FETAL BIRTH INJURIES
• Fetal birth injuries represent an important
commonly avoidable cause of neonatal morbidity
and mortality. They vary from minor skin
abrasions to severe intracranial haemorrhage.
Prevention of serious birth trauma depends
mainly upon the art of obstetrics and the
experience of the obstetrician, and is considered
a reflection of the improvements in antenatal
and perinatal care.
TYPES OF FETAL BIRTH
Difficult forceps delivery.
Delivery through a contracted pelvis.
Fracture vault: linear or depressed (associated with intra-
cranial haemorrhage so needs surgical intervention).
Fracture base: usually associated with intra-cranial
2-Others bone injuries:
• Spine injuries.
• Fracture humerus
• Fracture femur.
• Fracture clavicle.
• Dislocation of hip.
• Dislocation of shoulders
Soft tissue birth injuries
1-Intra-cranial haemorrhage over compression of cranial
2-Cephalhaematoma (instrumental trauma especially
3-Nerve Injuries (undue traction on neck, shoulders, and
4-Visceral and Muscle Injuries.
6-Injury of hymen, or anal sphincter especially in breech
presentation, during examination.
7-Skin and scalp Injuries by the scalpel on opening the
uterus in a C.S.
• Prematurity, due to:
Fragile blood vessels.
Increased susceptibility to birth trauma.
• Breech delivery: due to sudden
compression and decompression of cranial
• Excessive compression, due to:
Excessive moulding, in cases of cephalopelvic
Excessive compression by forceps (oblique
application or persistent locking).
• Asphyxia: leads to hypoxia of the walls of
blood vessels with subsequent leakage.
• Hemorrhagic disease of the newborn.
Sites of Haemorrhage:
• Intra-ventricular haemorrhage.
• Intra-cerebral haemorrhage.
• Subdural haemorrhage.
• Subarachnoid haemorrhage
• Subdural and subarachnoid
haemorrhages usually develop with
• The vein of Galen is torn due to tear in
dura at jnction of falx cerebri with
tentorium cerebelli (that results from
excessive moulding due to increased
antero-posterior diameter of the head)
• Stillbirth or neonatal asphyxia.
• Drowsy, refuse suckling with sudden
• Convulsions and rigidity.
• Tense bulging anterior fontanelle.
• Asphyxia neonatorum.
• Neonatal convulsions
• Investigations: Brain CT scan.
• Breech delivery: see breech presentation.
• Premature delivery: see prematurity.
• Vitamin K for the mother (10 mg IM early
in labour when we suspect difficult
• Careful forceps application.
• Resuscitation with minimal handling.
• Chloral hydrate, Magnesium sulphate 50% 1 cc
• NaCl per rectum for edema.
• Dehydrating measures even lumbar puncture.
• Vitamin K for the fetus (1 mg IM).
• N.B.: Penicillin is used for prophylaxis
3. NERVE INJURIES
• . Facial Nerve Palsy .
• Brachial Plexus Injury
Facial nerve palsy
Compression of the nerve by blade of forceps results in
edema and haematoma around the nerve.
• Clinical picture: unilateral and temporary
Absent nasolabial fold.
Angle of the mouth is deviated to the healthy side.
Absent blinking on the affected side.
Conservative management. May need corticosteroids.
Bracial plexus injury
Forcible lateral flexion of the head during
delivery causes damage of the roots of
brachial plexus (edema and haematoma
around the nerves).
Bracial plexus injury
• Upper injury (Erb’s palsy):
• Injury to C5 and C6.
Characters: Policeman tip position:
• The affected limb is adducted to the body
and internally rotated.
• Elbow is extended.
• Wrist is flexed.
Bracial plexus injury
– Lower injury (Klumpke's palsy):
• Injury to C7, C8 and T1.
• Wrist drop.
• Absent grasp reflex.
• Paralysis of small muscles of hands
Brachial plexus injury
• Upper injury (Erb's palsy):Fixation of the
affected limb in pharaoh’s position.
• Lower injury (Klumpke’s palsy):
Rarely, it may need plastic correction.
4. VISCERAL AND MUSCLE
• Visceral Injury:
e.g. liver, spleen.
It may occur during breech delivery
Muscle Injury: (Especially
• Cause: due to forcible traction on the
head ® (tilting of the head towards the
• Clinical picture: It may subside or cause
• Treatment: by passive stretching of
muscle several times/day
Cepalhaematoma ( subperiosteal )
• Cause • Forceps or ventouseDifficult
delivery through contracted
• Appearance • Few hours after birth
• Edges • Well defined
• Sutures • Normal
• Complications • No overlap & limited to one
• Treatment • infection and hyper-
• Expectant treatment
(disappears within few
• Cause • Obstructed labour
• Appearance • At birth
• Edges • ILL defined
• Skin • May be ecchymotic
• Sutures • Overlap sutures and
cover more than 1
• Treatment • No treatment
• Complications • (disappears after 1 -2