DEFINE BIRTH INJURIES
Birth injuries are an impairment of the infant’s body
function or structure due to adverse influences that
occurred at birth.
Birth injuries may be severe enough to cause neonatal
deaths, still births or number of morbidities.
RISK FACTORS FOR BIRTH INJURIES
Small maternal stature
Maternal pelvic anomalies
Prolonged or unusually rapid labor
Malpresentation of the fetus
Use of mid forceps or
Versions and extractions
Very low birth weight or
Fetal macrosomia or
large fetal head
Skull injuries are those injuries that impairs the structure of the skull
and functions of the underlying organs in the skull.
The most common site of birth injury is head, because 96% babies
are delivered by cephalic presentation.
I. Caput succedaneum
III. Skull Fractures
IV. Scalp injuries
A caput succedaneum is an edematous swelling which forms
normally in the soft tissues over the presenting part of the scalp
due to infiltration of serosanguinous fluid by the pressure of
girdle of contact.
The edema disappears within the 1st few days of life.
Molding of the head and overriding of the parietal bones
disappear during the 1st weeks of life.
Rarely, a hemorrhagic caput may result in shock and require
It is present at or shortly after birth and doesn't tend to
The swelling is diffuse , boggy, pits on pressure and may cross
No specific treatment is needed
Advice the woman and family to avoid applying pressure on
But if extensive ecchymoses are present, hyperbilirubinemia
Shock – Blood transfusion
A Cephalohematoma is a sub periosteal blood collection
caused by rupture of vessels beneath the periosteum.
Causes It is due to rupture of a small vein from the skull
that may be from : • Friction between bones of maternal
pelvis and fetal skull as in cephalopelvic disproportion or
The swelling is usually never at birth, gradually develops a few hours after birth and
may persist for weeks.
It is incompressible and never crosses the suture line.
The overlying scalp may show discoloration.
The condition may be confused with caput succedaneum or meningocele. Meningocele
lies over a suture line or fontanels and there is impulse on crying.
Rarely suppuration occurs.
No active treatment is necessary unless it becomes infected or complicated.
A head CT should be obtained if neurological symptoms are present.
Vitamin K 1-2 mg IM should be given to correct any coagulation defect.
In case of infected hematoma, the condition is treated with incision and drainage, systematic
antibiotics and monitoring of hematocrit and bilirubin level.
Advice the woman and family to avoid hot compress by using oil.
3. Scalp Injuries
Scalp injuries are those injuries that are characterized by impairment in integrity of the
• Forceps delivery (tip of the blades)
• Incised wound inflicted during cesarean section
• Scalp-electrode placement
The wound should be dressed with an antiseptic solution like 2% mercurochrome.
On occasion, the incised wound may cause risk hemorrhage and requires stitches.
4. Skull Fracture
Fracture of the vault of the skull (frontal bone or anterior part of the parietal bone) is defined
as distortion in the continuity of skull bone which may be of fissure/linear or depressed type.
Effect of difficult forceps delivery or due to wrong application of forceps.
Projected sacral promontory of the flat pelvis.
Fissure fracture if uncomplicated is usually symptomless.
Depressed fracture may be associated with neurological manifestations.
Signs of associated complications such as intracranial hemorrhage, raised intracranial
pressure, leakage of CSF.
History of type of delivery, other injuries to head during birth. •
X-ray can confirm diagnosis.
Linear or fissure fracture requires no treatment.
Depressed fracture may require surgical elevation.
If there is leakage of cerebral fluid through nose, antibiotic
therapy is indicated.
Intracranial injuries are the
injuries to the structures inside the
cranium during the process of the
birth that is characterized by
manifestations within first 48
hours of life.
Traumatic Intracranial Hemorrhage
It is defined as hemorrhage inside cranium due to trauma and it can be extradural or
Extradural hemorrhage: It is defined as hemorrhage in space between cranial bones and outer
layer of duramater. It is usually associated with fractured skull bone.
Subdural hemorrhage: It is defined as hemorrhage in the space between arachnoid mater and
inner layer of duramater.
Causes of Traumatic ICH
Excessive moulding in deflexed vertex.
Rapid compression of the head during delivery of the after-coming head of breech or in
Forcible forceps traction following wrong application of the blades.
Clinical Features of Traumatic ICH
The hemorrhage may be fatal and the baby is delivered stillborn or with severe respiratory
Gradually, the features of cerebral irritation appear.
Hydrocephalus and mental retardation may be a late sequelae.
Anoxic Intracranial Hemorrhage
It is defined as hemorrhage inside the cranium due to perinatal asphyxia, trauma and ischemia.
It can be intraventricular, subarachnoid and intracerebral.
