Post on 25-Mar-2020
Neonatal Birth InjuriesNeonatal Birth Injuries
Dr. Dr. SaadSaad AlsaediAlsaedi
•• Inappropriate or deficient medical skill or attentionInappropriate or deficient medical skill or attention
•• They may occur, despite They may occur, despite skilled and competent obstetric competent obstetric
carecare
Birth injuries may result fromBirth injuries may result from
Predisposing factorsPredisposing factors
•• MacrosomiaMacrosomia
•• PrematurityPrematurity
•• Cephalopelvic disproportionCephalopelvic disproportion
•• DystociaDystocia
•• Prolonged laborProlonged labor
•• MalpresentationMalpresentation (breech, transfers lie)(breech, transfers lie)
Cranial InjuriesCranial Injuries
ErythemaErythema, Abrasions, , Abrasions, EcchymosesEcchymoses
•• Of facial or scalp soft tissues may be seen after Of facial or scalp soft tissues may be seen after
forceps or vacuumforceps or vacuum--assisted deliveries assisted deliveries
•• Their location depends on the area of Their location depends on the area of
application of the forcepsapplication of the forceps
CephalohematomaCephalohematoma
•• subperiostealsubperiosteal hemorrhagehemorrhage
•• IIt may result from difficult vacuum or forceps extraction t may result from difficult vacuum or forceps extraction
•• Does not cross the suturesDoes not cross the sutures
•• always limited to the surface of one cranial bonealways limited to the surface of one cranial bone
•• swelling is not visible until several hours after birthswelling is not visible until several hours after birth
•• Most cephalohematomas are resorbed within Most cephalohematomas are resorbed within
2 2 -- 12 wk depending on their size12 wk depending on their size
•• They may begin to calcify by the end of the 2nd wkThey may begin to calcify by the end of the 2nd wk
•• central depression suggesting( but not central depression suggesting( but not
indicative )of an underlying fracture or bony indicative )of an underlying fracture or bony
defectdefect
CephalohematomaCephalohematoma
Management:Management:
•• usually resolves spontaneously usually resolves spontaneously
•• phototherapy if Jaundicedphototherapy if Jaundiced
•• Blood transfusion if anemic due to severe Blood transfusion if anemic due to severe
hemorrhage hemorrhage
•• Incision and drainage are contraindicatedIncision and drainage are contraindicated
CephalhaematomaCephalhaematoma
Peripheral Nerve Peripheral Nerve
InjuriesInjuries
Risk Factors Associated
With Perinatal Brachial Plexus
Maternal Factors
• Excessive maternal weight gain
• Maternal diabetes
• Uterine abnormalities
• Past history of PBPP
Risk Factors Associated
With Perinatal Brachial Plexus
Fetal Factors
• Fetal macrosomia
Parturitional Factors
• Shoulder dystocia
• Prolonged labor
• Assisted delivery with forceps or vacuum
• Breech delivery
Brachial Plexus Palsy:Brachial Plexus Palsy:
It is due to over traction on the neck as in:It is due to over traction on the neck as in:
1.1. Shoulder Shoulder dystociadystocia
2.2. AfterAfter--coming head in breech deliverycoming head in breech delivery
•• due to injury to C5 and C6 rootsdue to injury to C5 and C6 roots
•• Adduction and internal rotation of the arm with Adduction and internal rotation of the arm with pronationpronationof the forearm of the forearm
•• The upper limb drops beside the trunk, internally rotated The upper limb drops beside the trunk, internally rotated with flexed wrist with flexed wrist (policeman(policeman’’s or waiters or waiter’’s tip hand)s tip hand)
•• Moro reflex is absent on the affected sideMoro reflex is absent on the affected side
Erb'sErb's palsypalsy
Treatment:Treatment:
•• Support to prevent stretching of the paralyzed Support to prevent stretching of the paralyzed
musclesmuscles
•• Physiotherapy: massage, exercise and faradic Physiotherapy: massage, exercise and faradic
stimulationstimulation
Brachial Plexus Palsy:Brachial Plexus Palsy:
If the paralysis persists without improvement for 3If the paralysis persists without improvement for 3--6 months:6 months:
neuroplastyneuroplasty, neurolysis, end, neurolysis, end--toto--end anastomosis, or nerve end anastomosis, or nerve
graftinggrafting
offers hope for partial recovery.offers hope for partial recovery.
TreatmentTreatment
The prognosisThe prognosis
•• Depends on whether the nerve was merely Depends on whether the nerve was merely
injured or was laceratedinjured or was lacerated
•• If the paralysis was due to edema and If the paralysis was due to edema and
hemorrhage about the nerve fibers, function hemorrhage about the nerve fibers, function
should return within a few monthsshould return within a few months
•• If due to laceration, permanent damage may If due to laceration, permanent damage may
result.result.
Fracture ClavicleFracture Clavicle
Difficulty in delivery of:Difficulty in delivery of:
•• the shoulder in vertex presentations the shoulder in vertex presentations
•• The extended arms in breech deliveriesThe extended arms in breech deliveries
•• The infant characteristically does not move the The infant characteristically does not move the
arm freely on the affected side;arm freely on the affected side;
•• Crepitus and bony irregularity may be palpated, Crepitus and bony irregularity may be palpated,
and and
•• Discoloration is occasionally visible over the Discoloration is occasionally visible over the
fracture sitefracture site..
Fracture ClavicleFracture Clavicle
•• No interventionNo intervention
•• immobilization of the arm and shoulder on the immobilization of the arm and shoulder on the
affected side affected side
•• A remarkable degree of callus develops at the A remarkable degree of callus develops at the
site within a week and may be the first evidence site within a week and may be the first evidence
of the fracture of the fracture
•• The prognosis is excellentThe prognosis is excellent
Fracture ClavicleFracture Clavicle