Birth trauma of newborns. Classification of injuries sustained during childbirth by newborns: the main causes that lead to injuries, the consequences for the child from various injuries, methods of treatment, rehabilitation Birth injuries and injuries to newborns

Content:

At birth, children can receive birth trauma - serious damage to organs and tissues. They also include a holistic response of the body to these disorders. No one is immune from them, but if there is such a threat, doctors do everything possible to prevent any, even the slightest, injury to the baby. However, the delivery process until the very end is unpredictable and can go completely differently than planned. That is why, even with modern medical technology and highly qualified doctors, the percentage of birth injuries is quite high. This is explained by a variety of factors.

Too much when a baby is born is completely unpredictable. The organisms of the mother and the child can behave differently, and medical omissions are not excluded. The reasons can be both external and internal factors. According to statistics, birth trauma in newborns is due to the following indicators.

"Maternal" factors:

early or late age of a woman;
hyperantheflexia, uterine hypoplasia,
preeclampsia;
narrow pelvis;
cardiovascular, gynecological, endocrine diseases;
occupational hazards (if a woman, for example, worked in the chemical industry);
post-term pregnancy.

Fetal pathologies:

large sizes;
prematurity;
abnormal (with a reversal) position of the fetus;
asphyxia;
asynclitic (incorrect) or extensor insertion of the head.

Abnormalities of labor:

protracted labor;
discoordinated or strong, as well as weak labor.

Obstetrics errors:

rotation of the fetus on the leg;
the use of forceps (this is the main cause of birth trauma to the central nervous system in children, since not only the baby's limb is often damaged, but also the spine with the spinal cord);
vacuum extraction of the fetus;
C-section.

Very often, birth trauma of newborns is caused by a combination of several unfavorable factors at once, which disrupt the normal course of labor. As a result of an undesirable set of circumstances, some internal organs or vital functions of the fetus are disturbed, and to varying degrees. Some of them are so serious that they are diagnosed immediately. However, in some cases, they can manifest themselves only over time.

According to statistics... In Russia, according to statistics, 18% of births end with injuries to the baby. But, given the problems of diagnostics in maternity hospitals, statisticians assure that the official figure is significantly underestimated.

Signs

In hospitals, childbirth injuries are diagnosed in a child only when their signs are literally visible to the naked eye and represent open injuries of a mechanical nature:

fractures;
breaks;
tears;
dislocations;
hemorrhages (hematomas);
compression.

Since birth injuries in children require, in some cases, a forensic prosecutor's investigation due to the detection of medical errors, neonatologists and pediatricians are not very active in diagnosing them. Therefore, most often the symptoms are detected after discharge from the hospital and are explained by pathologies of intrauterine development or improper care of a newborn in the first days of his life.

Symptoms of soft tissue damage:

scratches, petechiae (punctate hemorrhages), abrasions, ecchymosis (bruises);
tumors;
absence, its painlessness, is often accompanied by jaundice and anemia.

Signs of injury to the skeletal system:

swelling and swelling;
inability to perform active movements with the injured limb;
pain syndrome, due to which the child often cries a lot;
the main signs of intracranial birth trauma are muscle weakness, temperature changes, attacks of suffocation, uncoordinated movements of the limbs, their trembling, convulsions, spontaneous eye movement, bulging fontanelle, drowsiness, weak cry;
deformities, shortening of the limbs.

Symptoms of trauma to internal organs:

bloating;
, atony;
depressed physiological reflexes;
constant profuse regurgitation;
arterial hypotension;
vomit.

Signs of CNS disorders:

lethargy, areflexia;
muscle hypotension;
weak cry;
diaphragmatic breathing;
vegetative disorders: sweating, vasomotor reactions;
shortness of breath, cyanosis, swelling of the chest;
congestive pneumonia;
asymmetry of the face, mouth;
displacement of the eyeball;
difficulty in sucking.

Most of the symptoms of birth trauma in a baby do not appear immediately, but only 4-5 days after birth. It often happens that the mother writes off the lethargy and drowsiness for the usual state of the crumbs, and in the meantime, there is damage to any internal organ. It is possible to make the correct diagnosis only after a comprehensive examination and passing the appropriate tests. They will depend on the type of birth injury.

On a string to the world... The charming crooked smile of Hollywood actor Sylvester Stallone is nothing more than a consequence of a serious birth injury. As well as a severe speech defect, which the artist had to get rid of for a long time.

Kinds

Depending on the cause and nature of the injury, there are various types of birth trauma, the main classifications of which are two.

Classification # 1 (for reasons)

If the provoking factors were precisely intrauterine pathologies and fetal abnormalities, a neonatal birth trauma in a child is diagnosed. In some cases, it can be prevented if it is detected in advance by means of ultrasound.
Spontaneous trauma occurs during normal labor.
Obstetric trauma is caused by certain physical actions, manipulations of the doctor.

Classification No. 2 (for damage)

1. Damage to soft tissues: skin, muscles, subcutaneous tissue, tumor, cephalohematoma.

2. Injury to the osteoarticular system: fractures, cracks of the clavicle, femur, humerus, epiphysiolysis of the shoulder, subluxation of the joints, damage to the bones of the skull.

3. Disorders in the work of internal organs: hemorrhages in the liver, adrenal glands, spleen.

4. Birth trauma of the central nervous system:

more often than others, intracranial birth trauma is diagnosed, since the soft bones of the skull cannot withstand the compression and pressure of the birth canal;
spinal cord
peripheral nervous system (Duchenne-Erb paralysis, Dejerine-Klumpke, paresis of the diaphragm, facial nerve).

Each of the injuries is dangerous for the baby's life and does not go away without consequences. Particularly often diagnosed with a birth trauma to the head, which paves the way for the entire body and is thus crushed or broken. The result is a dysfunction of the central nervous system, which is practically not amenable to treatment. Much less often, such cases occur with a cesarean section, but it does not guarantee 100% safe removal of the baby from the mother's womb.

Facts... In 90% of women who have children with cerebral palsy, delivery was artificially induced or accelerated.