Perinatal asphyxia, trauma and ischemia
Altered level of consciousness
Focal neurological defecits
Diagnosis of ICH
Doppler ultrasonography can detect any change in cerebral circulation.
CT scan is useful to detect cortical neuronal injury.
Magnetic resonance imaging (MRI) is used to evaluate any hypoxic ischemic brain injury.
CSF analysis: Elevated RBCs, WBCs and protein.
MANAGEMENT OF ICH
The baby should be nursed in quiet ,warm and well ventilated environment.
Maintain cleanliness of the air passage, suction immediately after birth to
remove the secretion that occludes the pharynx. And supply oxygen as
Frequently monitor the baby for skin color, vital signs and neurological
Feeding by nasogastric tube is advisable, fluid balance is to be maintained, if
necessary by parenteral route. .
Administer Vitamin K 1mg IM to prevent further bleeding due to hypoprothrombinaemia.
Prophylactic antibiotics are to be administered.
Anticonvulsants like phenobarbitone, phenytoin and diazepam can be given for seizures
Open surgical evacuation
-Rarely ventricular- peritoneal shunt and subdural-peritoneal shunt is required.
Soft tissue injuries are the injuries to skin, subcutaneous tissues, muscles and visceral
organs due to some degree of disproportion between the presenting part and the maternal
pelvis during the birth process and also from forcep blades, vacuum extractor cups, scalp
electrodes and scalpels.
A. Injury to Skin and Subcutaneous Tissue
Erythema and abrasions: Erythema and abrasion during birth are superficial reddening of the
skin with impaired integrity that usually are the result of the application of forceps,
discoloration is same configuration as the instrument.
Ecchymosis: Ecchymosis are small hemorrhagic areas( greater than 10 mm in diameter) that
may occur after traumatic or breech delivery.
Lacerations or scalpel cut: it is injury may occur during cesarean section. They usually occur
on the buttocks, scalp or thigh. Small cut heal spontaneously. Some time it may need repair by
stitches with 0-7 nylon. Healing is usually rapid.
B. Muscles injuries:
Injury to muscle are those trauma to muscle that can occur when it is torn or when its blood
supply is disrupted.
Torticollis and sternomastoid hematoma are common muscle trauma during birth.
Torticollis or twisted neck is defined as damage and spasm of sternomastoid muscle during the
birth of the anterior shoulder when the fetus presents by the vertex or during rotation of the
shoulders when the fetus is being born by breech.
The head tilts towards the affected side constantly and the chin points towards one shoulder.
One shoulder may be higher in the body than the other shoulder.
Neck muscle swelling right after the birth.
Muscle stretching exercises and neck braces.
The uncomplicated swelling will resolve within 7-10
days. If it doesn't resolve even after 6 months of
muscle stretching exercise then muscle release
surgery is required.
It is sternomastoid muscle injury caused by rupture of the muscle fibers and blood vessels,
followed by a hematoma and cicatrical contraction and may be associated with difficult breech
delivery or attempted delivery following shoulder dystocia or excessive lateral flexion of the
neck even during normal delivery.
It usually appears few days after birth and is usually situated at the mid position of the muscle.
Small moderately dense or rather small consistency of mass of with the size of walnut appears.
There is transient torticollis.
Muscle stretching exercises.
Surgery is indicated if hematoma fails to get reabsorbed.
Injuries to organs like liver, spleen ,kidney, adrenals or lungs are called visceral injuries .
Visceral organs are commonly injured during breech delivery.
The most common result of the injury is hemorrhage. The hemorrhage may remain concealed
as subcapsular hematoma or capsule may rupture with the blood flowing into peritoneal cavity.
Prognosis is usually poor.
Pallor , tachycardia, shock and symptoms according to the organs being injured.
Correction of hypovolemia, anemia and coagulation disorders.
Management may be needed to repair injured viscera surgically.
FACIAL NERVE INJURIES
• It is an injury to C5,6, there is failure of abduction of the arm from the
shoulder inability for external rotation of the arm and to supinate the forearm.
The characteristic position is adduction and internal rotation of the arm and
pronation of the forearm.
• The biceps and Moro reflex is absent on the affected side.
• This type of plexus involving 7th and 8th cervical and the 1st thoracic nerve
roots. There is paralysis of muscles of the forearm. The arm is flexed at the
elbow and wrist is extended.
Phrenic nerve paralysis:
• C3, C4, & C5 injury result paralysis of the ipsilateral diaphragm. This is
due to excessive stretching of neck at birth. with dyspnoea, cyanosis and
FACIAL NERVE PALSY (BELL’S PALSY)
• forceps delivery – prolonged second stage of labor may caused
• During crying, there is inability to wrinkle the forehead or close
the eye on the ipsilateral side, and the mouth is drawn awayfrom
the affected side.