BIRTH INJURIES
DEFINITION
* An impaivment of body's funchon o shmuctue due to 0dverse
infuences
that oc(uY at biYth
Avoidaole and Unavoidalbole Mechani cal (forcaps ,vaCuum deliveng , Fachi
abevyaions) and anoic trauma absene of 3uppy to any part of the
body)
RISK FACTORS:.
*hrimipavithy * Oligohydraminos
* Smal] maternal statur * Malpresentaion of foetus
* Maternal pelvic anomalies * ToYtops| vacuum delivery
* Prolonged deliveny Very low birth weight
* Unusu ally apid doliverg t MacYDSomia.
TYPES.
i) Head and Neck injunes i) Nerve injuies
Tuiy Faial injuies fv) tntya-abdomina)
9 Frachures
vi) 3oft tissue injunes
i) HERD ANO NEK
INJURIES: aput
Extyacvania phalhemshona
Caput Iccedaneum
sub aleal
(ephaloh aem atorn a henolae
5 Subgaleal haerni orvhage
SCALP Galool
apontnos
5 Connethve Tissu Poiosteun
tktl
b Loose freclay Tissue Exha dural
haanohage
b Peicranium
5 Bone.
Caput succed aneum: blood with sexum. (yellowish with small amounts of blood )
Sevo sang uinous tlid colle cion above peiosteuum
s Presents as soft tissue swelling wilth puypura and ccchymosis over the
isuetovatio
presenting portion of the scalp puvple spots
Aus to leat of blood l4-1OWh )
may also exlend acss the mdline and cross the sutuYC. Iines
5 Edima is seen immedialely atey deliveny Diasappeavs within Hrst Ru days
of ife.
L No spei fic
treatment is needed
ls f shock is pre sent, blood transfusion is done
The edema pits.
Cephalohaematoma:
b Subpenosteal
blood colle chion CaUAed bu the uptue of
the periosftum vesscls beneath
, tis nevey pYesent at birth Gradualls develops
after 2 to 24 hrs
Siwelling byey parietal ocipital bone.
L hoesnt CYoss he suhure line kiot associated witfh the cisolovaion of
tyevlying stalp
Limited to the surface of one CYanial bone.
Ly Fluchuant sweling. t moVes
Ly Slow reAoluhon : o to 02 months.
Lf sepsis > antibiohcs administredrni nooa
y ln case of infecions , aspiYahon ef mass is advised
L tapevbiliri numéa pnotoheray
Subgaleal haemorrh age:
5 Bleecdinq behween galeal apon eurosis and periosteum
L RYm to Flucuant masS
y orosses the suture line
y Reawts from foreps vacuum delivery or co8qUulathon disoYdevs.
5 AJo lecd within 4hrs of birth.
TYeatment:
Ly Trans fusion in case cf heavu olood \oss
s Sungey in ttrvention to auterize the bleeding vessels.
Ly H takes about 2-3 weeks o Yesolve
CRANIAL NIURIES: > LineaY Skull fYachuYe
bepressed skull fracre
i) Lineay skull rathure:
L Involvement of parietal bones
5 Compressions from the application of torcops |skul pushing aqainst he
maernal symphuss isthia\ spines
y Assouatd with duval teaY with sub seouent development of tepho meningeal
ast (1epto- AYachnoid +Pia maitr).
ebeeid
iiy Depressed skull fracture:
Ly RodiogYaphic evidence of bone fraqments in evebrum
Ly resen ce of new
Ls Non suYqical man agement
INTRA CRAN|AL HAEMORRHAGE:
Ly Extravas Cul ay acuumulahon of blood ithìn drffevrentinhhacranial spaces.
Epiduural - behuween innev Skull and duya
sub cual - Duva ano aYachnoid
Sub avahnoid between avach noid and pia.
- byain tissue
Inhraparendhymal
Geymina) matix Intraventricul ar
CeYebellaY bleedig -Pxelem wih Complica led labe1X.
NERVE INJURIES: - Facial ieYve injuies
RisK fachors
Brachial plexus ’ Erb duchenene
Macrosomia Phrenic nerve 5Xlumpkels patsy
Shoutdev dystoua Ly Total
loyngeal norve
Inshument dolivevy
Malpresentahon of foetu
EYbs palsy:
y c5,Co nerves injuYed
5 Loses the poweY to abdct the arm Fom
showder, Dtate the arm eslenallg,
Supinate the foreaYm
Ls Assoialed wlh injun to phrenic nerve hich is
innervaBed wih hbres mom
(phrenic nerve supplies diaphrag m)
y Adduchion anc intemal Yotaion of arm with
ponahon of foream.
ls Biceps re fley absent MoYo's refler absent on the afectd side
Ly he affectedl aYm is held in the walev's tip" posi tion with adduchon and
inkYnal Yotahon of arm, exension of elbow, pronahbn of foreaYm and
Flexi on of wist
b Grasp Yeflea is present.
