BIRTH INJURIES

 BIRTH INJURIES

Birth injuries refer to trauma that a foetus sustains during birth. The structures commonly involved are muscles, nerves, bones, visceral organs and skin.

types of birth injuries

 

1. Internal organ injuries – spleen, liver, adrenal glands

2. Nerve injury –mostly brachial plexus leading to Erb’s palsy

3. Soft tissue injury –intracranial haemorrage, skull fractures

4. Extracranial injuries –cephalohaematoma,caputsuccadenium.

predisposing factors

Ø Prematurity

Ø Large for dates

Ø Cephalo pelvic disproportion

Ø Malpresentation

Ø Congenital malformation e.g. hydrocephalus

CAPUT SUCCADENIUM AND CEPHALOHAEMATOMA

Caput succadenium – is an oedematous swelling due to accumulation of serum fluid under the foetal scalp. It results from pressure between the foetal skull and pelvic bones during delivery that leads to reduced venous blood and lymphatic drainage and part of the serum escapes into the tissues. The swelling is self – limiting and disappears within 36hours of life.

Cephalohaematoma –is accumulation of blood between the periosternum and the skull bone. It is caused by friction between the foetal skull bones and the pelvic bones e.g. in CPD

Caput succadeniumCephalohaematoma

Present at birth Appears after 12 hrs of life

Disappears within 36 hrs May persist for weeks

Diffuse and pits with pressure Circumscribed; doesn’t pit on pressure

May cross a suture line Never crosses a suture line

Double suture line is unilateral Double cephalohaematoma is bilateral

Tends to grow less with time Tends to grow larger with time

 

INTRACRANIAL INJURIES AND HAEMORRHAGE

This refer to the damage of structures within the cerebral hemispheres of the brain. Various structures may be injured leading to different types of haemorrhage:

v Cerebral tissue – injury to cerebrum leading to cerebral haemorrhage

v Cerebral hemisphere and basal ganglia –supra tentorialhaemorrhage

v Veins of gallen and tentorium – subarachnoid haemorrhage

v Falxcerebri (fold of dura mater and tentoriumcerebelli) –subdural haemorrhage

PREDISPOSING FACTORS

ü Prematurity

ü Excessive moulding

ü Instrumental delivery

ü Hypoxia that leads to engorgement of blood vessels

ü Precipitate labour

ü Prolonged labour

ü Large babies

CLINICAL FEATURES

ü Dyspnoea

ü Asphyxia

ü Rolling of the eyes

ü Pallor of the skin and mucous membranes

ü Bulging of the anterior fontanelle due to increased intracranial pressure

ü Shock due to circulatory collapse

ü Twitching of the facial muscles if facial nerve is affected

ü Cyanosis

ü Grunting respirations

ü High pitched cry

ü Rigidity of limbs

GENERAL MANAGEMENT OF BIRTH INJURIES

ü Intraparetally, predisposing factors should be diagnosed and managed early e.g. preterm labour, malpresentation, prolonged labour.

ü Observe the baby closely for skin colour, twitching, rolling of the eyes, convulsions

ü Keep the baby warm

ü Administer Vitamin K 0.5 -1 mg i.m for they are predisposed to haemorrhage

ü Maintain 2 hrly turning of the baby

ü Provide intermittent oxygen therapy PRN

ü Give IV fluids e.g. 10% dextrose for the first 24 hrs then introduce oral feeds if the condituion improves

ü Give symptomatic management

ü Have resuscitative equipment ready in case of an emergency

ü Administer anticonvulsants e.g. Phenobarbital prophylactically

COMPLICATIONS

ü Musculoskeletal deformities

ü Brain damage

ü Respiratory distress

ü Hyperbilirubineamia

ü Hypoglycaemia

HYDROCEPHALUS

This is a condition where ther is accumulation of CSF within the ventricles of the brain with the resultant increased ICP and enlargement of cerebral ventricles. It can be detected prenatally by ultrasound and in labour they may present by breech presentation, fontanel and sutures are very wide on VE.