birth injuries

1. Birth Injuries

2.  Birth injuries are defined as those
sustained during labour and delivery.
 Birth injuries may be severe enough to
cause neonatal deaths, still births or
number of morbidities.
 Therefore birth injury remains an
important cause of perinatal mortality
and morbidity in all countries when
antenatal and intranatal care is
inadequate and child birth is
supervised by untrained attendants.

3. Classification of Birth Injuries
Birth
Injuries
Intracrania
l injury &
Haemorrh
age Injuries
to the
head
Injuries
to the
nerve
Muscle
Traum
a
Fractures
and
Dislocatio
n
Trauma
to skin
and
superficia
l tissues
Injury to
the
internal
organs

4. Types of injuries and affected organs
Type of Injury Organs affected
Soft tissue Skin- Lacerations, abrasions, fat
necrosis
Nerve Facial nerve, palsy Brachial
plexus, spinal cord
Eye Hemorrhage- sub conjunctiva,
retina
Viscera Rupture of liver, adrenal gland,
spleen
Scalp Laceration, abscess,
Haemorrhage

5. Types of injuries and affected organs
Type of Injury Organs affected
Dislocation Hip, shoulder, cervical vertebrae
Skull Cephalohaematoma, sub galeal
haematoma, Fractures
Intracranial Haemorrhages- Intraventricular, subdural,
subarachnoid
Bones Fractures- Clavicle, Humerus, Femur

6. Causes of Birth Injuries
Difficult Labour
Shoulder dystocia
Precipitate Labour
Prolonged or Obstructed
labour
Fetal macrosomia
Cephalopelvic Disproportion
Abnormal presentation (Breech,
transverse lie etc)
Manipulative Delivery
Instrumental Delivery (Forceps
or ventouse)

7. Causes of Birth Injuries:
Injuries to a baby are more likely during a
difficult delivery. The difficulty of delivery
is affected by such factors as:
 The baby's size:
o When a baby weighs more than eight
pounds (four kilograms), birth injury
becomes more likely.
o Similarly, premature babies (those born
before 37 weeks) are more susceptible
to injury.

8.  Cephalopelvic Disproportion :
o The size and shape of the mother's
pelvis is not adequate for the child to be
born by vaginal delivery.

9.  Difficult labor or childbirth :
o ("Dystocia") or prolonged labor.
 The baby's position :
o A "breech birth", where the fetus
buttocks or legs are presented first, is
more likely to result in birth injury.
If a mother experienced complications
during a prior birth, doctors should be
on alert for possible complications
during any subsequent birth.

10. Medical Malpractice
 Medical error can cause birth injuries,
or can increase their severity or
permanence.
 Medical errors which may support a
malpractice action include:
 Failing to anticipate birth complications
with a larger baby, or in cases involving
maternal health complications;
 Failure to respond appropriately to
bleeding
 Failing to observe or respond to

11.  Failure to respond to fetal distress
(including irregularities in the fetal
heartbeat);.
 Delay in ordering cesarean section (c-
section) when medically necessary;
 Misuse of forceps or a vacuum extractor
during delivery,
 Inappropriate administration of Pitocin,
a synthesized hormone used to induce
or augment (speed up) labor.

12. HEMORRHAGE

13.  Meninges, brain and great cerebral
veins are the delicate organ of the
body.
 Skull bone is protecting these vital
organs.
 During the labour process, the fetus
pass through narrow birth canal.
 There may be change in shape of skull
due to excessive or rapid compression

14.  Sometimes prolonged, precipitate,
difficult labour need instrumentation
such as forceps, vacuum etc.
 There may be pressure on the fetal
head (meninges, brain and blood
vessels) and cause intracranial injury
and haemorrhage.
 Few babies who are still birth or who
are die during first week of life are
found to have intracranial injury.
 The babies who survive may have
impaired physical and mental states.

15. Intracranial Hemorrhage
 It is very scary when an infant suffers a
birth injury, especially when it is serious.
 Bleeding in the brain, also known as
intracranial hemorrhage has been
known to affect newborns.
 Bleeding can occur in various places
within the newborn's skull.
 Some of the types of hemorrhages
include the following:

16.  Subarachnoid hemorrhage:
o This term is used to describe bleeding
that occurs below the innermost area of
the two membranes that cover the
brain.
o It is the most common type of bleeding
in the skull.

