BIRTH INJURIES IN NEWBORN: Definition of birth injuries , statistics, etiology, classification of birth injuries , head injuries: cephalhematoma and Caput succedaneum, skull fractures , nerve injuries: erb's palsy and klumpke's palsy, bone injuries: clavicular and long bone fracture , intra-abdominal and soft tissue injuries, management and prevention of birth injuries

1. Presented by:
Ms. Manisha Thakur
Nursing Tutor
Child Health Nursing

2. • Birth trauma is defined as injury to the infant
resulting from mechanical forces (such as
compression or traction) during the delivery.
• The injury is generally due to tremendous
pressure put upon the baby while passing
through the birth canal.

3. Incidence
• More significant injuries occur in 2-7 per 1000
live births. Birth trauma mortality occurs in
approximately 3.7 per 1,00,000 live births.

4. Risk factors of birth injuries
Maternal causes
• Primipara
• Small maternal
stature
• Maternal pelvic
anomalies
• Oligohydroamnios
Foetal causes
• Vacuum extraction
• Very low birth weight
babies (VLBW)
• Fetal macrosomia
• Large fetal head
• Breech presentation
• Use of forceps

5. TYPES OF BIRTH INJURIES
1. Head injuries
2. Nerve injuries and spinal cord injuries
3. Bone injuries
4. Intra-abdominal injuries
5. Soft tissue injuries

6. Injuries of Head
Head
injuries Caput succedaneum
Cephalhematoma
Subgaleal hemorrhage
Skull fractures
Intracranial hemorrhages

7. HEAD INJURIES
1. CEPHALHAEMATOMA
• Subperiosteal collection of blood between the skull and
the periosteum. It occurs due to the rupture of small
veins from the skull resulting from friction between the
fetal skull and pelvis.
• It is never present at birth but gradually develops after
12-24 hours.
• It tends to grow larger and may persists for weeks.
• This may be caused by forceps delivery.

8. Contd…..
• Management:
• No active treatment.
• Vit k 1 to 2mg IM in order to correct any coexistent
coagulation defect.
• If it becomes infected : incision and drainage and antibiotics
should be started
• The infant can need transfusion of blood.
Complications: Jaundice & shock

9. 2. Caput succedaneum
It is the edematous swelling on the babies scalp due to
infilteration of serosanguinous fluid by pressure of girdle of
contact i.e. cervix, bony pelvis.
Treatment:
• no specific treatment.
• Swelling subsides within within few days.
Complications: Rarely anemia

10. Subgaleal hemorrhage
Definition:
it is the collection of blood beneath the aponeurosis that
covers the inner surface of the scalp.
Causes: it is due to the extensive pressure of forcep.
s/s: firm fluctuant massthat increases in size after birth.
Management:
• Monitor for LOC, Hb.
• Transfusions may be required if blood loss is
significant.
• In severe cases, surgery may be required to cauterize
the bleeding vessels.
• Antibotics: to prevent infection

12. Skull fractures
• It is commonly frontal bone or at the anterior of
parietal bone.
• Skull fractures can be associated with the Subdural
bleeding, subarachnoid haemorrhage, or contusion or
laceration.
Causes: difficult forceps delivery in disproportion or
wrong application of the forceps.

13. break in a cranial bone
resembling a thin line
break in a cranial bone
(or "crushed" portion
of skull)
with depression of the
bone

14. Contd……
• Management:
• No treatment for linear fracture.
• For depressed fracture:
– Open surgical evacuation of the clot is the usual
management for infants with progressive neurological signs
or progressive increased intracranial pressure.
– Neonatal seizures may require anticonvulsant treatment.

15. Intracranial hemorrhage
• Subarachnoid hemorrhage, intracerebral
hematomas, subdural hematomas usually results
from trauma of normal delivery process or
excessive forces used because of instrumentation or
abnormal presentation such as breech delivery.
Treatment
• Replace the blood volume loss and stabilize cardio-
vascular system.

17. NERVE INJURIES
Nerve injuries
1. Facial palsy
2. Brachial palsy
3. Phrenic nerve
palsy
2. Brachial palsy
Erb’s palsy
Klumpke’s palsy

18. NERVE INJURIES
1. Facial Palsy/Bell’s palsy:
 It is involved by direct pressure of the forceps blades or by
haemorrhage & edema around the facial nerve.
 S/S:
 Loss of movement of affected side.
 affected eye side which remains open.
 Facial asymmtery.
 Absent of rooting reflex
 MANAGEMENT:
• Treatment aims at protecting the eye with antiseptic ointment,
which remains open even during sleep.
• Neuroplasty (surgery to repair nerve tissue)
• The condition disappears within weeks.
• NG or OG feed.

19. 2. Brachial palsy:
• Either the nerve roots or the trunk of the brachial plexus
are involved.
• It can be caused by:
• Shoulder dystocia
• Breech extraction
• Hyper extension of the neck
• Simple stretching
• Haemorrhage within a nerve
• Tearing of the nerve or root

20. 1. Erb's palsy
• Upper brachial plexus injury.
• This is the commonest type
when the 5th & 6th cervical
roots are involved.
S/S arm to hang limply
adducted and internally rotated
& flexion of the wrist.
• Moros reflex is absent.

