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Presented by:
Ms. Manisha Thakur
Nursing Tutor
Child Health Nursing
• 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.
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.
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
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
Injuries of Head
Head
injuries Caput succedaneum
Cephalhematoma
Subgaleal hemorrhage
Skull fractures
Intracranial hemorrhages
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.
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
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
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
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.
break in a cranial bone
resembling a thin line
break in a cranial bone
(or "crushed" portion
of skull)
with depression of the
bone
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.
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.
NERVE INJURIES
Nerve injuries
1. Facial palsy
2. Brachial palsy
3. Phrenic nerve
palsy
2. Brachial palsy
Erb’s palsy
Klumpke’s palsy
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.
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
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.
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.
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.
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.
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
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.
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
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
Soft Tissue Injuries
1. Abrasion and laceration
2. Petechiae
3. Ecchymosis
4. Subconjuctival hemorrhagic
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
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.
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
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.
Intranatal Period
• Care during Normal delivery
• Care during Forceps delivery
• Care during Breech delivery
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.
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.
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
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.
• http//www.birth injuries.us
BIRTH INJURIES IN NEWBORN

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BIRTH INJURIES IN NEWBORN

  • 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
  • 11.
  • 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.
  • 16.
  • 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.
  • 23.
  • 24.
  • 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.
  • 33.
  • 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. • http//www.birth injuries.us