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Birth Injuries: Dr. Alsayed Alsharkawy Senior Pediatric Lecturer Widad University College

This document discusses birth injuries that may occur during delivery. It notes that 0.7% of births result in injuries, accounting for under 2% of neonatal deaths. Injuries can be caused by mechanical forces during delivery and are more likely with certain risk factors like primiparity, large infant size, or difficult delivery. Injuries are classified and can include soft tissue damage, skull fractures, facial or nerve damage. Common injuries described in more detail include brachial plexus injuries, facial paralysis, and sternocleidomastoid injury. Diagnosis involves examination and imaging while most soft tissue injuries require only cleaning; more serious injuries may need splinting, surgery, or physical therapy.

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Ellis Nabila
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192 views35 pages

Birth Injuries: Dr. Alsayed Alsharkawy Senior Pediatric Lecturer Widad University College

This document discusses birth injuries that may occur during delivery. It notes that 0.7% of births result in injuries, accounting for under 2% of neonatal deaths. Injuries can be caused by mechanical forces during delivery and are more likely with certain risk factors like primiparity, large infant size, or difficult delivery. Injuries are classified and can include soft tissue damage, skull fractures, facial or nerve damage. Common injuries described in more detail include brachial plexus injuries, facial paralysis, and sternocleidomastoid injury. Diagnosis involves examination and imaging while most soft tissue injuries require only cleaning; more serious injuries may need splinting, surgery, or physical therapy.

Uploaded by

Ellis Nabila
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Birth

Injuries
Dr. ALSAYED
ALSHARKAWY
Senior Pediatric Lecturer
Widad University College
Birth Injuries
BIRTH INJURIES

• An impairment of the infants


body function or structure due Aruna. A P
I Year MSc Nursing

to adverse effects that occur at


birth

• Injuries to the infant may result


from mechanical forces (i.e.,
compression, traction) during
the birth process
Birth Injuries
• 0.7% (Seven of every 1,000)
births result in birth injuries. BIRTH INJURIES

Aruna. A P
I Year MSc Nursing

• Birth injuries account for fewer


than 2% of neonatal deaths
Factors predisposing to injury
include the following
• Primiparity
• Maternal Short Stature
• Maternal pelvic anomalies
• Prolonged or unusually rapid labor
• Oligohydramnios
• Malpresentation of the fetus (breech)
• Cephalopelvic disproportion
Factors predisposing to injury
include the following
• Instrumental delivery
• Very low birth weight or
extreme prematurity
• Fetal macrosomia birth weight
over about 4 Kg
• Fetal macrocephali (Large head)
CLASSIFICATION OF BIRTH
INJURIES

• Soft tissue injuries


• Head and neck injuries
• Facial injuries
• Cranial nerve injuries
• Spinal cord injuries
• Peripheral Nerve injury
• Fractures - Torticollis
• Intra-abdominal injury
CLASSIFICATION OF BIRTH
INJURIES
Soft tissue
- Abrasions Peripheral nerve
- Erythema petechia - Brachial plexus palsy
- Ecchymosis - Unilateral vocal cord
- Lacerations paralysis
-Subcutaneous fat - Radial nerve palsy
necrosis
Skull -Lumbosacral plexus injury
- Caput succedaneum Musculoskeletal injuries
- Cephalohematoma - Clavicular fractures
- Subgaleal hemorrhage - Fractures of long bones
Linear fractures
--Intracranial
-Sternocleido-mastoid injury
Face
hemorrhages Intra-abdominal injuries
- Subconjunctival - Liver hematoma
-Retinal
hemorrhage
Cranial
hemorrhage nerve & spinal cord - Splenic hematoma
injuries - Adrenal hemorrhage
- Facial palsy
- Renal hemorrhage
SOFT TISSUE INJURIES

- Abrasions
- Erythema petechia
- Ecchymosis
- Lacerations
- Subcutaneous fat
necrosis
Abrasions and lacerations

May occur as scalpel cuts during Cesarean


delivery or during instrumental delivery
(i.e, vacuum, forceps)

Management
Careful cleaning, application of
antibiotic ointment, and
observation
Lacerations occasionally require
suturing
Subcutaneous fat necrosis
Irregular, hard, non pitting,
subcutaneous induration
May be caused by pressure
during delivery.

