Birth injury

Births, especially complicated, can end unfavorably for the child - birth trauma may occur.

[1], [2], [3], [4], [5]

Birth injury to the head

Deformation of the head often occurs during childbirth per vias naturalis because of the high pressure created by the contractions of the uterus on the supple skull of the fetus during its passage through the birth canal.

A generic tumor (caput succedaneum) is the edema of the present part of the head. It occurs when the present part is pushed out of the cervix. Hemorrhage under aponeurosis occurs with more damage and is characterized by a testic consistency, fluctuating over the entire surface of the head, including the temporal areas.

Kefalogematoma, or subperiosteal hemorrhage, differentiates from hemorrhage for aponeurosis due to the fact that it is clearly limited to the area of one bone, in the seam area the periosteum is closely adherent to the bone. Kefalogematomes, as a rule, are one-sided and located in the area of the parietal bone. In a small percentage of cases, linear fractures (fractures) of the underlying bone are noted. Treatment is not required, but the consequence may be the development of anemia or hyperbilirubinemia.

Depressed fractures of the skull are rare. In most cases, they are the result of the application of forceps, rarely - the location of the head on the bone protrusion is intrauterine. Newborns with depressed skull fractures or other head injuries may also have intracranial hemorrhage, subdural hemorrhage, subarachnoid hemorrhage, or bruising, or brain crushing). With a crushed fracture of the skull, a palpable (sometimes visually noticeable) deformity is noted, which must be differentiated from the elevating periosteum, palpable in cephalohematemata. CT is performed to confirm the diagnosis and eliminate complications. Neurosurgical intervention may be required.

[6], [7], [8], [9]

Traumas of craniocerebral nerves

The most common damage to the facial nerve. Despite the fact that this is often associated with the application of forceps, birth trauma is probably a consequence of the pressure acting on the nerve in the uterus, which can occur due to the position of the fetus (for example, the head is located opposite the shoulder, Cape of the sacrum or uterine fibroids).

Damage to the facial nerve occurs in a place or distal to its exit from the stylophyllum and is manifested by asymmetry of the face, especially when the baby cries. It may be difficult to determine which side of the face is affected, but on the side of nerve damage the facial muscles are immobile. Separate branches of the nerve can also be damaged, most often the mandibular. Another reason for the asymmetry of the face is the asymmetry of the lower jaw, which is a consequence of the pressure on her uterus, in this case the innervation of the muscles is not broken and both halves of the face can move. With asymmetry of the lower jaw, the occlusal surfaces of the upper and lower jaw are not parallel, which distinguishes them from the trauma of the facial nerve. A deeper examination or treatment is not required for peripheral lesions of the facial nerve or asymmetry of the lower jaw. They, as a rule, pass to the age of 2-3 months.

Injuries of the brachial plexus

Injuries of the brachial plexus occur as a result of stretching, which is caused by difficulties in the eruption of the shoulders, the extraction of the fetus with the breech presentation or hyperactivity of the neck in the head preposition. Birth trauma can occur with simple stretching, hemorrhage in the nerve, rupture of the nerve or its root or detachment of rootlets with concomitant damage to the cervical spinal cord. There may also be concomitant injuries (eg, fractures of the clavicle or shoulder, or subluxation of the shoulder or cervical spine).

Injuries of the upper part of the brachial plexus (C5-C6) affect the muscles of the shoulder and elbow, while the injuries of the lower part of the brachial plexus (C7-C8 and T1) primarily affect the muscles of the forearm and hand. The location and type of nerve root damage determine the prognosis.

Erba's paralysis is a trauma to the upper part of the brachial plexus, which causes the induction and internal rotation of the shoulder with pronation of the forearm. Often there is paresis of the diaphragm on the same side. Treatment involves protecting the shoulder from excessive movements by immobilizing the arm across the upper abdomen and preventing contractures with passive metered-dose exercises for the involved joints, which must be performed with caution daily from the 1st week of life.

Kliumpke paralysis is an injury to the lower part of the brachial plexus, which leads to paralysis of the wrist and wrist, and can often be accompanied by the development of Horner's syndrome on the same side (miosis, ptosis, facial anhidrosis). Passive metered exercises are the only treatment that is required.

