps delivery, prolonged
labour
‹ Haemorrhage not limited
by sutures so large area is
involved
‹ Associated features:
swelling of eyelids and
around the ears
‹ Shock and anaemia 9
INTRACRANIAL(INTRA
VENTRICULAR)
HAEMORRHAGE
‹ Causes: 1.Trauma 2.Asphyxia
3. Primary bleeding
disorder
4. Congenital vascular
malformation
‹ TRAUMA:-epidural, subdural,
or subarachnoid haemorrhage
‹ Risk factors: CPD, Prolonged
labour, breech delivery,
Precipitate delivery, Injudicious
mechanical interference eg
vacuum extraction, Premature
delivery

10
‹ Commonly intraventricular
especially in the preterms-
occurs in the germinal
matrix
‹ Risk factors: prematurity,
ischaemia, increased or
decreased blood flow

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 Clinical features

‹ Incidence is high in very

low birth weights,
‹ 80-90% of cases are
evident by 3rd day of life
‹ SYMPTOMS:-Poor muscle
tone, lethargy, apnoea,
shrill cry, diminished or
absent Moro reflex,
cyanosis, poor sucking,
twitching, convulsions etc.

12
 Diagnosis

‹ Ultrasound through the

anterior fontanelle
‹ 4 grades:
1-bleeding confined to the
germinal matrix or <10%
filling of the ventricle
2-bleeding filling 10-50%of
the ventricle
3- >50% with dilated
ventricles
4- G 3 plus involvement of
intraparenchymal lesions

13
 prognosis

‹ Deterrioration and death in

massive bleeds
‹ Post-haemorrhagic
hydrocephalus
‹ Neurological sequelae- CP

14
 Treatment

‹ Seizures are treated with

anticonvulsants
‹ Anaemia requires
transfusion
‹ Hydrocephalus may require

1) serial LPs-beware of
risk of infection
2) Neurosurgical shunt

15
PERIPHERAL NERVE
INJURIES
‹ Brachial plexus injury may
cause paralysis of the upper
arm with or without paralysis
of the forearm or hand.
‹ Risk factors: macrosomic
infants, shoulder dystocia-
lateral traction exerted on the
head and neck during delivery
of the shoulder in vertex
presentation; arms are
extended over the head in
breech; excessive traction on
the shoulders.

16
 ERB’S PALSY

‹ Injury to the 5th and 6th

cervical nerves.
‹ “Waiter’s/Porter’s tip” position:
adduction and internal rotation
of the arm with pronation of
the forearm.
‹ Power of extension of forearm
is intact but biceps reflex is
lost;
Moro reflex is absent on the
affected side.
‹ Presence of hand grasp is a
good prognostic sign.
‹ Treatment: Physiotherapy after
10-14 days after birth
17
 Klumpke’s paralysis

‹ Injury to C7,8 and T1nerves

‹ Paralysis of hand with clawing;
if there is ipsilateral ptosis
and miosis (Horner syndrome)
then sympathetic fibres of T1
are involved.
‹ Prognosis: 1. Return of
function if oedema or
haemorrhage- may take
months
2. laceration:- permanent
damage
Treatment : Partial
immobilization and appropriate
positioning;
Gentle massage and range of 18
motion exercises started 7-10
 INJURY TO VISCERA

‹ LIVER:-Pressure on the organ

during delivery of the head in
breech presentations.
Infant may be usually normal 1-
3days after birth
Non-specific signs:-poor feeding,
listlessness, pallor, jaundice,
tachypnoea, tachycardia,
palpable R Upper Quadrant
mass
Treatment: Surgical repair
SPLEEN:May occur alone or in
association with rupture of the
liver.
Causes, treatment-similar to that
in liver. 19
 FRACTURES

‹ CLAVICLE: The most fractured

bone during delivery; mostly
during delivery of the shoulder
in vertex and of the extended
arms in breech
Signs:-no free arm movement
on affected side
-crepitus and bony
irregularity
-Moro reflex may be
absent
Excellent prognosis
Treatment(if any)-immobilization
of arm and shoulder
A remarkable degree of callus
forms within a week and may 20
be the first sign of the fracture.
 LONG BONES

‹ Humerus: big babies, CPD,

Shoulder
dystocia- are risk factors
Mgt:
2wks of immobilization with arm
strapped to the chest.
‹ Strap upper arm to the chest
wall using a bandage
‹ Flex the elbow at 900 and strap
the forearm across the
abdomen using a separate
bandage

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‹ Femur: risk factors: breech,
macrosomia
Treatment: 1. Skin traction
(GALLOW’S
traction/suspension) of lower
extremities for 2 weeks
2. Splinting of femur:
- strap the splint from waist
to below the knee and apply a
bandage around the waist and
from the thigh to below the
knee.
- ? advantages of splinting
over Gallows:
CAUTION in
strapping/gallows:….? 22
‹ Forearm/leg -splints are