Is a cesarean section a salvation?

According to statistics, birth injuries during cesarean section are rare, but not excluded. It seems that with a planned, well-thought-out operation, any surprises can be avoided, but nature makes its own adjustments here too. Doctors explain this by various factors:

Strong compression of the child during the passage of the birth canal starts the work of his cardiovascular and respiratory systems. With cesarean, this mechanism is absent, the restructuring of the body for functioning outside the uterus occurs in other, unnatural ways, which further affects the development of the child's central nervous system.
Themselves can lead to birth injuries.
The technique of the operation does not exclude mechanical damage to the fetus.

So in children, even after cesarean, doctors diagnose cranial injuries, displacement of several cervical vertebrae at once, retinal hemorrhages and other injuries. Those young mothers who deliberately insist on the operation in the absence of medical indications for it should understand that it is not always possible to protect the baby from injury in this way.

Keep in mind! With a caesarean section, the doctor makes a 25 cm long transverse incision in the uterus. And the average circumference of the shoulders in most babies is at least 35 cm. Accordingly, obstetricians have to make an effort to remove them. Therefore, birth trauma of the cervical spine is so common in children born through this operation.

Care

Young mothers should keep in mind the peculiarities of caring for children who have suffered a birth trauma in order to minimize its negative consequences. Treatment is very diverse, as it depends on the type of damage, the degree of their severity, aggravating factors. If the injury is very serious, and the woman does not have a medical education, nurses are often invited, who know how to professionally care for such children.

If the skeletal system (limbs) is damaged

No special care required.
Constant observation by the local pediatrician.
Surgeon's control in the first 2 months of the baby's life.
Exclude re-damage to the bone.
2 weeks after giving birth, an X-ray is taken and a conclusion is made about the bone fusion.

Spine injury

Regular exercise therapy classes.
Continuous dispensary observation.
Therapeutic and prophylactic massage.
Spinal cord injury is very dangerous, but with proper care, babies live a long time: you need to take measures to prevent pressure ulcers, carry out constant treatment of the urinary system and various infections, and periodically take the child for examinations to detect uropathy.

In case of soft tissue injury

Leaving is not difficult.
Avoid breastfeeding for 3-5 days. They are given expressed milk to drink.
Abrasions are treated with a brilliant green solution.
Complete rest.
Control of the external symptoms of birth trauma.

Internal organ damage

Syndrome treatment.
Constant supervision of a pediatrician.

Intracranial injury

Sparing regime.
In case of a serious condition, the child should be in the incubator (specially equipped incubator).
In the presence of convulsions, respiratory failure, asphyxia, any movement of the child is excluded. It will be necessary to provide him with maximum immobility.
Skin processing, feeding, swaddling are done in the crib.
Any head injury during childbirth (both internal and external) involves spoon or pipette feeding, possibly tube feeding.

Massage

Exercise therapy and therapeutic massage are of great importance for injuries of the spine and limbs, cerebral palsy. They strengthen weakened muscles, improve blood circulation and metabolic processes in the affected area, restore coordination of movements, fight limitation of mobility or curvature of the spine, and have a general strengthening effect on the body. Parents of affected babies should know the features of baby massage for birth injuries and learn it in order to help the baby at home.

For the procedure, heated oils are used (preferably olive or fir).
To relax damaged or atrophied muscles, stroking, felting, shaking, light vibration are used.
To stimulate them - planing, deep stroking, kneading, rubbing with weights, shading.
The techniques of tapping and squeezing are strictly prohibited.
The massage is performed on the back, neck area, arms (starting from the shoulder), legs (starting from the hip), chest, and abdomen.
The duration of the procedure is from 5 to 15 minutes.
The course includes 20-35 sessions.
4 to 6 courses are required per year.
In addition to the classic one, segmental or acupressure massage can be prescribed.

If the damage is serious and entailed irreversible consequences, the child needs professional care, in particular, a birth brain injury requires neurosurgical care in a hospital. The period in the first 1-5 months of a baby's life is especially difficult. If he was provided with timely, competent help from doctors, proper care from parents, the body will recover as much as possible and return to normal, as much as possible. However, a lot here depends on the severity of the deviation. For example, a birth injury to the neck of a newborn without CNS damage can be completely neutralized. But if the nerve endings are damaged, the consequences cannot be avoided even with full care.

On a note... The use of any stimulants during childbirth (prostaglandins, kelp, antiprogestogens, cans, oxytocin), as well as a puncture of the bladder, often leads to damage to the baby's central nervous system. Moreover, in 90% of cases, it is not detected at the time of delivery, but is diagnosed by a neurologist later.

Consequences

Complications and consequences of birth trauma are of varying degrees. With timely diagnosis, professional treatment and proper care, they can be avoided. But some processes turn out to be irreversible and significantly affect the functioning of the brain, while threatening not only health, but also the life of the baby. The most common and severe consequences are called:

- dropsy of the brain;
intracranial pressure surges;
retardation in mental and physical development, cerebral palsy (these are the most frequent and dangerous consequences of a birth traumatic brain injury, when the child's central nervous system is damaged);
decrease or complete absence of some reflexes;
to whom;
fatal outcome;
limb spasms;
tachycardia;
muscle atrophy;
enuresis;
hyperactivity, rapid excitability, increased nervousness;
paralysis;
diseases: bronchial asthma, food allergies, eczema, neurodermatitis, deformation of the spinal column (this is most often caused by birth trauma of the spine), paresis, disturbances in the work of the cardiovascular system.

Parents of babies with birth trauma should be extremely attentive to such babies and be patient as much as possible. If the lesions of the central nervous system are superficial and are not accompanied by total changes in the work of the brain and spinal cord, recovery is possible with complex treatment and careful care. Despite this, many of these babies in the future - 95% delayed mental, motor, speech development, muscle tone disorders. The consequences of birth trauma are often very, very distant.

For your information... Early clamping of the umbilical cord is one of the causes of encephalopathy and mental retardation in children.