17.  Subdural hemorrhage:
o This condition occurs when there is
bleeding between the outer and inner
layers of the brain covering.
o Subdural hemorrhage is not as
common.

18. Intraventricular hemorrhage:
o This term describes bleeding in the
normal fluid-filled spaces, also known
as ventricles, in the brain.
o It affects the brain tissue.

19. Causes
1. Preterm baby because of lack of
protection by their soft skull bones and
wide sutures.
2. Trauma: Compression and stretching
in moulding.
• Excessive compression of fetal head
due to contracted pelvis, occipito
posterior position, and large baby.

20. • Rapid compression on fetal head,
breech delivery, precipitate labour.
• Upward compression as in breech
delivery, face presentation.
3. Instrumental Delivery

21. Clinical Features
 Baby cannot establish respiration
himself..
 In severe cases, at birth, the infant is
shocked, the eyes roll upward.
 Trunk and limbs may be rigid, the first
clenched, limpness is also common.
 Difficult grunting expiration after most
due to excess of mucosa.

22.  Sometimes shallow, rapid and irregular
with attack of apnea and cyanosis.
 Worried and anxious expression, eyes
are wide open for long period, starring
with a knowing look, sunken eyes, rigid
neck, and spongy fontanelle.

23. Prevention
 Prevent or detect intrauterine fetal
asphyxia in earliest by intensive fetal
monitoring.
 Liberal episiotomy and use of forceps
to deliver the premature baby minimize
the intracranial disturbance.
 Avoid traumatic vaginal delivery in
preference to caesarean section.

24.  Difficult forceps should be avoided.
 In vaccum delivery, traction is made
only after proper cephalic application.
 Extend the use of caesarean section in
breech more liberally.
 Avoid prolonged and difficult labour.

25. Treatment and Management
1. The baby should be nursed in quiet,
warm and well ventilated surrounding.
2. Maintain cleanliness of the passage,
suction immediately after birth to
remove the secretion that occludes
the pharynx.
3. Incubator nursery is preferable to
supply oxygen and to maintain the
temperature and humidity.

26. 4. If respiration is established wrap
properly and keep the infant on one side
turns.
5. Restrict handling the baby. Bathing,
weighing and measuring should be
withheld because it may provoke
convulsions.
6. Feeding by nasogastric tube is
advisable, fluid balance is to be
maintained, if necessary by parenteral
route.
7. Administer vitamin K 1 mg
intramuscularly to prevent further

27. 8. Prophylactic antibiotics is to be
administered as needed.
9. Anticonvulsant may need to prevent
convulsion i.e.
o Phenobarbitone 5-10mg/kg/day in
divided doses at 6 hourly interval
intramuscularly.
o Phenytoin 10-15mg/kg intravenously as
loading dose at the rate of
0.5mg/kg/min for maintenance dose of
5mg/kg/day with cardiac monitoring.
o Diazepam 0.1mg/kg IM thrice daily.

28. 11. The following equipments should be
at hand i.e.
o Suction machine
o Oxygen
o Laryngoscope
o Endotracheal tube

29. 12. Keep close observation on:
 Vital signs 4 hourly or as needed
 Skin colour.
 Respiration; type and regularity.
 Apex beat; type and regularity.
 Convulsion: spasm of muscles, part,
duration etc.

30. Cephal Hematoma

31.  Cephalhaematoma is a collection of
blood between the periosteum of a skull
bone and the bone itself.
 It occurs in one or both sides of the
head.
 It occasionally forms over the occipital
bone.
 The swelling with Cephalhaematoma is
not present at birth rather it develops
within the first 24 to 48 hours after birth.

32. Causes
1. Rupture of a periosteal capillary due
to the pressure of birth
2. Instrumental delivery
3. Precipitate delivery
4. Prolonged pressure on the head
5. Cephalopelvic disproportion

33. Signs and Symptoms
1. Swelling of the infant's head 24-48
hours after birth
2. Discoloration of the swollen site due to
presence of coagulated blood
3. Has clear edges that end at the suture
lines.

