undergraduate lecture

1. Fetal Birth InjuriesFetal Birth Injuries
Hend Shalaby
Prof. Of Obs & Gyn.

2. DefinitionDefinition
avoidable and unavoidable
mechanical, hypoxic and ischemic
injury
affecting the infant
during delivery.

3. Birth injuries may result fromBirth injuries may result from
1.Inappropriate or deficient medical skill or attention.
2.They may occur, despite skilled and competent
obstetric care.

4. IncidenceIncidence
Has been estimated at 2-7/1,000 live births.
Predisposing factors:
1. Macrosomia,
2. Prematurity,
3. Cephalopelvic disproportion,
4. Dystocia,
5. Prolonged labor, and
6. Breech presentation.

5. Cranial InjuriesCranial Injuries
Subconjunctival ,retinal hemorrhages
Caput succedaneum
Cephalhaematoma
Intracranial hge

6. Caput succedaneumCaput succedaneum
Diffuse edematous swelling of the soft tissues
of the scalp involving the portion presenting
during vertex delivery.
It may extend across the midline and across
suture lines.
The edema disappears within the first few
days of life

9. CephalohematomaCephalohematoma
Is a subperiosteal hemorrhage, so it is always limited to
the surface of one cranial bone.
There is no discoloration of the overlying scalp, and
swelling is usually not visible until several hours after birth
An underlying skull is occasionally associated with
cephalohematoma.

10. Differential DiagnosisDifferential Diagnosis

11. Intracranial HaemorrhageIntracranial Haemorrhage::
Causes:
1. Sudden compression and decompression of the
head as in breech and precipitate labour.
2. Marked compression by forceps
3. Fracture skull.

12. Intracranial HaemorrhageIntracranial Haemorrhage::
Predisposing factors:
1. Prematurity
2. Asphyxia due to anoxia
of the vascular wall .
3. Blood diseases.

13. Intracranial HaemorrhageIntracranial Haemorrhage::
Clinical picture:
1- Altered consciousness.
2- Flaccidity.
3- Breathing is absent, irregular and periodic or gasping.
4- Eyes: no movement, pupils may be fixed and dilated.
5- Vomiting .
6- Anterior fontanelle is tense and bulging.

14. Intracranial HaemorrhageIntracranial Haemorrhage::
Prophylaxis:
1. Vitamin K: to the mother in late pregnancy or early in labour.
2. Episiotomy: especially in prematures and breech delivery.
3. Forceps delivery: carried out by an experienced obstetrician

15. Peripheral NervePeripheral Nerve
InjuriesInjuries

16. Brachial Plexus PalsyBrachial Plexus Palsy::
It is due to over traction
on
the neck as in:
1. Shoulder dystocia.
2. After-coming head in
breech delivery.

17. Brachial Plexus PalsyBrachial Plexus Palsy::
Erb's palsy
Klumpke’s palsy

19. BRACHIAL PALSYBRACHIAL PALSY
These injuries occur in:
1. Macrosomic infants
2. When the arms are extended over the head in a breech
presentation
3. When excessive traction is placed on the shoulders.

21. Klumpke's paralysisKlumpke's paralysis
Is a rarer form of brachial palsy;
Injury to the 7th and 8th cervical
nerves and the 1st thoracic nerve
produces a paralyzed hand,
(Horner syndrome)

22. The prognosisThe prognosis
Depends on whether the nerve was merely injured or
was lacerated.
If the paralysis was due to edema and hemorrhage about
the nerve fibers, function should return within a few
months;
If due to laceration, permanent damage may result.

23. CLAVICLECLAVICLE
This bone is fractured during labor
more frequently than any other bone;
It is particularly vulnerable when there is:
1. Difficulty in delivery of the shoulder in vertex presentations
2. The extended arms in breech deliveries.

25. CLAVICLECLAVICLE
Treatment, consists of immobilization of the arm and
shoulder on the affected side.
The prognosis is excellent.

26. Rare injuriesRare injuries
Long bone fractures
Abdominal injuries