Prophylaxis

To avoid such negative and very life-threatening consequences for the baby, prevention of birth injuries is carried out even in the neonatal period by both parents and doctors:

planning conception and pregnancy in advance;
timely treatment of diseases in both parents;
a healthy lifestyle for the mother during pregnancy;
full, balanced nutrition of a woman;
instant elimination of infections picked up during pregnancy;
receiving professional medical care;
regular consultations with a gynecologist.

Doctors should take into account during childbirth any pathologies and abnormalities in the development of the fetus, identified during pregnancy. This greatly reduces the risk of injury to the baby. Professionalism and competent, well-coordinated actions of obstetricians in case of any deviation that has arisen is a guarantee of a safe, successful delivery.

- various damage to the fetus arising in the process of childbirth. Among birth traumas of newborns, there are injuries of soft tissues (skin, subcutaneous tissue, muscles), skeletal system, internal organs, central and peripheral nervous system. Birth trauma of newborns is diagnosed taking into account the obstetric and gynecological history of the mother, characteristics of the course of labor, examination data of the newborn and additional studies (EEG, ultrasound, radiography, ophthalmoscopy, etc.). Treatment of birth injuries of newborns is carried out differentially, taking into account the type and severity of the injury.

General information

The birth trauma of newborns is understood as a violation of the integrity of the tissues or organs of the child, due to the mechanical forces acting during childbirth. Birth injuries are diagnosed in 8-11% of newborns. Birth trauma of newborns is often combined with birth trauma to the mother (ruptures of the vulva, vagina, perineum, uterus, urogenital and vaginal-rectal fistulas, etc.). Birth trauma of newborns can have a serious impact on the further physical health and intellectual development of the child. All this makes birth traumatism one of the most pressing problems of obstetrics and gynecology, neonatology and pediatrics, pediatric neurology and traumatology.

Classification of birth injuries of newborns

Depending on the location of the damage and the predominant dysfunction, the following types of birth trauma of newborns are distinguished:

1. Birth trauma of soft tissues(skin, subcutaneous tissue, muscles, birth tumor, cephalohematoma).

2. Birth injuries of the osteoarticular system(cracks and fractures of the clavicle, humerus and femur; traumatic epiphyseolysis of the humerus, subluxation of the C1 and C2 joints, damage to the bones of the skull, etc.).

3. Birth trauma of internal organs(hemorrhages in internal organs: liver, spleen, adrenal glands).

4. Birth trauma of the central and peripheral nervous system in newborns:

intracranial birth injury (epidural, subdural, subarachnoid, intraventricular hemorrhage)
birth trauma of the spinal cord (hemorrhage in the spinal cord and its membranes)
birth trauma of the peripheral nervous system (damage to the brachial plexus - Duchenne-Erb paresis / paralysis or Dejerine-Klumpke paralysis, total paralysis, paresis of the diaphragm, damage to the facial nerve, etc.).

Causes

Analysis of the causes of birth trauma in newborns allows us to distinguish three groups of factors that increase the likelihood of its occurrence: related to the mother, to the fetus, as well as to the course and management of childbirth.

Predisposing "maternal" factors can be early or late reproductive age, gestosis, a narrow pelvis, hypoplasia or hyperactivity of the uterus, diseases of a pregnant woman (cardiovascular, endocrine, gynecological, etc.), post-term pregnancy, occupational hazards, etc.

The most extensive group of causes leading to birth trauma of newborns are the circumstances associated with the fetus. Pelvic presentation of the fetus, oligohydramnios, abnormal (asynclitic or extensor insertion of the head), prematurity, large fetal size, fetal malformations, intrauterine hypoxia and asphyxia, etc. can provoke birth trauma.

Anomalies of labor can lead to a birth trauma of a newborn: prolonged or rapid labor, delivery with weak labor, uncoordinated or excessively strong labor. A serious group of causes of birth trauma to newborns is the incorrect or unreasonable use of obstetric benefits (turning the fetus on the leg, applying obstetric forceps, using a vacuum extractor, performing a cesarean section, etc.).

As a rule, when birth trauma occurs in newborns, there is a combination of a number of unfavorable factors that disrupt the normal biomechanics of childbirth.

Different types of newborn injuries

Birth injuries of soft tissues

The most common manifestations of birth trauma in newborns are damage to the skin and subcutaneous tissue. These include scratches, abrasions, petechiae, ecchymosis on various parts of the body. Such damage is detected by visual examination of the newborn by a neonatologist; they are usually not dangerous and only require local antiseptic treatment and aseptic dressing. Minor birth injuries of soft tissues disappear by the end of the first week of a newborn's life.

A type of birth trauma of newborns is a birth tumor, which is characterized by local swelling of the soft tissues of the head. The generic tumor has a soft-elastic consistency, bluish color with multiple petechiae and ecchymosis. Its occurrence is usually associated with prolonged labor in the cephalic presentation or the imposition of obstetric forceps. A generic tumor does not require treatment; it disappears on its own in 1-3 days.

A more severe type of birth trauma of newborns is damage (hemorrhage, rupture) of the sternocleidomastoid muscle, usually its lower third. In this case, a small tumor of moderately dense or doughy consistency is determined at the site of injury. Damage to the sternocleidomastoid muscle may not be detected immediately, but after about a week, when the child develops torticollis. In the treatment of birth trauma of the sternocleidomastoid muscle in newborns, corrective head position using rollers, dry heat, electrophoresis of potassium iodide, massage are used; if ineffective - surgical correction.

Cephalohematoma, as a type of birth trauma of newborns, is characterized by hemorrhage under the periosteum of the parietal or occipital bones of the skull. Typical signs of cephalohematoma are elastic consistency, absence of pulsation, painlessness, fluctuation, presence of a roller along the periphery. In the future, newborns with cephalohematoma may experience jaundice caused by increased extravascular bilirubin production. Cephalohematoma decreases in size by 2-3 weeks of life, and completely resolves by the end of 6-8 weeks. Complications of subperiosteal birth trauma of newborns include anemia, calcification and suppuration of cephalohematoma. Children with large (more than 6 cm in diameter) cephalohematomas need an x-ray of the skull to exclude bone fractures. Since cephalohematomas in premature infants are often associated with intrauterine mycoplasmosis, PCR or ELISA diagnostics are required.