No treatment is necessary
Subcutaneous fat
necrosis sometimes
calcifies
SKULL INJURIES

- Caput succedaneum
- Cephalohematoma
- Subgaleal hemorrhage
- Skull fractures (Linear-
Depressed)
- Intracranial hemorrhages
Caput succedaneum

• Oedema of the presenting


part caused by pressure
during a vaginal delivery

• This is a bloody, subcutaneous,


extraperiosteal fluid collection
with poorly defined margins,
non fluctuating
Cephalhematoma
• 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 or crosses
suture lines
Cranial X-ray of the girl with
Cephalohematoma
Intracranial hemorrhages
Intracranial hemorrhages
• Bleeding can occur
– External to the brain into the epidural, subdural or subarachnoid
space
– In to the parenchyma of the cerebrum or cerebellum
– Into the ventricles from the subependymal germinal matrix or
choroid plexus

• Intracranial haemorrhage
• Epidural hemorrhage
• Subdural hemorrhage
• Subarachnoid hemorrhage
• Intraparenchymal haemorrhage
• Germinal matrix hemorrhage / intraventricular haemorrhage
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
Intracranial hemorrhages

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.
Severe or grade III hemorrhage (subependymal with
significant ventricular enlargement) in ultrasonography.
FACIAL INJURIES

- Subconjunctival
hemorrhage

-Retinal hemorrhage

-Nasal septal dislocation


Subconjunctival hemorrhage

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
PERIPHERAL NERVE
INJURIES

- Brachial plexus palsy


- Phrenic nerve injury
- Laryngeal nerve injury
(unilateral vocal cord
paralysis)
- Radial nerve palsy
-Lumbosacral plexus
Brachial plexus injury
• Erb-Duchenne palsy
(C5-C6) common
phrenic N (C3-5)
• Klumpke palsy
(C 7-8, T1)
rare
Horner syndrome (T1 S)
Sternocleidomastoid Hem
vs clavicle fracture
Brachial plexus injury

Risk factors
Macrosomia
Shoulder
dystocia
Instrumental deliveries
Malpresentation
Brachial plexus injury
• Erb-Duchenne palsy (C5-C6)
• The most common
• 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.

• Erb’s palsy may be associated with injury


to
the phrenic nerve, innervated with
fibers from C3–C5
- This baby presents with an
asymmetric posture of the arms.
• The left arm is not flexed and hangs
limply. Adduction and internal rotation
of the arm with pronation of the
forearm.
• Biceps reflex is absent
• Moro reflex is absent
• Grasp reflex is present
• The involved arm is held in the ‘‘waiter’s
tip’’ position, with adduction and
internal rotation of the shoulder,
extension of the elbow, pronation of
the forearm, and flexion of the wrist
and fingers.
Brachial plexus injury
• Klumpke paralysis (C 7-8, T1)
Rare
Weakness of the intrinsic muscles of
the hand; and long flexors of the wrist
and fingers (clawing)
Grasp reflex is absent
Biceps reflex is present
• If cervical sympathetic fibers of the Th
1 are involved, Horner syndrome is
present (ptosis, miosis, and
anhydrosis).
• Hematomas of the sternocleidomastoid
muscle, and fractures of the clavicle
and humerus.
Brachial plexus injury
Diagnosis & Management

• Physical examination.
• Radiographs of the shoulder and upper arm
• Initial treatment is conservative.
• The arm is immobilized across the upper abdomen &
elevated in abduction external rotation of shoulder during
the first week
• Physical therapy with passive range-of-motion exercises at
the shoulder, elbow and wrist should begin after the first
week.
• Infants without recovery by 3 to 6 months of age may
be considered for surgical exploration and repair
CRANIAL NERVE
& SPINAL CORD
INJURIES

-Facial
palsy
-Spinal
cord
injuries
-
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.
• protection of the involved eye by
application of artificial tears to prevent
corneal injury.
• neurosurgical repair of the nerve should
be considered only after lack of
resolution during 1 year of conservative
Sternocleido-mastoid injury
Congenital muscular torticollis
• atrophic muscle fibers • The head is tilted toward the
surrounded by collagen side of the lesion and rotated
and fibroblasts. to the contralateral side,
• tearing of the muscle • chin is slightly elevated.
fibers or fascial sheath • If a mass is present, it is firm,
with hematoma formation spindle-shaped, immobile, and
and subsequent fibrosis. located in the midportion of
the sternocleidomastoid
muscle, without accompanying
discoloration or inflammation.
Sternocleido-mastoid injury
Congenital muscular torticollis
• DIAGNOSIS
• physical examination
• Radiographs should
be obtained to rule
out abnormalities of • TREATMENT
the cervical spine.
• Ultrasonography may be
• active and
useful both passive
diagnostically and stretching
prognostically. • Surgery < 2years
THANK YOU

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