Introduction to birth injuries
Birth injuries are those suffered during childbirth. They include extensive caput succedaneum, cephalhaematoma, subgaleal haemorrhage, nerve palsies and fractures.
The presentation varies depending on type and site of injury.
Excessive traction may result in injury to the brachial plexus and may be associated with fracture or injury of the humerus or shoulder joint.
Causes of birth injuries
Birth injuries are caused by difficult delivery (including instrumental delivery)
Symptoms of birth injuries
The following are the symptoms of birth injuries:
- Swelling of head
- Inability to move a limb properly
- Pallor
Signs of birth injuries
Extensive Caput Succedaneum
- Diffuse swelling of the presenting part of the scalp that may extend beyond cranial suture lines
Cephalhaematoma
- Large swelling of the scalp that is restricted to one half and does not extend beyond the midline
Subgaleal haemorrhage
- Diffuse swelling of the scalp which may result in a distorted shape of the head and face Severe pallor
- Jaundice
Nerve injuries
- Erbs Palsy – Whole upper limb does not move. There is movement only in the fingers
- Klumpke’s Palsy – Fingers of the affected hand do not move (claw hand) but there is active movement in the arm and forearm
Fractures
- Reduced movement of affected limb
- Swelling of the affected limb
- Abnormal position of limb
- Pain and tenderness on movement of limb
Investigations
- Haemoglobin level for subgaleal haemorrhage
- Serum bilirubin if jaundiced X-ray of relevant part if fracture is suspected
Treatment for birth injuries
Treatment Objectives
The treatment objectives of birth injuries are:
- To arrest further bleeding treat complications of anaemia and jaundice
- To re-establish near normal movement in affected limb.
- To promote normal healing of fracture
Non-pharmacological treatment
A. Extensive caput succedaneum
- Reassure parents
- Leave swelling alone (spontaneous resolution over 3-4 days)
B. Cephalhaematoma
- Reassure parents
- Leave swelling alone (spontaneous resolution with time)
- Do not perform incision and drainage
- Phototherapy if jaundiced
C. Subgaleal Haemorrhage
- Phototherapy if jaundice levels require this (See ‘Neonatal Jaundice)
D. Nerve injuries
- Physiotherapy Fractures
E. Fracture
- May require splinting
Pharmacological treatment
A. Cephalhaematoma and Subgaleal haematoma
To reduce bleeding
Evidence Rating: [A]
- Phytomenadione (Vitamin K), IM, 1 mg stat. even if baby received a dose at birth
To correct Anaemia if Hb < 12 gm/dl
- Blood transfusion, 15-20 ml/kg
Referral Criteria
Refer severe cases to an appropriate specialist facility.