Birth trauma, BT

Notes
  • Birth trauma (BT) occurs when tissues/organs of a newborn child are damaged by physical pressure during childbirth. It may lead to long-term consequences such as loss of a cognitive nature and damage to the brain or cranium
  • Statistics: BT constitutes about 2% of all infant deaths. it is the 14th cause of deaths in Kenya.
  • Predisposing factors to BT during delivery include: fetal macrosomia (a newborn who's significantly larger than average i.e. > 4,000gm), obesity of the mother, shoulder dystocia (where presentation is vertex, but the anterior fetal shoulder is lodged (behind the symphysis pubis after delivery of the fetal head), forceps instruments, vacuum extraction, prolonged or too short labor, maternal pelvic anomalies, large fetal head, oligohydramnios (inadequate amniotic fluid), deep, transverse arrest of descent of presenting part of the fetus, small maternal stature, and skills of obstetrician.
Symptoms

##Caput succedaneum

  • Subcutaneous serosanguineous fluid collection beneath the scalp as a result of pressure against the mother’s cervix during labor
  • It manifests as a soft, puffy swelling on the scalp specifically along the suture line.
  • This is a self-limiting condition.

##Cephalohematoma

  • It is hemorrhage of blood between the skull and the periosteum due to rupture of blood vessels crossing the periosteum
  • It is common in the vacuum-(ventouse) assisted delivery / vacuum extraction or in a prolonged labour
  • When severe, it can lead to jaundice, anemia and/or hypotension.
  • It tends to take a long time to resolve.

##Subgaleal hemorrhage

  • It is common in the vacuum (ventouse) assisted delivery / vacuum extraction due to the rupture of the emissary veins leading to accumulation of blood under the aponeurosis of the scalp muscle and superficial to the periosteum
  • It manifests as a swelling on the scalp that is not limited by suture line.
  • Occasionally, it can be extensive causing anemia and jaundice.

##Midclavicular fracture

  • It is the most common fracture during birth with a global prevalence of 0.2-3.5% of all deliveries.
  • The neonate appears irritated and unable to move the affected arm even when the Moro reflex is elicited.
  • This fracture is treated by immobilizing the arm for 14 days. Prognosis tends to be good.

##Fractures of femur and humerus

  • Affected limb(s) are swollen and painful
  • There are signs of pseudo-paralysis
  • It is the 2nd most common fracture during birth
  • These fractures have good prognosis at long-term follow-up

##Soft tissue injuries

  • Edema and ecchymosis (that is the escape of blood into the tissues from ruptured blood vessels often after injury) particularly of the periorbital and facial tissues in face presentations and of the scrotum or labia in breech deliveries.

##Facial nerve injury

  • It is the most common nerve injury during delivery
  • Injuries are mainly due to forceps pressure and due to fetal positioning in utero e.g. fetus lying next to fibroids, the head lying against the shoulder and sacral promontory
  • It is manifested by lack of movement of the facial muscles on the affected side.
  • Mandibular asymmetry can occur
  • The effects of these injuries tend to resolve after 2-3 months.

##Brachial plexus injury

  • Brachial plexus injury is caused by lateral stretching of the neck during delivery as the result of shoulder dystocia, breech extraction, or hyperabduction of the neck in cephalic presentations
  • The most common brachial plexus injury is Erb palsy, which is the injury of an upper brachial plexus (C5 to C7). It causes adduction and internal rotation of the shoulder with pronation of the forearm. Occasionally the biceps reflex cannot be noted and the Moro reflex is asymmetric.

##Other types of birth injuries include;

  • Subdural hemorrhage
  • Subarachnoid hemorrhage
  • Intraventricular and/or intraparenchymal hemorrhage
  • Epidural hematoma
  • Peripheral nerves
  • Phrenic nerve injuries
  • Klumpke palsy
  • Intra-abdominal injury of organs like liver
  • Intracranial injury
  • Intrathoracic injury
  • Severe scalp bleeding
  • Massive edema
Diagnosis
  • Clinical review
  • X-ray of the affected limb
  • Ultra-sound of cranium and abdomen
  • Complete Blood Count (FBC)
Differential
  • None
Prevention
  • Accepting alternative of cesarean delivery when natural birth is risky
  • Comprehensive antenatal care
  • Use of qualified staff in obstetrics
Management
  • Most types of injuries (such as Caput succedaneum, cephalohematoma, massive edema and scalp bleeding) resolve without treatment
  • Physiotherapy in case of nerve damage
  • Align and immobilize the fracture
  • Subdural drainage, if required
Drug Index 2.0 is here
Our new update features a more powerful search feature and easier login. Having any issues? Contact us today. Contact Us