BIRTH INJURIES

Difficult deliveries may lead to birth injuries

Clinical features

  • Common injuries requiring no treatment include:
    • Caput succedaneum – Oedema over presenting part.
    • Massive oedema of scalp.
    • Conjunctival haemorrhage.
    • Subgaleal/aponeurotic haemorrhage – Fluctuant swelling on the head not limited by suture lines. Can be extensive to cause anaemia and jaundice.
    • Cephalohaematoma – Firm but fluctuant swelling limited by suture lines. Takes very long to resolve.
  • Nerve injuries
    • Erb’s palsy – Injury to the upper roots of the brachial plexus: Affected limb held extended at the elbow and forearm pronated.
  • Fractures
    • Clavicle – Mother notes the baby cries on being lifted and after a few days swelling along the affected clavicle.
    • Femur or humerus – Affected limb swollen and very painful on movement. There is pseudo paralysis.
  • Less common but serious injuries include the following:
    • Intracranial: Can be subdural or intracerebral. Baby is lethargic with signs of raised intracranial pressure and may have convulsions.
    • Intrathoracic: Presents with respiratory distress.
    • Intrabdominal: Usually ruptured liver either subcupsular or haemoperitoneum. If severe, baby shows features of hypovolaemic shock without obvious evidence of external bleeding; consider intrabdominal
      haemorrhage.

Investigations

  • Full blood count if there is pallor
  • X-ray of affected limb
  • Ultrasound for cranial or abdominal injuries

Management

  • Caput succedenum and massive oedema of scalp: Do not need any special treatment.
  • Severe scalp bleed: Requires no specific treatment; never aspirate as this predisposes to infection. If anaemia is severe, transfusion may be needed.
  • Nerve injuries: Rest the baby for a few days then start passive movements. Most injuries will recover fully. Inform the mother and ask her to lift the baby carefully in order to prevent further injury. Involve an occupational therapist or
    physiotherapist.
  • Fractures: Align the affected limb and immobilize. Usually healing occurs within 3 weeks.
  • Intracranial: drainage if subdural is present.
  • Intrathoracic and intrabdominal injuries: Refer for surgery.