21. Treatment:
Massage and passive range-of-motion
exercises to involved joints done gently every
day.
Recovery takes place within weeks or months,
but in severe injury permanent disablility may
develop.

22. 2. Klumpke's palsy
• Occurs due to damage to 7th & 8th cervical
or even the first thoracic nerve roots.
• Resulting in paralysis of the hand and
wrist.
S/S: shoulders and arm are adducted &
internally rotated, wrist is extended.
Treatment:
• Massage and Passive range-of-motion
exercises are the only treatment.

25. 3. Phrenic nerve palsy
Defintion: phrenic nerve palsy causes paralysis of the diaphragm
that can be seen on usg as an elevated diaphragm.
s/s: respiratory distress: nose flaring, tachypnea
• It is usually unilateral, the affected lung doesnot expand during
respiration
Management:
• position the baby on affected side to facilitate lung
expansion on unaffected side.
• Oxygen therapy administration
• Respiratory failure may be treated with mechanical
ventilation.
• Gavage feedings.

26. MUSCULOSKELETAL INJURIES
1. Clavicular fractures:
When a baby is born too
quickly, or the baby is too
big for the mother’s birth
canal, the baby’s head can
get delivered, but the
shoulders and chest get
stuck.
2. Fractures of long
bones

27. 1. Clavicular fracture
• These fractures are seen in
vertex presentations with
shoulder dystocia or in
breech deliveries when the
arms are extended.
Management:
• heal quickly on their own
without treatment.
• keep the infant’s arm and
shoulder still for several days.
This is done by putting the
infant’s arm in a sling.

28. 2. long bone injuries
a) Humeral fractures typically occur during a
difficulty delivery of the arms in the breech
presentation and/ or of the shoulder in vertex.
Direct pressure on the humerus may also result
in fracture.
b) Femoral fractures usually follow a breech
delivery. Physical examination usually reveals an
obvious deformity of the thigh.
Treatment:
• Simple splinting applied for 4 weeks.
• Closed reduction casting

29. Intra-abdominal injuries
These are uncommon injuries.
• It involve rupture or hemorrhage into the liver, spleen
or adrenal gland.
• Infants with hepatosplenomegaly are at increased risk
of these injuries.
S/S:
sudden pallor, hemorrhagic shock, abdominal
discoloration.
Anemia, poor feeding, tachypnea, and tachycardia.
Management:
• volume replacement
• Correction of any coagulopathy

30. Soft Tissue Injuries
1. Abrasion and laceration
2. Petechiae
3. Ecchymosis
4. Subconjuctival hemorrhagic

31. 1. Abrasions and lacerations
May occur as scalpel cuts during Cesarean delivery or
during instrumental delivery (i.e, vacuum, forceps)
Infection remains a risk, but most uneventfully heal
Management: Careful cleaning, application of
antibiotic ointment, and observation
Lacerations occasionally require suturing

32. 2. Petechiae: these are non raised pinpoint
hemorrhage caused by sudden increase and
release of pressure during passage through birth
canal.
• May be seen on face, chest or head.
3. Ecchymosis: small hemorrhagic areas(larger
than petechiae) occur after traumatic delivery.
4. Subconjuctival hemorrahges: rupture of
capillaries in sclera from pressure on fetal head
during delivery.

34. Prevention of the injuries in newborn
Comprehensive antenatal and Intranatal care
is the key to success in the reduction of birth
trauma and consequently in the reduction of
perinatal mortality and neonatal morbidity

35. Antenatal Period
• To screen out the risk babies likely to be
traumatized during vaginal delivery: babies of DM,
congenital abnormality, mothers with abnormal
pelvis and presentation
• To employ liberal use of elective Caesarean section
is important.

36. Intranatal Period
• Care during Normal delivery
• Care during Forceps delivery
• Care during Breech delivery

37. Normal delivery:
• Continuous fetal monitoring, if available is able to
detect early evidences of fetal distress.
• Episiotomy is to be done carefully to prevent injury to
the scalp.
• The neck should not be unduly stretched while
delivering the shoulders to minimize the injuries.

38. Forceps delivery
• Majority of the severe injuries are inflicted by
applications of forceps.
• Difficult forceps are to be avoided in
preference to the safer caesarean section.
• Never apply the force unless the application is
a correct one.

39. Vaginal breech delivery
• Proper selection of cases, care and gentleness
are to be executed while conducting vaginal
breech delivery.
• Skilled health care professionals should
conduct deliveries

40. Bibliography
• D.C Dutta. Textbook of Obstetrics;ed-6th.Calcutta:
Published by New Central Book Agency;2004. Pp-
483-86
• Myles Midwifery. A Text book of Midwives.14ed
New York. Elsevier Publishers;2003.Pp-825-835
• Gupta Piyush. Essential Pediatric Nursing. ed-Ist.
New Delhi: Published by A.P.Jain;2004.Pp-73-75.
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