Birth Injuries Flashcards
When do birth injuries occur?
Infants may be injured at birth, particularly if they are malpositioned or too large for
the pelvic outlet.
Injuries may also occur during manual manoeuvres, from forceps blades or at
Ventouse deliveries
What soft tissue injuries can occur in birth?
Extracranial haemorrhage
Chignon
Bruising
Abrasions
Forcep marks
Subaponeurotic haemorrhage
What nerve palsies can occur in birth?
Brachial palsy
Erb’s palsy
Klumpke’s palsy
Facial nerve palsy
Cervical spine
What are common fractures in child birth?
Clavicle
Humerus/ femur
Which extracranial haemorrhages may occur in birth?
o Caput Succedaneum - bruising and oedema of the presenting part extending beyond the margins of the skull bones (resolves within a few days)
o Cephalhaematoma - haematoma from bleeding below the periosteum, confined within the margins of the skull sutures. Centre of haematoma feels soft. Usually involves the parietal bone (resolves over several weeks)
What is chignon?
o Oedema and bruising from Ventouse
delivery (using vacuum device)
o Resolves over few days
When does bruising occur?
Can occur in face after a face
presentation, and to genitalia and buttocks after
breech delivery. Preterm infants bruise easily,
even from mild trauma
How do abrasions occur?
from scalp electrodes applied during
labour, or from accidental scalp incision at C-section
What do Subaponeurotic haemorrhage look like?
very uncommon; diffuse, boggy swelling of scalp on examination; blood loss may be severe and lead to hypovolaemic shock and coagulopathy
What is brachial palsy?
A paralysis of the upper extremity due to an injury to the nerves that control movement and sensation to the upper extremity occurring at the time of birth
Can result from traction to the brachial plexus nerve roots
This can occur during breech deliveries or with shoulder dystocia
What is Erb’s palsy?
Type of brachial plexus birth palsy, involving the C5 and C6 nerve roots
Due to a vaginal delivery complicated by shoulder dystocia – the head and
neck can be laterally deviated away from the shoulder, producing traction on
the brachial plexus as the nerve root exits the spinal column → the forces of
delivery, either through strong uterine contractions or assistance of delivery,
may then exceed the strength of the nerves causing a stretch injury or rupture
What are the clinical features of Erb’s palsy?
▪ Paralysis of affected arm
▪ Lack of motion of an arm
▪ Abnormal posture of the arm: usually infant will hold arm at the side
with shoulder internally rotated, elbow extended, wrist flexed, fingers
flexed (‘waiter tip position’)
▪ May be accompanied by phrenic nerve palsy causing an elevated
diaphragm
What is the management of Erb’s palsy?
o Usually resolves completely, but should be referred to an orthopaedic or
plastic surgeon if not resolved by 2-3 months. Most recover by 2 years
▪ Initial supportive care – avoid extremes of movement at first
▪ Physiotherapy at 2 weeks of age – home-based range of motion
stretching exercise programme
What is Klumpke’s palsy?
o Type of brachial plexus palsy involving C8 and T1 nerve roots
o Usually due to breech birth
o Leads to claw hand and sensory loss of ulnar border
Which facial nerve palsies occur?
o Unilateral, facial weakness on crying but eye remains open
o Usually transient, but methylcellulose drops may be needed for eye