In most cases, birth injuries of soft tissues in newborns go away without consequences.

Birth injuries of the skeletal system

Among birth injuries of the osteoarticular system in newborns, damage to the clavicle and bones of the limbs is more common. They always refer to purely obstetric types of injuries. Subperiosteal fractures of the clavicle without displacement are usually detected 3-4 days after delivery by the presence of a spindle-shaped dense swelling - forming callus. A displaced clavicle fracture is accompanied by the inability to perform active movements, pain, crying with passive arm movement, swelling and crepitus over the fracture site.

A type of birth trauma to the skeletal system of newborns is traumatic epiphyseolysis of the humerus. Its manifestations are soreness, swelling and crepitus in the area of the shoulder or elbow joints, limitation of the range of motion in the affected arm. The outcome of such an injury may be paresis of the radial nerve, the formation of flexion contracture in the joints. Treatment consists of limb immobilization, physiotherapy, massage.

Birth trauma to internal organs

Damage to internal organs occurs as a result of mechanical impact on the fetus during an abnormal course of childbirth. The most common hemorrhages are in the liver, spleen and adrenal glands. Clinical manifestations of birth trauma of internal organs in newborns develop on the 3-5th day due to internal bleeding. When a hematoma ruptures, bloating occurs, intestinal paresis develops, muscle hypotension (or atony), inhibition of physiological reflexes, arterial hypotension, persistent regurgitation and vomiting.

If there is a suspicion of a birth trauma to the internal organs of the newborn, an overview X-ray of the abdominal cavity, ultrasound of the abdominal organs and ultrasound of the adrenal glands are performed. Treatment consists in carrying out hemostatic and symptomatic therapy; if necessary - laparoscopy or laparotomy with revision of internal organs.

With hemorrhage into the adrenal glands, the child may develop acute or chronic adrenal insufficiency. The prognosis for birth trauma of internal organs in newborns is determined by the volume and severity of the lesion, the timeliness of detecting the damage.

Birth trauma of the central and peripheral nervous system

Injuries to the nervous system in newborns constitute the most extensive group of birth injuries. Within the framework of this review, we will focus on the birth trauma of the spinal cord and peripheral nervous system; detailed characteristics of intracranial birth injuries of newborns will be given in the corresponding article.

Spinal cord birth injuries in newborns can include hemorrhage, sprain, compression or rupture of the spinal cord at various levels, associated with or without a fracture of the spine. Severe injuries are characterized by the clinic of spinal shock: lethargy, muscle hypotonia, areflexia, weak cry, diaphragmatic breathing. The death of children can occur from respiratory failure. In more favorable cases, there is a gradual regression of the phenomena of spinal shock; hypotension is replaced by spasticity; vegetative disorders (vasomotor reactions, sweating), trophic changes in muscle and bone tissue develop. Mild birth injuries in newborns are accompanied by transient neurological symptoms: changes in muscle tone, reflex and motor reactions.

The diagnosis is facilitated by examination of the child by a pediatric neurologist, X-ray or MRI of the spine, electromyography, lumbar puncture and examination of cerebrospinal fluid. Treatment of birth trauma of the spinal cord in newborns includes immobilization of the damaged area, dehydration and antihemorrhagic therapy, rehabilitation measures (orthopedic massage, exercise therapy, electrical stimulation, physiotherapy).

Birth injuries of the peripheral nervous system in newborns combine damage to the roots, plexuses, peripheral and cranial nerves.

Taking into account the localization of paresis of the brachial plexus (obstetric paresis), it can be superior (proximal), inferior (distal) or total. Upper Duchenne-Erb paresis is associated with damage to the plexuses and roots, originating in the C5-C6 segments, which is accompanied by dysfunction of the proximal upper limb. In this case, the child assumes a characteristic position with the hand brought to the body, unbent at the elbow joint, turned inward at the shoulder and pronated into the forearm; bent in the palm of the hand and head bent to the sore shoulder.

With the lower obstetric paresis of Dejerine-Klumpke, plexuses or roots, originating from C7-T1, are affected, resulting in a dysfunction of the distal part of the hand. Manifestations include muscle hypotonia, hypesthesia, limitation of movement in the wrist and elbow joints, fingers, and the symptom of a “clawed paw”. With a total type of obstetric paresis, the hand is completely inactive, muscle hypotonia is sharply expressed, and muscle atrophy develops early.

The diagnosis and localization of damage is clarified using electromyography. Treatment of birth trauma of the brachial plexus in newborns consists in the immobilization of the hand with a splint, massage, exercise therapy, physiotherapy (applications of ozokerite, paraffin, electrical stimulation, electrophoresis), drug therapy.

With paresis of the diaphragm, the newborn develops shortness of breath, paradoxical breathing, cyanosis, swelling of the chest on the affected side. The detection of paresis is facilitated by fluoroscopy and chest x-ray, in which the high standing and inactivity of the dome of the diaphragm is determined. Against this background, children may develop congestive pneumonia. Treatment of a birth injury consists of percutaneous stimulation of the phrenic nerve; if necessary - mechanical ventilation until adequate spontaneous breathing is restored.

Facial nerve paresis is associated with damage to the trunk or branches of the facial nerve. In this case, the child has facial asymmetry, lagophthalmos, upward displacement of the eyeball when screaming, asymmetry of the mouth, difficulty in sucking. Birth trauma in newborns is diagnosed on the basis of clinical signs, electroneurography, recording of evoked potentials. Often, paresis of the facial nerve goes away without special treatment; in other cases, thermotherapy, drug therapy is carried out.

More rare types of birth trauma of newborns include injuries of the pharyngeal, median, radial, sciatic, peroneal nerves, and lumbosacral plexus.

