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    BIRTH INJURIES Final

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    Alvin Omondi
    This document discusses various types of birth injuries, including their definition, incidence, predisposing factors, and management. It describes cranial injuries like bruising, hematomas, and hemorrhages. Nerve injuries including brachial plexus palsies and phrenic nerve paralysis are covered. Skeletal injuries especially clavicle fractures are common. Muscle tears and organ injuries to the liver, spleen, and adrenals from difficult deliveries are also addressed. Congenital injuries such as amniotic band syndrome and postural deformities from oligohydramnios are mentioned.

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    BIRTH INJURIES Final

    Uploaded by

    Alvin Omondi
    98 views48 pages
    This document discusses various types of birth injuries, including their definition, incidence, predisposing factors, and management. It describes cranial injuries like bruising, hematomas, and hemorrhages. Nerve injuries including brachial plexus palsies and phrenic nerve paralysis are covered. Skeletal injuries especially clavicle fractures are common. Muscle tears and organ injuries to the liver, spleen, and adrenals from difficult deliveries are also addressed. Congenital injuries such as amniotic band syndrome and postural deformities from oligohydramnios are mentioned.

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    BIRTH_INJURIES_final[1]

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    This document discusses various types of birth injuries, including their definition, incidence, predisposing factors, and management. It describes cranial injuries like bruising, hematomas, and hemorrhages. Nerve injuries including brachial plexus palsies and phrenic nerve paralysis are covered. Skeletal injuries especially clavicle fractures are common. Muscle tears and organ injuries to the liver, spleen, and adrenals from difficult deliveries are also addressed. Congenital injuries such as amniotic band syndrome and postural deformities from oligohydramnios are mentioned.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    98 views48 pages

    BIRTH INJURIES Final

    Uploaded by

    Alvin Omondi
    This document discusses various types of birth injuries, including their definition, incidence, predisposing factors, and management. It describes cranial injuries like bruising, hematomas, and hemorrhages. Nerve injuries including brachial plexus palsies and phrenic nerve paralysis are covered. Skeletal injuries especially clavicle fractures are common. Muscle tears and organ injuries to the liver, spleen, and adrenals from difficult deliveries are also addressed. Congenital injuries such as amniotic band syndrome and postural deformities from oligohydramnios are mentioned.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 48

    BIRTH INJURIES

    OBJECTIVES
    1. Definition
    2. Incidence
    3. Predisposing factors
    4. Types of birth injuries
    5. Discussion of the various types and
    their management.
    Definition
    The term birth injury is used to
    denote:
    avoidable and unavoidable
    mechanical, hypoxic and
    ischemic injury affecting the
    infant during labor and
    delivery.
    Cont..
    • Birth injuries may result from:
    -Inappropriate or deficient
    medical skill or attention.
    -They may occur, despite skilled
    and competent obstetric care.
    Incidence
    • Has been estimated at 2-7/1,000 live
    births.
    Incidence importance:
    • 5-8/100,000 infants die of birth
    trauma
    • 25/100,000 die of anoxic injuries
    Overall, such injuries represent 2-3% of
    infant deaths.
    Predisposing factors:

    • Macrosomia
    • Prematurity
    • Cephalopelvic disproportion
    • Dystocia
    • Prolonged labor
    • Breech presentation
    Types
    I - Cranial Injuries
    II- Nerve Injuries
    III – Skeletal & Muscle Injuries
    IV – Organ injuries
    V – Congenital Injuries
    Cranial Injuries
    Erythema, abrasions, ecchymosis

    • Of facial or scalp soft tissues may be


    seen after forceps or vacuum-
    assisted deliveries.
    • Their location depends on the area of
    application of the forceps.
    Subconjunctival ,retinal hemorrhages and
    petechial of the skin of the head and neck

    • All are common and are secondary to a


    sudden increase in intrathoracic pressure
    during passage of the chest through the birth
    canal.
    • Parents should be assured that they are
    temporary and the result of normal hazards
    of delivery.
    Molding
    • Molding of the head and overriding
    of the parietal bones are frequently
    associated with caput succedaneum.
    • It becomes more evident after the
    caput has receded but disappear
    during the first weeks of life.
    Caput succedaneum
    • Diffuse, sometimes ecchymotic, edematous
    swelling of the soft tissues of the scalp
    involving the portion presenting during
    vertex delivery.
    • It may extend across the midline and across
    suture lines and may contain blood, serum
    or both.
    • No specific treatment is required and the
    edema disappears within the first few days
    of life.
    Cont..
    Cephalohaematoma
    • It is a sub periosteal
    hematoma most commonly
    lies over one parietal bone.
    • It may result from difficult
    vacuum or forceps delivery..
    Cont..
    Cephalohaematoma
    Management:
    - It usually resolves spontaneously.
    - Vitamin K 1 mg IM is given.
    - Phototherapy if jaundiced
    Cephalohematoma

