-FETAL BIRTH INJURIES

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					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
INJURIES
Bone injuries:
1-Skull fracture:
•   Etiology:
Difficult forceps delivery.
Delivery through a contracted pelvis.
•   Types:
Fracture vault: linear or depressed (associated with intra-
    cranial haemorrhage so needs surgical intervention).
Fracture base: usually associated with intra-cranial
    haemorrhage.
Fracture mandible
Bone injuries

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
     bones).
2-Cephalhaematoma (instrumental trauma especially
     ventouse).
3-Nerve Injuries (undue traction on neck, shoulders, and
     arms).
4-Visceral and Muscle Injuries.
5-Eye Injury.
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.
          INTRA-CRANIAL
          HAEMORRHAGE
AETIOLOGY:
• Prematurity, due to:
Fragile blood vessels.
Hypoprothrombinaemia.
Increased susceptibility to birth trauma.
• Breech delivery: due to sudden
  compression and decompression of cranial
  bones.
Aetiology
• Excessive compression, due to:
Excessive moulding, in cases of cephalopelvic
   disproportion.
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
  traumatic delivery.
• 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)
           Clinical features

• Stillbirth or neonatal asphyxia.
• Drowsy, refuse suckling with sudden
  sharp cry.
• Convulsions and rigidity.
• Tense bulging anterior fontanelle.
• Vomiting
Differential Diagnosis

• Asphyxia neonatorum.
• Neonatal convulsions
• Investigations: Brain CT scan.
Treatment

Prophylactic Treatment
• Breech delivery: see breech presentation.
• Premature delivery: see prematurity.
• Vitamin K for the mother (10 mg IM early
  in labour when we suspect difficult
  delivery)
• Careful forceps application.
Treatment
Active Treatment
• Resuscitation with minimal handling.
• Chloral hydrate, Magnesium sulphate 50% 1 cc
    and Luminal.
•   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
    against infection
3. NERVE INJURIES

• . Facial Nerve Palsy .
• Brachial Plexus Injury
Facial nerve palsy
• Cause:
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.
• Treatment:
Conservative management. May need corticosteroids.
Bracial plexus injury

• Cause:
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
Clinical picture:
     • 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.
Characters:
• Wrist drop.
• Absent grasp reflex.
• Paralysis of small muscles of hands
   (atrophy).
Brachial plexus injury

• Treatment:
• Upper injury (Erb's palsy):Fixation of the
 affected limb in pharaoh’s position.
• Lower injury (Klumpke’s palsy):
Physiotherapy.
Rarely, it may need plastic correction.
4. VISCERAL AND MUSCLE
INJURY
• Visceral Injury:
e.g. liver, spleen.
It may occur during breech delivery
Muscle Injury: (Especially
sternomastoid muscle)
• Cause: due to forcible traction on the
  head ® (tilting of the head towards the
  affected side
• Clinical picture: It may subside or cause
  permanent torticollis
• Treatment: by passive stretching of
  muscle several times/day
Cepalhaematoma ( subperiosteal )
• Cause             • Forceps or ventouseDifficult
                      delivery through contracted
                      pelvis
•   Appearance      • Few hours after birth
•   Character
•   Edges           • Well defined
•   Skin
•   Sutures         • Normal
•   Complications   • No overlap & limited to one
                        boneCalcification,
•   Treatment       •   infection and hyper-
                        bilirubinaemia
                    •   Expectant treatment
                        (disappears within few
                        weeks)
Caput succedaneum
• Cause           •   Obstructed labour
                  •   Ventouse
•   Appearance    •   At birth
•   Edges         •   ILL defined
•   Skin          •   May be ecchymotic
•   Sutures       •   Overlap sutures and
                      cover more than 1
                      bone
• Treatment       •   No treatment
• Complications   •    (disappears after 1 -2
                      days)

				
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Description: A birth injury is a trauma to the baby that occurs during the birth process. The injury is generally due to tremendous pressure put upon the baby while passing ...