Ireatment: Pavhal immoblizaion of afecled exthremity foY about oto o2 weeks
in a position oppositk o that held by infant. Gentle massage and passive exerises
afteY 2-3 weeks and onti ued ill 3 month s.
1f there is hoimproverment Neurosurgica) inteyvention:
Klumpke's palsy
Ls C&,T4 nerve injuy
Ly Weakness of intinsic headl msces and long Fleyors of wist and ingexs
y Forearm supinaltd , wnst+ Fingers - hyper extended nith exion at
inerphalangeal and meta aeophalahgeal joints claw Hand"
erasp Yefley -absent
s Biceps reley - Ye sent
Ly Flacid extremity
Management.
Ls conservahive manaqement
1 wek
Afleded arm is imnobil 2a d and placed on upper abdomen
5 Physioherapy wi th passi re exevise at shoul der, wist,ebow afey 1t
No reLOVeny foY 3 ob months SurgeIy
Bel's palsy
> foraps delivery t prol onged 2nd srage of lalbour
Compression of peripheval branches of façal neve.
Ly Mandibular branh is mosty affeced
> Less musCulay contrathion, Loss of nasolabial fold decreased ability fo
ConhYact the lowey fadal mUA Cles on the afected side Droopi ng of moutn
y ResolveS within 2 to 3months or) de compression neuo
plashy done
y Crying - inabiliy to winkie the forehead cio se the eye on he ipsi lalval
sIàe - mouth draws away fom the afectec side
TYeatmen t: Proteohon of involved eue by the applicaion of arh fidal
teer.
and taping to prevent torneal injumy
PHRENIC NERVE NTURY
y Nere fibres ot 3,l4, 5 aYe afe cec
y Tpsilaex al diaphvagm being atcded.
occy due to re Svetching of the/ nork.
Ly AsSOuated with
espiratory dishre ss Cnd diminushed breah
Ly chest Odiognaphs she sound.
elovaion of atectecl diaphraam.
Nanagement: Suppoive mx.
* 02 SuPply is given.
* In cae respiratory distre
ss,posihire ainw ay prexue OF
mchani al venilahon is provided
k Gowage keding.
* Plicarion of diaçhrag.
Laryngeal Newe
* COuwedd by excesive taction on heoc
voCal covd poonalysis.
dinicod siqn Theatrn ent:
* Small fire quent fteding
Dyaphagi
d Aspirotion
A 0n4ngo Scopy - dx.
spinal cord injung
s DeeOecl Iab Sente of spontane movemont of infant.
y Lack ot TponL to poinful simaus.
’ f JaTon is obore CA- caUNe apnea
Aoion bhw l4 BT4 - Re piratory diahres RCOn dDy to VOruying deqree
of phren+c nowe and intrcostad nwe damace.
Mona qemnti Suspectd in LabouY YOormn (ck,head, spine immobile)
Ncsad Septal Deyiation:
Dislocohion of triongulo caoloages of note
onganutal muy udar tbticollis.
claviculaY fachue: moYe common dunng b i r t h . o e opr
Risk fachoys :
* High bivth weight
4 Prolonqed 2d staqc of abouY
Rsymptormahc : No teatment.
Symptomahc: -l0 days immobilizaho n
Long bone hacrure: (Humeny Femu)
Risk facoYs
* Brecch position
+ Low birth
wignt
bevayed movemernt,Swelling,pain and pcwaivt movenent
DioghosiS. US6,xy
Treatn ent Imnobili 26hon, Spìntng
Intr Abdominad Injuny.
bue to pottnhal mechanism
* Compre îbn of chet acimt
spleon e re.
Acheyt compresion leoding to teOnng of lgoment
soHt isue injuny:
Pelechiae: pin heod Sizod molucule of buod (42mmy
Ecchymoses : lovae exhavathon of bood in skin (>lm)
\o0ahon s
hbvoions
Subcutancow fa necwsis
A3PHVXIA NEONATOR UM
* Defined as impaired xespivaroYy gas exchange acomparnied by fhe
deviahon of aidosis
* Combinahon of hypoia, hupevcaybi2 and metabclic aidosis
Perinalal Asphyxia
* Acc to WHO Failure to inihale and sustain breathing at bvh
* ACe to NNF. (Nation al Neonatlogy forun)
7 MOeYdle asphyxia: slow gaspina, byeathirng toy) an APGAR sove ot
4to b at ot minue of a0e
at ol mi
evere asphyia : ho bre athing anc an APGA score ct Oto3
of age
HON?:
k interuphon of umbili cal cova bood flpw Eq: Cord compression, Arosme
* failuYe of exchange aross placonta Eq: Abrupho plaune
Inadequate perfusion of maernal side of placonta Eq:
Maltvnal HypottnsTon
fes who cannot tolerale transient intrmitent
hypoia of
* Compyomised
AsoYmal LabouY.