Prophylaxis

Prevention of birth injuries in newborns involves assessing the risk of their occurrence even at the stage of pregnancy, the most careful attitude towards the child during childbirth, and refusal from the unjustified use of benefits for fetal extraction and operative delivery.

A diagnosed birth injury does not always mean serious consequences for the life and health of the child. In obstetric practice, birth injuries are observed in most children, but in some they increase the adaptive abilities of the body, while in others they lead to their decrease.

What is birth injury

Birth trauma is a reaction that occurs in a child's body to damage that occurs during the passage through the birth canal. Birth trauma can occur with normal delivery, as well as with pathological childbirth.

With an unfavorable course of childbirth, fetal injury can cause severe damage to the brain, spinal cord, bones and spine... This leads to severe neurological diseases, mental retardation, disability, and, in severe cases, death of the fetus or newborn.

Photo 1. Birth trauma is a more common phenomenon than it seems. Source: Flickr (Jonatan P.).

Classification and types

The existing classifications take various factors as a basis for differentiation.

So, birth injuries are divided into spontaneous and obstetric.

The first occurs during natural delivery with a normal or complicated course. Obstetric birth trauma is the result of mechanical action by the obstetrician (use of forceps, fetal rotation, pressure on the fundus of the uterus).

By type, birth injuries are divided into hypoxic and mechanical.

Hypoxic injury is the result of oxygen starvation (hypoxia) or a complete cessation of oxygen supply (asphyxia).

Mechanical birth injuries are divided into:

trauma to the skull and brain;
sprains and lacerations of the spine and spinal cord;
damage to internal organs;
damage to the skeleton and soft tissues.

It is important! Birth trauma and birth injury are closely related but not identical terms. Birth trauma is a broader concept that includes not only the traumatic factor itself, but also the subsequent reaction to it on the part of the child's body.

Traumatic brain injury

Injury to the fetal skull and brain is the most common type of birth injury and the most a common cause of childhood disability and mortality in infancy.

This type of damage occurs due to compression of the fetal skull during movement along the birth canal, as well as due to the actions of the obstetrician. In addition to mechanical effects, brain damage also occurs as a result of oxygen starvation during placental abruption and other pathological factors.

It is important! Compression of the fetal skull during childbirth is a natural process that all naturally born babies go through. In the normal course of labor, the fetal skull bones are displaced in such a way as to facilitate the labor act. This does not lead to the development of pathology in the absence of other negative factors (asphyxia, asynclitism, etc.)

Common types of birth injuries to the skull and brain include:

hemorrhage into the brain with the formation of a hematoma;
mechanical damage to the meninges and the body of the brain;
bone fractures skull and lower jaw;
displacement of the meninges.

Immediately after the birth of the fetus, the consequences of birth trauma to the skull and brain are expressed in various neurological conditions, such as coma, lethargy, weak or absent reaction of the newborn to external stimuli, increased excitability, etc.

Internal injuries

Damage to the internal organs of the fetus during childbirth is much less common. Most often they develop not due to mechanical stress, but as a result of oxygen starvation... Birth traumas of organs include:

hemorrhage in the liver;
intraperitoneal bleeding;
hemorrhage in the adrenal glands.

Less commonly, ruptures of the spleen and stomach occur as a result of the traumatic mechanical impact of the obstetrician.

Photo 2. In many ways, the success of childbirth depends on the correct assistance provided. Source: Flickr (away with words).

Skeletal injury

Damage to the bone structures of the fetus occurs with excessive strength during childbirth, less often - during physiological childbirth without obstetric care. Most often, such skeletal injuries occur:

fracture of the shoulder;
fracture of the femur.

In most cases bone fractures heal very quickly: Often 3-4 days after birth, X-rays are detected, and the function of the limb is restored.

Note! Caesarean section - removing the fetus from the uterus through an incision in the anterior abdominal wall is not a guarantee of the absence of birth trauma. Sometimes during the operation, various injuries to the bones of the child occur with careless extraction by the legs or arms.

Soft tissue injury

Damage to fetal tissue during childbirth - the result of exposure to obstetric instruments... Soft tissue injuries include pressure, which results in hematomas and tumors of the skin and subcutaneous tissue on the head and body of the fetus. They most often go away on their own 2-3 days after childbirth. In rare cases, complications occur in the form of suppuration, which is localized with an incision and drainage.

Cervical and spine injuries

The fetal cervical spine accounts for the maximum application of mechanical force during childbirth, especially during rotation and traction. Most often occurs hyperextension of the spine and spinal cord in the cervical spine, which can lead to ruptures, hemorrhages, fractures, displacement and separation of the vertebral epiphyses.

It is important! The danger of this type of birth injury is that it cannot always be diagnosed immediately. Often, hyperextension of the spinal cord, accompanied by the prolapse of its trunk, is not visible even on an x-ray. the spine remains intact.

Causes of birth trauma of newborns

The causes of injury can be by the fetus and / or mother... Features of intrauterine development lead to conditions that cause pathological childbirth and trauma in a child:

large fruit (from 3.5 kg);
abnormal position of the child in the uterus (facial, gluteal, transverse presentation);
abnormalities in the development of the fetus;
post-term pregnancy;
pathological childbirth;
weak labor activity.

Complications leading to fetal injury occur and with various anomalies in the structure of the mother's pelvis causing a physical discrepancy between the fetal head circumference and the pelvic joint.

Obstetric care during childbirth is also a common cause of birth trauma. Traction (forced extraction), rotation (turning the head or torso), using forceps and other influences lead to the various injuries described above.

Signs, symptoms and diagnosis of trauma

Various methods can be used to determine the presence, nature and severity of a birth injury, depending on its localization.

Traumatic brain injury, spine and spinal cord injuries They manifest themselves in the form of various neurological symptoms, such as paresis (involuntary movements of the arms and legs), sleep disturbances (lethargy or increased excitability of the nervous system), swelling of the fontanelle and an increase in head volume, vomiting or incessant regurgitation. X-rays and magnetic resonance imaging / computed tomography of the head are used to diagnose TBI.
Internal injuries more difficult to detect and diagnose. The most common signs of this type of injury are a drop in blood pressure, constant regurgitation, and vomiting. An abdominal ultrasound is performed to confirm the diagnosis.
Bone fractures are manifested in severe pain syndrome, crepitus (crunch) of damaged bones on palpation, limitation of limb mobility, local edema. If a fracture is suspected, an x-ray is required.

