Birth Injuries

Definition

The term birth injury is used to denote:
 avoidable and unavoidable
 mechanical, hypoxic and ischemic injury
 affecting the infant during labor and delivery

Birth injuries may result from :

1. Inappropriate or deficient medical skill or attention.
2. They may occur, despite skilled and competent obstetric care.

Predisposing factors

1. Macrosomia,
2. Prematurity,
3. Cephalopelvic disproportion,
4. Dystocia,
5. Prolonged labor, and
6. Breech presentation.

Cranial Injuries

Subconjunctival ,retinal hemorrhages and petechiae
of the skin of the head and neck
 All are common.
 All are probably secondary to a sudden increase in
intra-thoracic pressure during passage of the
chest through the birth canal.
 Parents should be assured that they are
temporary and the result of normal hazards of Delivery.

Molding

 Molding of the head and overriding of the parietal bones are
frequently associated with caput succedaneum and become
more evident after the caput has reduced but disappear
during the first week of life.
 Rarely, a hemorrhagic caput may result in shock and require blood transfusion.

Caput succedaneum

Diffuse, sometimes ecchymotic, edematous swelling of the soft tissues of the scalp (Skin, Dense CT, Galea) involving the portion presenting during vertex delivery (Vaginal delivery), caused by compression exerted mainly by the cervix.
 It may extend across the midline and across suture lines.
 The edema disappears within the first few days of life.
 swelling, discoloration, and distortion of the face are seen in face
presentations.
 The edema is soft and superficial, and does not involve the periosteum
 No specific treatment is needed, but if there are extensive ecchymoses,
phototherapy for hyperbilirubinemia may be indicated.

The edema is soft and superficial, and does not involve the
periosteum.

No specific treatment is needed as the edema resolves in a few
days, but if there are extensive ecchymoses, phototherapy for
hyperbilirubinemia may be indicated.

Cephalhaematoma

 It is a subperiosteal haematoma most commonly lies over one parietal bone
(confined to the space between the outer table of the skull and
the periosteum, and is located between the cranial sutures).
 It is present in 1% to 2% of “normal” deliveries.
 It may result from difficult vacuum or forceps extraction.
 Midforceps are rarely used in modern obstetrical practice; thus,
the incidence of cephalohematoma is decreasing.
Management:

• It usually resolves spontaneously.
• Vitamin K 1 mg IM is given.

The hemorrhage in cephalhematoma is subperiosteal, which
explains why the hematoma is confined by the sutures.
• Most hematomas are unilateral and located over the parietal bone.
From 10% to 25% of the cases are caused by an underlying
skull fracture.
• Both skull fracture and stripping of the periosteum from the
underlying skull result from the crushing and sheering forces that
uterine compression and squeezing of the skull within the
pelvic outlet cause.
• The lesion presents as a tense, firm mass after birth, frequently
enlarging during the first few days.
• It may be painful due to the stretching of the periosteum during the
first days.
• Typically, the hematoma is contained by the periosteum
adhesions to the cranial sutures.

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,
because subperiosteal bleeding is a slow process.
 An underlying skull fracture, usually linear and not
depressed, is occasionally associated with
cephalohematoma.

Cranial meningocele is differentiated from cephalohematoma by:

1. Pulsation,
2. Increased pressure on crying, and the
3. Radiologic evidence of bony defect.
    Most cephalohematomas are resorbed within 2 wk-3 mo,
   depending on their size.
    They may begin to calcify by the end of the 2nd wk.

 A sensation of central depression suggesting ( but not
indicative )of an underlying fracture or bony defect
 Cephalohematomas require no treatment, although
phototherapy may be necessary to hyperbilirubinemia.

Incision and drainage are contraindicated because of
the risk of introducing infection in a benign condition.
 A massive cephalohematoma may rarely result in
blood loss severe enough to require transfusion.

 It may also be associated with a skull fracture and
intracranial hemorrhage.

TREATMENT

• It requires no treatment unless there is shock or intracranial
hemorrhage that requires blood transfusion.
• The hemorrhage is beneath the aponeurosis (galea), peripheral to the
periosteum. Coagulapathies may be present, so emergency
coagulation and bleeding studies should be performed.
• The lesion frequently enlarges after birth and presents as a
fluctuant, firm mass. The blood is liquid, and epicranial aspiration
is frequently necessary.
• The procedure is easily performed under local anesthesia after
the area has been shaved. Aspiration must be done with all the
necessary surgical asepsis.
• Following aspiration, a compressive dressing is applied.
• Blood transfusion may be necessary since the subgaleal space is
large.
• Repeated aspirations may occasionally be necessary