Birth Injury

Question 1

Birth Injury Skull Injuries

Answer 1

Cephalhaematoma
-Bleeding between periosteum and skull, usually parietal haematoma, does not cross sutures
-Can cause hyperbilirubinaemia
Subgaleal Haematoma
-Between periosteum and scalp, associated with ventouse
-77% following instrumental delivery
-12-72 hours after birth, soft fluctuant mass, non-restricted spread
Caput Succedaneum
-Poorly defined fluid build up
-Common after prolonged labour

Question 2

Birth Injury Brachial Plexus Injury

Answer 2

Erb’s palsy
-C5,C6 segments of brachial plexus
-Loss of motion of shoulder, limp arm, adducted and internally rotated
-Grasp reflex maintained but Moro, biceps and radial reflexes lost
Klumpke’s (much less common)
-Claw hand, lower brachial plexus
-Most cases resolve within four months
-X rays are required to exclude phrenic nerve paresis
-Immobilise arm across upper abdomen then start physio
-Neurosurgery if no improvement after three months

Question 3

Birth Injury Hypoxic Ischaemic Encephalopathy

Answer 3

• Two phases of ischaemic brain damage
• Primary and secondary
• Secondary can take 6 hours to develop so induced hypothermia can help