34. Management
1. Observation and support of the
affected part.
2. Transfusion and phototherapy may
be necessary if elevated or sub blood
accumulation is significant
Complication
1. Jaundice

35. Caput
Succedaneum

36.  A caput succedaneum is an edema of
the scalp at the neonate's presenting
part of the head.
 It often appears over the vertex of the
newborn's head as a result of pressure
against the mother's cervix during
labor.
 The edema in caput succedaneum
crosses the suture lines.
 It may involve wide areas of the head
or it may just be a size of a large egg.

37. Causes
1. Mechanical trauma of the initial
portion of scalp pushing through a
narrowed cervix
2. Prolonged or difficult delivery
3. Vacuum extraction
 Caput Succedaneum also occurs
when a vacuum extractor is used.

38. Signs and Symptoms
1. Scalp swelling that extends across
the midline and over suture lines
2. Soft and puffy swelling of part of a
scalp in a newborn's head
3. May be associated with increased
molding of the head
4. The swelling may or may not have
some degree of discoloration or
bruising
5. Tends to disappear within 24-36
hours and tends to reduce to size.

39. Management
 Needs no treatment. The edema is
gradually absorbed and disappears
about the third day of life.
 Advice not to applying pressure over
caput

40.  Mother is very anxious so we must
explain about what it is, its causes in
simple language.
 Baby should be handled gently Apply
dressing on abrasions..
 An abraded chignon usually heals
rapidly if the area kept clean, dry and is
irritated..
 Advice mother that caput need no
treatment and disappear within 36
hours of birth.

41. Complication:
1. Jaundice - results as the bruise
breaks down into bilirubin.

43. Facial Paralysis

44.  The facial nerve remains unprotected
after its exit through the stylomastoid
foramen.
 It is involved by direct pressure of the
forceps blades or by haemorrhage and
edema around the nerve.

45. Causes
 Forceps delivery: It may occur in
spontaneous delivery when grasping
the head or due pressure is applied on
the mastoid process or over the ramus
of lower jaw where the facial nerve lies
superficially.

46. Clinical Features:
 There is unilateral facial weakness with
the eyelid of the affected side
remaining open and mouth drawn over
to the normal side.
 The paralyzed side is smooth. On
crying, the mouth is drawn to the
uninjured side of the face.
 If the baby cannot form an effective
seal on the nipple or teat, there may be
some initial feeding difficulties.

47. Management:
 There is no specific treatment, improve
the conduction on 1 week.
 Protect the eyes, which remain open
even during sleep, with antiseptic
ointment.
 Feeding difficulties are usually
overcome by the baby's own
adaptation, although alternative feeding
position can be adopted.

48.  Maintain oral hygiene.
 If instrumental delivery and the baby
have any injury, clean and dress with
antiseptic lotion.
 The condition usually disappears
within weeks unless complicated by
intracranial damage.

49. Erb's palsy

50.  This is the commonest type when the
5th and 6th cervical nerve roots are
involved.
 The resulting paralysis causes the arm
to lie on the side with extension of the
elbow, pronation of the forearm and the
flexion of the wrist.
 The moro reflex and biceps jerks are
absent on the affected side.
 The arm is inwardly rotated and the half
closed hand turned outwards.

51. Cause
 Erb's palsy are twisted on neck in
delivery of after coming head,
excessive lateral flexion of the neck
when delivering the shoulder in vertex
presentation and forceps delivery.

52. Treatment
 Use of a splint so as to hold the arm
abducted.
 Massage and passive movement are
useful.
 Full recovery takes weeks or even
months.
 Severe injury may produce permanent
disability.

53. Torticollis (twisted neck)

54.  The most commonly damaged muscle
is the sternomastoid muscle during the
birth of the anterior shoulder when the
fetus assumes a vertex presentation or
during rotation of the shoulder when
the fetus is being born by the breech.
 This damage causes torticollis, which
means twisted neck.
 Torticollis presents as a small lump
over the sternomastoid muscle on the
affected side of the neck.

55.  The lump consists of blood and fibrous
tissue and appears to the painless for
the baby.
 Stretching of the muscle can be
achieved by lying the baby to sleep on
the unaffected side and by using
muscle stretching exercises under the
guidance of a physiotherapist.
 The swelling will resolve over several
weeks.