Neither Erb's paralysis nor Klyumpka's paralysis usually show a marked loss of sensitivity, which indicates a rupture or detachment of the nerve. With these conditions, usually there is a rapid improvement, but there may be some shortage of movement. If a significant deficit persists for more than 3 months, an MRI is performed to determine the prevalence of plexus injury, rootlets and cervical spinal cord. Surgical examination and correction are sometimes effective.

If there is a birth injury of the entire brachial plexus, the affected upper limb can not move, usually a loss of sensitivity, pyramidal symptoms from the same side indicate trauma to the spinal cord; you need an MRI. The subsequent growth of the affected limb can be disturbed. The prognosis for recovery is unfavorable. Treatment of such patients may include neurosurgical examination. Passive metered exercises can prevent contractures.

Other birth injuries of peripheral nerves

Damage to other nerves (eg, radial, sciatic, blocking) is rare in newborns and usually does not bind to labor and delivery. They are usually secondary to local trauma (eg, injection in or near the sciatic nerve). Treatment includes resting the antagonists of paralyzed muscles until complete recovery. Neurosurgical examination of the nerve is rarely shown. With the majority of injuries of the peripheral nerves, a full recovery comes.

Birth injury to the spinal cord

Birth trauma of the spinal cord is rare and includes spinal cord ruptures of varying severity, often with hemorrhage. A complete rupture of the spinal cord is very rare. Trauma usually occurs during labor in the breech presentation after excessive longitudinal spinal distension. It can also follow the hyperextension of the fetal neck in utero (the "flying fruit"). Damage usually affects the lower cervical spine (C5-C7). If the damage is higher, the trauma is usually fatal, because the breathing is completely broken. Sometimes you can hear a click during childbirth.

Immediately there is a spinal shock with a flaccid paralysis below the level of defeat. Usually, partial sensitivity or movement is kept below the level of damage. Spasmodic paralysis develops within days or weeks. Respiration is diaphragmatic, since the diaphragmatic nerve remains unaffected, as it leaves higher than (C3-C5) a typical site of spinal cord injury. With complete damage to the spinal cord, the intercostal muscles and muscles of the anterior abdominal wall become paralyzed and dysfunction of the pelvic organs is noted. Sensitivity and sweating are also absent below the level of damage, which can cause fluctuations in body temperature depending on changes in ambient temperature.

On the MRI of the cervical spinal cord, one can see damage and exclude conditions that require surgical treatment, such as congenital tumors, hematomas that compress the spinal cord, as a rule, blood is detected when examining the cerebrospinal fluid.

With proper care, most babies live for many years. Common causes of death are frequent pneumonia and progressive decline in kidney function. Treatment includes careful care to prevent bedsores, proper treatment of urinary tract infections and respiratory infections and regular examinations for the early detection of obstructive uropathy.

[10], [11]

Fractures

Fracture of the clavicle, the most frequent fracture during labor, occurs when hamstring birth is difficult and with normal non-traumatic births. First, the newborn baby is restless and does not move the hand on the affected side spontaneously, nor when the Moreau reflex is caused. Most clavicle fractures occur as a green twig and heals quickly and without complications. A large callus is formed at the site of the fracture within a week, and remodeling is completed within a month. Treatment involves the application of a fixative bandage by attaching the sleeve of the hamstring of the affected side to the opposite side of the infant's rasp.

The shoulder and thigh can be broken in difficult births. In most cases these are fractures of the diaphysis by the type of green twig, usually a successful bone remodeling is noted, even if a moderate displacement initially occurs. Fracture of a long bone can occur through the epiphysis, but the prognosis is favorable.

Birth injury of soft tissues

All soft tissues are susceptible to damage during labor, if they were the presenting part or the point of impact of the forces of contraction of the uterus. Birth trauma is accompanied by edema and ecchymosis, especially periorbital and facial tissues with facial presentation and scrotum or labia with gluteal presentation. When the hematoma develops in the tissues, its resorption and transformation of the subject into bilirubin occurs. This additional bilirubin can cause neonatal hyperbilirubinemia, sufficient to require phototherapy, and sometimes - blood transfusion. No other treatment is required.

[12], [13], [14], [15], [16]