Treatment

Methods for treating birth injuries are determined by their severity and localization. Not all types of injuries require medical attention. and often go away on their own a few days / weeks after birth.

Such injuries include hematomas and tumors of soft tissues, depressed fractures of the skull bones, and others.

In other cases need medical help:

with intracranial hematomas- puncture, craniotomy, as well as decongestant, hemostatic, metabolic conservative therapy;
with spinal injuries and bone fractures- traction, fixation and immobilization of the arm or leg from 7 to 14 days, depending on the location of the fracture;
with injuries of internal organs- hemostatic and replacement therapy with glucocorticosteroid drugs (in case of damage to the adrenal glands), in severe cases - surgery.

Prevention of birth trauma

Prevention of trauma to the newborn during labor is in competence of an obstetrician-gynecologist.

The doctor who leads the pregnancy should examine the patient during the last weeks of pregnancy in order to assess the position of the fetus, the condition of the placenta, as well as the possibility of natural birth for the mother, depending on the structure of the pelvis.

If there is a high likelihood of a birth fetus or mother (for example, with a breech or transverse presentation), a cesarean section is indicated.

Injuries that occur during the birth act are recorded from 5 to 10% of cases, which are accompanied not only by violations on the part of the child, but also by traumatism in the mother (rupture of the vagina, uterus, the formation of fistulas between the reproductive system and the intestine). Today they occur much less frequently than several decades ago, but nevertheless they can lead to serious complications, because injuries in newborns are a dangerous phenomenon.

The concept of the disease

Birth trauma is defined as damage to the baby of various localization and severity, which occurs due to improper management tactics or pathology of labor. Violations can be triggered by mechanical (when squeezing or pulling the fetus) or hypoxic (with insufficient oxygen transport to the body of the unborn child) factors.

Damage during childbirth can be of a different nature, but it is this period of life that has an important role in the further physical and mental development of the child. Distinguish:

Soft tissue injuries:

skin - abrasions on the scalp and other parts of the body when using instruments during childbirth;
subcutaneous fat;
muscles;
cephalohematoma - hemorrhage in the subonectomy (a thin layer of connective tissue that covers the outside of the bone);
compression of the head - the bones of the baby's skull have properties of displacement, but during natural childbirth under high vaginal pressure, deformation may occur.

Injuries to the bones and joints of the newborn:

collarbone fracture or cracks;
fracture of the humerus or femur;
subluxation of the first and second cervical vertebrae;
damage to the cranial bones;
fractures of the bones of the skull due to indentation with forceps during childbirth.

Birth trauma to the peripheral nervous system:

facial nerve - a very common birth injury that occurs when the head is presented and the nerve is pressed against the sacral promontory, own shoulder or uterine fibroids;
brachial plexus - occurs due to stretching of the neck and extraction of the fetus by the shoulder with gluteal or pronounced extension of the neck in the cephalic presentation. Plexus injury is of two types: superior or Erb's palsy, which affects the muscles around the shoulder and elbow joints; lower or Klumpke paralysis, in which there is weakness of the muscles of the forearm and wrist joint;
phrenic nerve - occurs in parallel with damage to the brachial plexus due to traction on the head and neck (extraction of the fetus from the birth canal).

Damage to the central nervous system:

Spinal cord injury occurs as a result of overstretching of the cervical spine with breech presentation, difficulty in moving the head, throwing the handle back.

There are two types of brain damage:

hypoxic - in which suppression of the function of the central nervous system occurs due to insufficient oxygen levels in the child's body;
hemorrhagic - hemorrhage in or around the brain tissue.

Bleeding during childbirth can occur in different structures of the central nervous system and be of the following types:

epidural - an accumulation of blood between the skull and the dura mater;
subdural - hematoma under the dura mater;
intraventricular - hemorrhage into the internal formations of the brain - the ventricles;
subarachnoid - between the subarachnoid and pia mater;
parenchymal - hemorrhage in the soft tissues of the brain.

Internal injuries:

The abnormal course of labor leads to hemorrhage in:

spleen;
adrenal glands;
liver.

Causes and risk factors

The immediate cause of injury is the use of physical stimulation during labor, for example:

using obstetric forceps or a vacuum extractor;
rotation of the fetus by the leg;
incorrect conduct of a cesarean section.

Exacerbates fetal damage and lack of oxygen (hypoxia), which in some cases leads to hemorrhage even without injury to the vessels.

The provoking factors of this pathology are:

Discrepancy between the size of the fetus and the mother's pelvis

large fruit;
narrow pelvis;
maternal pelvic anomalies;
hypoplasia of the uterus (underdevelopment).

Pathology of labor

breech presentation;
exacerbation of chronic diseases of the cardiovascular, respiratory or endocrine system in the mother;
rapid or protracted labor;
uncoordinated labor activity;
post-term pregnancy.

