*Birth Injuries

Question 1

Types of birth injuries

Answer 1

Trauma to skin and superficial tissues
Muscle trauma
Nerve trauma
Fractures

Question 2

How might trauma to the skin and superficial tissues occur?

Answer 2

• Forceps blades
• Vaccum cup
• Fetal blood sample
• Fetal scalp electrode

Question 3

Management of skin and superfical trauma

Answer 3

Refer to Paed:
* Any injury noted
* Any signs of infection (ABs may be required)
Abrasions and lacerations - clean and dry
Deeper lacerations - close with butterfly strips or sutures

Note:
Healing is usually rapid with no residual scarring
Fat necrosis (caused by pressure) should resolve spontaneously

Question 4

What is caput succedaneum?

Answer 4

Swelling of blood and serum above the periosteum and under the scalp due to pressure.

• Pits on pressure
• Can cross suture line
• Present at birth
• Lasts 24-48hrs
• More common in first baby due to longer labour

• Chignon = false caput succedaneum from vacuum extractor cup, resolves within a few hrs usually

Question 5

What is cephalhaematoma?

Answer 5

Swelling of blood under the periosteum and over the skulll due to friction during birth process.

• Swelling is firm, does not pit on pressure
• Cannot cross suture line
• Develops 12hours after birth
• May take 6 weeks to co away
• Needs to be reabsorbed slowly as its underneath the periosteum

Question 6

Other types of birth injuries

Answer 6

• Bruised and odematous face with face presentation
• Brusied and oedematous genatalia and buttocks with breech presentation
• Subconjunctival haemorrhage from breakage of small vessels during pressure of birth
• Facial congestion from brusing and breaking of small vessels during pressure of birth

Question 7

Type of muscle trauma

Answer 7

Torticollis (wry neck)

Question 8

Types of nerve trauma

Answer 8

Facial palsy
Brachial plexus
* Erbs palsy - paralysis of shoulder and arm (not hand)
* Klumpke’s palsy - paralysis of lower arm, wrist and hand
* Total brachial plexus palsy - paralysis of shoulder, arm and hand, lack of sensation and circulatory problems

Management: Further investigations (X-ray, USS), physio, MRI at 1 month, recovery?, follow up, microsurgical nerve repair

Question 9

Caput succedaneum vs. Cephalhaematoma

Location, Suture line, Timing, Pitting, Duration, Treatment

Answer 9

Location: Between periosteum and scalp vs. between periosteum and skull
Suture Line: Does not cross suture line (confined to one bone) vs. may cross suture lines
Timing: Present at birth vs. appears 12 hours after birth
Ptting: Pits on pressure vs. does not pit on pressure (swelling is firm)
Duration: Resolves in 24-48hrs vs. may take 6-9 weeks but swelling may ossify, tends to grow larger before it disappears
Treatment: Resolves spont vs. Resolves spont