Faiwre to inflatt lungs.
havateristics of Pevinatal Asphyxia:
* Protound metabolic acidosis (ph<1.00)
than 5 minutes.
* PeYsis tence of APGAR scOYe 0-3 for mOYe
tmmeciate ne onatal period.
* cinicat seauale in
neuological itmmediale noonatal period
dysfunchion in
viclene of mulhiornan system
dinical featurts:
k Apnoea, BYadu cardia
k Allexed Roapiyatory patern - Erunfing,Gasping.
* wanosis
* Unresponsiven ess.
* PalloY - shock.
Hypotonia
OYgans involved:
Ly Kidney bo.
L CNS 301
L cvs and pulmonay 25.
HYPOXIC IsCHEMIC ENCEPAALOPATH Y (H)E)
SNeonatal Encephalopathy following severe birth asphya 7
þerinatal hypox
cP.
Mortality | Long tYm sequelae like disabili hes and
Mild HIE:
MUsde tone incvea sed slightu
b DTR - Brisk foY |st few days.
L Transient behavioral abnomalities, pooY ftecing, iitability,
Excessive cnging Jsleepiness .
y ln 3-4 days, the cNs exeminahon hinings beome normal
Moderale HIE:
5 Letharqic significaht hypounia
L Oiminished DTR
suugish absent
5 Crasp, Moro, Sucking refex es are
Ly occacion al periads of apnea
seizures within 24 hrs (maybe)
y
within lor 2 weeks assod atd
with beter long lem
outcome
Severe HIE
y shupor coma is typical
Maynot vespond to any shimulus.
, Breathing ireqular - venhlatory support
L Generalized hypotonia
swallow, Moo)
Neonatal yelees absent (6rasp ,sucking,
eue)
Distuyban t of owlay mohon (NgtagmuWs, bobbing, dol's
b Pupils dilaked | FixAd / Rooy Yeachve to laht
Nevenhon of Asphyxia:
Requlay antnatal checkup
y High visk approach Pevinatal
b Anhiupahon of compli caion during labour ASsessnent
5Timely inteventhon
s Timely referal Pevinatal
L management.
Management of maltmal complicahons
Manaqement:
osalt Care 1 shhct asepsis, ensure nuha) themal environ ment
Matagem ent of shock. seiziiYe cevobral bedama kidney tatle
mstabolic devangemant.
Prevention of Birth Injuy:
htdl Cavefhal screening MaCYOSomia CPD, mothers with conrachle
lvis, GDM, HT, malpreentaion. c-sechon
Inhranatal onhinuoud FHR moniton na to detect ear y abnomalihes,
corehul uting of epis+oto ms to prevent stull ngur,
Careh puling of neck
to prerernt haemohee
Adminishrahion of vit k to prelerm ba by
ne wholesome pro cos of partuition is trouble some to the baby because
of drlu
This dldeig is physiologica and is caused os 9Addal
If his dlits makos l 42 in Ts, results in a
condhon
termed
Siveling is seen on head at time ot birth
on eaminaton, the sweling hay
same colour of scalp y non ttnder.
fatr , Inifialy- dldca
rith
Features uually subsides |ueos
Ra y a t with sa
1f if remains unreli ered with the ase aar
A S.
(
in 44 ond dat stage sle fAre.
Teatness ’Royut frorm either eoY injuy any intra cYanial loson
leada to dee Al sote oot cawye Bchl AaUUHL
Comm on injuies in eay duning bifh e:
kHauatoma of extemad pinna
(auli floweY ear
* contilaqinous laanahion
* Temporal bone injuy
* Hamotynpanum
¥ ossi culay disaviulanon
Rasut from
RauYYent (anyngeol nerve injun chaYactenstics by biloueYal vocal cord pal
has sirnilor fahies
MandibulaY dislotañon and fauial) mandibulaY fractures cne characenzed
g Taual asgmmans ,echymo sis, oedema resucts in these condition.
decognised |unhrected fadal bone fracturea, CYaniofaual leformihes
are evcnt
Ongin of Al 8 dd is of 2types CUS,CNS
(NS, CVS: keapi\atony system
Aset - [Link] haumohaqe deads to pallor respirajon
dUShes, shock etc asoioed wih , 1e
BYoun contuion duu to skul bone inws oacy to aGI
1ntra abdominal inyuues
Rospiratory coue
spirahon of amniotic fued s mucOus
*S9norymos con dihons aR ike r , d6iAl, et
4 produ0 eithar b hupoxic isthoumic encephaloparuy | by periphuval
* Duchanene Eto's polay klurgke s poray sis oe dasic examplas of
Snelling eather by long bone injuries, epiph seal dicplacum ent,
steYnodaido maarbid musce injury
t MalPoihoning of head