Symptoms of the disease

Clinical manifestations - table

Pathology type	Symptoms
Cephalohematoma	It is manifested by a tumor-like soft formation that causes deformation of the skull. The skin above it is bluish. With large hematomas, jaundice occurs, due to the breakdown of red blood cells.
Internal hemorrhage	The resulting accumulation of blood also breaks down over time, which causes high levels of bilirubin and yellowing of the skin. A newborn child has an increase in the abdomen, bloating. The general condition of the baby deteriorates sharply, pressure decreases, vomiting appears and reflexes are inhibited.
Clavicle fracture	Lack of movement in the arm from the side of the fracture.
Fracture of the femur or humerus	The limb is brought to the body, there is swelling, the child cannot actively move the leg or arm.
Subluxation and dislocation of the cervical vertebrae	The child's head is in an unnatural position: turned to the side and lowered.
Facial nerve injury	Immobility of the facial muscles from the side of injury, asymmetry of the lower jaw, drooping of the corner of the mouth.
The shoulder of the newborn is brought to the body, and the forearm with the palm is turned outward.
The innervation of the hand muscles is impaired and the sensitivity of the inner surface of the hand decreases. If the branch of the first thoracic nerve is involved in the process, then there is a persistent omission of the upper eyelid and constriction of the pupil.
Phrenic nerve injury	The act of breathing is disturbed due to the failure of the innervation of the diaphragmatic muscle.
Injuries to spinal cord segments	If violations occur above the level of the seventh cervical vertebra, then they are fraught with death due to respiratory arrest. In case of injury below this segment, lethargy develops, which later manifests itself only in incomplete recovery of sensory and motor function. The sphincters of the anus and bladder of a child cannot be controlled. He has a weak, quiet cry, crying, shallow breathing.
Traumatic brain injury (compression of the head, depressed fractures of the skull)	On palpation of the cranium, under the doctor's fingers, there is a stepwise deformation of the bones, which are pressed inward, which also damages the brain tissue.
Hemorrhage in the membranes and tissue of the brain	In a full-term baby, trauma is manifested by hyperexcitability, and in a premature baby, by depression of the nervous system. The kid lags behind in physical and mental development from his peers, seizures often occur, the size of the head increases due to increased intracranial pressure.

Birth trauma symptoms - photo gallery

Manifestation of Erb's paralysis and atrophy of the muscles of the hand of the upper limb Klumpke paralysis is manifested by the lack of sensitivity of the upper limb Damage to the facial nerve is manifested by the smoothness of the facial muscles Hemorrhage leads to hydrocephalus Cephalohematoma - arises as a result of hemorrhage

Diagnosis of pathology

Frequent asymptomatic or atypical course of birth trauma complicates timely diagnosis and provision of specialized care. The main goal of the study is an early assessment of changes in damaged organs and their functional state. To do this, newborns use those methods that do not require a violation of the integrity of the skin (non-invasive), and also do not cause even more harm when exposed.

For the study of the bones of the skull, its cavity and brain tissue are used:

ultrasonography is a method for diagnosing brain structures, which works on the principle of ultrasound and shows the state and volume of the ventricles, gray matter, large vessels, the presence of hematomas, the area of ischemia;
computed tomography or magnetic resonance therapy - examines and determines the integrity of the cranium, the localization of hemorrhages, the presence of cysts, vascular pathologies, and is also performed in case of spinal cord injury;
electroencephalography - shows the functional state of the brain, registering biopotentials from the cortex;
ophthalmoscopy is a mandatory examination method for newborns. The position of the bottom corresponds to the degree of damage to the brain tissue: edema of the optic nerve head, varicose veins, and retinal hemorrhages are determined;
lumbar and ventricular puncture are invasive research options in which the spinal canal or ventricles are punctured to obtain cerebrospinal fluid (cerebrospinal fluid). It is used in case of high intracranial pressure, hydrocephalus, intraventricular or epidural hemorrhage.

For limb fractures, carry out:

X-ray - localization of the fracture and its type are determined.

To diagnose plexus or nerve damage:

X-ray of the cervical spine - allows you to find out the reasons for the violation of the integrity of the nerve fibers (fracture of the humerus, dislocation, collarbone, subluxation of the cervical vertebrae);
magnetic resonance imaging - shows damage to the roots, nerve fibers and plexuses.

With hemorrhages in the internal organs:

ultrasound examination of the abdominal cavity and adrenal glands - determines the size of the hematoma and the degree of bleeding.

Birth trauma treatment

In the acute period, the child undergoes restoration and stabilization of the vital functions of the body. Activities aimed at eliminating pathological mechanisms of brain damage:

resumption of airway patency and adequate ventilation of the lungs;
elimination of hypovolemia (low circulating blood volume);
maintaining an adequate blood supply to the brain;
prevention of hypothermia, overheating, infection;
systematic delivery of energy to the brain in the form of a glucose solution;
correction of pathological metabolic processes in a child.

The baby is placed in an incubator and oxygen therapy is performed.

From medications used:

drugs to stop bleeding - Vikasol, Etamzilat;
to reduce cerebral edema - Magnesium sulfate, Furosemide, Ethacrynic acid;
if seizures occur - Phenobarbital, Seduxen, Sodium Oxybutyrate;
for spinal cord injury and to improve neuromuscular conduction - Dibazol and Proserin;
to improve microcirculation - Papaverine, Trental.

Conservative therapy - photo gallery

Furosemide is used to reduce cerebral edema
Seduxen is a drug used for seizures in a child
Vikasol is used to stop bleeding Proserin - improves neuromuscular conduction
Trental improves the microcirculation of the newborn

When fractures are diagnosed, the limb of the newborn is immobilized using a plaster or elastic bandage.

Surgical intervention is performed if it is necessary to remove large hematomas or with intracerebral hemorrhages, to eliminate blood accumulation. This method of treatment is also performed to restore the outflow of cerebrospinal fluid from the brain.

If a birth injury leads to the formation of jaundice in a baby, then a physiotherapeutic method is used to eliminate it - phototherapy, which stimulates the breakdown of bilirubin.

With Erb's or Klumpke's paralysis, the limb is first immobilized so as not to additionally damage the nerve plexuses and prevent the development of muscle contracture (spasm), and after a month, therapeutic massage and gymnastics, electrical stimulation of the muscles of the upper extremities and reflexology are recommended.

Complications of birth trauma

Damage to the facial nerve, soft tissues and cephalohematoma do not need specific treatment and does not lead to consequences for the baby's health.
Adrenal hemorrhage leads to chronic adrenal failure.
Brain and spinal cord injuries are the most dangerous for the physical and mental health of the child: delayed psychomotor development, mental retardation, convulsions, paralysis, epilepsy, coma.
Death occurs with hemorrhage in the respiratory center and uncontrolled intracranial pressure.