    • Most cephalohematomas are


    resorbed within 2 wk-3 mo,
    depending on their size.
    • They may begin to calcify by the end
    of the 2nd wk.
    Diagnosis and Differential Diagnosis
    Intracranial hemorrhage
    Sites:
    • Subdural
    • Subarachnoid
    • Intraventricular
    • Intracerebral
    Peripheral Nerve
    Injuries
    Brachial Plexus Palsy:
    It is due to over traction on
    the neck in:
    1. Shoulder dystocia.     
    2. After-coming head in breech
    delivery.
    Brachial Plexus Palsy:
    (1)Erb's palsy:
    • It is common and is due to injury to C5
    and C6 roots (occasionally C7)
    • The upper limb drops beside the trunk,
    internally rotated, adducted with flexed
    wrist (policeman’s or waiter’s tip hand).
    • The scapula adopts an abnormal position
    known as ‘winging’ scapula
    Cont..
    Brachial Plexus Palsy:
    (2) Klumpke’s palsy:
    - It is less common,
    - Due to injury to C7, C8 and 1st
    thoracic roots.
    - It leads to paralysis of the
    muscles of the hand and
    weakness of the wrist and
    fingers' flexors.
    Cont..
    • elbow becomes flexed
    and forearm supinated
    (opened up, palm-
    upwards)
    “claw like deformity “
    • Sensation in the palm
    of the hand is
    diminished
    Brachial Plexus Palsy:
    Treatment
    • Support to prevent stretching
    of the paralyzed muscles.
    • Physiotherapy: massage,
    exercise and faradic
    stimulation.
    PHRENIC NERVE PARALYSIS
    • Phrenic nerve injury (3rd, 4th, 5th
    cervical nerves) with diaphragmatic
    paralysis must be considered when
    cyanosis and irregular and labored
    respirations develop.
    • Such injuries, usually unilateral, are
    associated with ipsilateral upper
    brachial palsy.
    Facial Nerve Palsy
    • Incidence: < 1 to 7.5 per 1000 term births
    • Pressure on the facial nerve as it emerges
    from the stylomastoid foramen
    • Maybe apparent at delivery or may
    develop shortly after birth
    • Spontaneous recovery within a few days
    is the rule.
    Cont..
    Skeletal Injuries
    CLAVICLE
    This bone is fractured during labor and
    delivery more frequently than any
    other bone;
    It is particularly vulnerable when there is:
    1. Difficulty in delivery of the shoulder in
    vertex presentations and of
    2. The extended arms in breech
    deliveries.
    CLAVICLE
    • Treatment, consists of
    immobilization of the arm and
    shoulder on the affected side.
    • A remarkable degree of callus
    develops at the site within a week
    and may be the first evidence of
    the fracture.
    • The prognosis is excellent.
    Others
    • Humerus
    • Femoral
    • Skull
    • Mandibular
    Muscular Injuries
    Sternocleidomastoid muscle

    –during breech delivery


    –or internal podalic version
    • will lead to tear of the muscle or
    facial sheath leading to
    hematoma & gradual contraction
    producing torticollis later in life
    Organ Injuries
    Cont..
    • Rupture of the liver: liver- large infants,
    IDM,breech
    • Rupture of the spleen: Large infants in breech
    position, erythroblastosis, congenital syphilis
    or underlying clotting defect
    • Adrenal hemorrhage: Macrosomic, IDM, cong
    syphilis, neuroblastoma, hemorrhagic disease
    Treatment: stabilize the baby, blood transfusion,
    laparotomy to evacuate the blood clots.
    Congenital Injuries
    1. Amniotic band syndrome

    –Focal ring constriction of the


    extremities & actual loss of digits
    or a limb
    2. Congenital postural deformities

    • Mechanical factors:
    – chronic oligohydramnios
    – inappropriate size & shape of the
    uterine cavity
    – produce deformities such as talipes,
    scoliosis, hip dislocation, limb
    reduction, body wall defects,
    hypoplastic lung
    Cont..

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