Injury prevention

Correct management of pregnancy and treatment of chronic diseases prevents the occurrence of injuries during childbirth. An important element of prevention is considered to be the avoidance of bad habits, occupational hazards, balanced nutrition of the mother and regular visits to antenatal clinics.

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The process of childbirth is quite unpredictable and can end in complications for both the mother and the baby. Birth trauma is one of these complications.

What's this?

Birth trauma of newborns is called the pathological conditions arising during the course of childbirth, in which the tissues or organs of the newborn are damaged, as a result of which their functions are impaired.

With prenatal trauma in a newborn, the work of the main body systems is disrupted

Types of injury

All birth injuries are divided into:

Mechanical... These are bone fractures, head injuries, birth tumors, various hemorrhages, injuries of the spinal cord and central nervous system, cephalohematomas, injuries of the cervical spine, nerve damage, traumatic brain injury and other pathologies.
Hypoxic... They are represented by damage to internal organs and brain tissues, which are caused by hypoxia and asphyxia during the birth process.

Cardiotocography is one of the methods for early diagnosis of intrauterine fetal hypoxia

Depending on the localization of the lesion, injuries are distinguished:

Bones.
Soft tissue.
Nervous system.
Internal organs.

Common causes

To the appearance of mechanical birth injuries give various obstacles in the advancement of the fetus along the female birth canal.

The cause of the appearance of hypoxic injuries is a complete or partial cessation of oxygen access to the child.

Damage to the central nervous system or traumatic brain injury of the baby is one of the most common problems during childbirth.

To predisposing factors in which the risk of injury during childbirth increases, include:

Large fetal weight.
Prematurity of the child.
A narrow pelvis of a pregnant woman.
Mother's pelvic injury.
Incorrect presentation.
Mom's advanced age.
The swiftness of the birth process.
Delaying the process of childbirth.
Stimulation of labor.
C-section.
Use of obstetric aids and devices.
Postmaturity.
Chronic fetal hypoxia.
Umbilical cord problems (entanglement, short length).

For a detailed explanation of how prenatal injuries occur in a baby, see the video:

Symptoms

The most common birth injuries are presented swelling of the soft tissues of the baby's head, called a birth tumor... It looks like a slight swelling on the head of a newborn. With this edema, babies may also experience hemorrhages in the skin in the form of small dots.
Cephalohematoma is manifested by hemorrhage in the baby's head. It occurs due to displacement of the skin and rupture of blood vessels, as a result of which blood collects under the periosteum of the cranial bones. The tumor appears immediately after childbirth and increases in size in the first two to three days.
Muscle hemorrhage often occurs in the neck(in the sternocleidomastoid muscles) and looks like a moderately dense mass of small size (for example, the size of a nut or the size of a plum).
Among the fractures of bones, the clavicle (often the right) is most often damaged without displacement. With such an injury, when feeling the body of the newborn in the place of the broken collarbone, swelling, crunching and soreness are revealed. Fractures of the femur or humerus are much less common. With them, movements in the limbs are impossible, their lethargy and soreness is noted.

Hematoma on the head of a newborn

Nerves can be damaged due to hypoxia and mechanical injury. The most common nerve problem is damage to the facial nerve. Brachial plexus injuries are also common.
Traumatic brain injury can have different severity. In severe cases, the baby may die in the first days or even hours after birth. Also, with severe trauma, organic changes in the tissues of the nervous system are possible, manifested by paralysis, paresis, and the development of mental retardation. Immediately after childbirth, the baby may develop seizures, inhibition of the sucking reflex, breathing problems, crying heavily, tremors of the arms and legs, insomnia and other symptoms of CNS arousal. Further, the baby becomes lethargic, his cry and muscle tone weakens, the skin turns pale, the child sleeps a lot, sucks poorly, spits up a lot.
Internal injuries are less common than other types of injuries and usually do not appear in the first time after childbirth. Your baby may have damage to the adrenal glands, spleen, or liver. The baby's condition worsens from the third to fifth day of life, when the hematoma in the damaged organ ruptures, which leads to internal bleeding and anemia.

Consequences

The prognosis for birth injuries is influenced by the severity of the injury, the timeliness of treatment, and the correctness of the selected therapy. If the child was diagnosed correctly on time and started to heal immediately, in 70-80% of cases he will fully recover.

The least dangerous is damage to soft tissues and bones. The birth swelling usually disappears in one to two days without any consequences for the child's body. A small cephalohematoma resolves by 3-7 weeks of life without treatment. Due to hemorrhage in the muscles of the neck, the child develops torticollis, in which the head of the crumbs tilts towards the formation, and the chin is directed in the opposite direction. This condition is corrected with a special massage.

The size of the hematoma affects the consequences of damage to internal organs. It is equally important how much the function of the affected organ is preserved. For example, a large hemorrhage in the adrenal glands in many children leads to the development of chronic insufficiency of these glands.

The consequences of hypoxic injuries depend on the length of the period when the child was experiencing a lack of oxygen. If such a period was long, a severe degree of delay in intellectual and physical development is possible, caused by the death of nerve cells in the brain. Children may develop cerebral palsy, hydrocephalus, seizures, nerve damage, encephalopathy and other pathologies. With an average degree of hypoxia in older children, increased fatigue, headaches, dizziness, and problems with posture may appear.

For what hypoxia is and how to avoid it, see the following story:

Therapy

In most cases birth injuries are diagnosed at the hospital, where the child is immediately prescribed the necessary treatment. In case of fractures, the damaged area is immobilized. In a serious condition, the baby is fed through a tube with colostrum, which is expressed by the mother.

With a severe degree of hypoxia, the treatment of the baby is carried out in the resuscitation of newborns

In the treatment of injuries, depending on the type of injury, drugs are used for blood vessels and the heart, drugs that affect the central nervous system, hemostatic agents, oxygen therapy, the introduction of vitamins and glucose.

Some types of injuries also require surgical treatment. For example, with a rapidly growing cephalohematoma, the child undergoes a puncture. Surgical treatment is also indicated for hematomas of internal organs.