Consequences of birth trauma in a child. Causes and consequences of birth trauma in newborns. Sciatic nerve injury in newborns

Childbirth does not always go well for both mother and baby. For various reasons, during the delivery process, birth injuries to newborns can occur - damage to the spine (usually the cervical spine), head, bones, and internal organs. Diagnosis and treatment of such pathologies as birth trauma of newborns must be timely and adequate. Otherwise, the consequences can be very serious - from intellectual problems and physical disability to the death of the child.

In obstetric practice, trauma to a newborn during childbirth is understood as a violation of the integrity of the child’s organs, tissues, and skeleton, which is caused by the influence of mechanical forces. Perinatal pathology is a widespread and very pressing problem: injuries of varying severity are diagnosed in 11% of newborns. In 50% of cases, they are combined with injuries to the mother during childbirth, including ruptures of the genital organs and the formation of fistulas.

Classification of birth injuries

Conventionally, all traumatic injuries to a child during childbirth are divided into:

mechanical (due to external influences);
hypoxic (due to mechanical influence, the child experiences hypoxia and asphyxia, which cause injury to the central nervous system).

In newborns, birth trauma can affect different areas of the body. Depending on its location, there is the following classification:

Trauma to bones and joints. This includes all cracks, fractures of the femur, clavicle, humerus, head bones, etc.
Soft tissue injury. These are damage to the skin, muscles, the appearance of birth tumors, cephalohematomas.
Internal organ injury. The group includes hemorrhages in any organs of the peritoneum.
Trauma to the nervous system, or any damage to the nerve trunks, brain, spinal cord.

The last group is divided into the following types of injuries to newborns during childbirth:

intracranial birth injury;
peripheral nervous system injury;
spinal cord injury.

Intracranial birth trauma includes subdural, intraventricular, subarachnoid, and epidural hemorrhages.

In addition, types of birth trauma are usually differentiated according to the degree of responsibility of the obstetric service:

Spontaneous. Occurs during complicated or normal childbirth due to circumstances beyond the control of the doctor.
Obstetrics. Appears due to the actions of the midwife, including the correct ones.

Causes of birth injuries

In many ways, birth injuries are determined by the pregnant woman’s belonging to a risk group for one or another indicator. Thus, the age of the expectant mother has a significant influence on the outcome of childbirth. The optimal age for the first birth is 20-25 years, since such women have much less chronic diseases and a history of abortions. The consequences of childbirth may be associated with trauma to the mother and baby if they occur over the age of 30 years (for repeat pregnancies - over 35 years).

Perinatal pathology occurs more often in the presence of the following risk factors:

incorrect positioning of the fetus during labor;
clinically, anatomically narrow maternal pelvis;
large fruit or low body weight;
intrauterine oxygen starvation of the fetus;
premature, post-term fetus;
weakness of labor;
rapid labor;
fetal malformations, such as hydrocephalus;
a history of bone injuries in a pregnant woman.

Mother's illnesses also have a negative effect on the nature of childbirth - pathologies of the heart, blood vessels, diabetes mellitus, gynecological disorders, as well as complications of pregnancy (preeclampsia, polyhydramnios, placental abruption). Birth injuries in newborns often occur due to the unreasonable use of obstetric instruments and aids (emergency caesarean section, forceps, etc.). Typically, serious damage to the fetus (for example, severe intracranial birth injury) occurs when several unfavorable factors combine to cause disruptions in the biomechanics of the act of delivery.

The immediate cause of mechanical birth trauma is the difficult rotation of the fetus, its extraction using a vacuum or forceps. Hypoxic injuries occur if there is suffocation (acute end of oxygen supply) or prolonged oxygen starvation of the baby with the accumulation of carbon dioxide in his tissues. Their causes are associated with tightening of the umbilical cord knot, accumulation of mucus in the mouth, and recessed tongue, which is recorded against the background of disturbances in the birth process as a result of abnormalities in labor or the actions of the midwife.

Birth injuries during cesarean section are diagnosed three times more often than during vaginal birth. This is mainly due to the “cupping effect”: when the baby is artificially removed from the uterus, negative intrauterine pressure is formed behind his body. As a result, the created vacuum interferes with the normal exit of the baby, and the surgeon has to make significant efforts to pull out the newborn. As a result, injuries to the cervical spine often occur, especially in premature babies with weakened bones and ligaments.

Symptoms of birth injuries in newborns

Immediately after birth, the clinical picture of perinatal pathology may be very different from that after a certain period of time. Below are the main signs of injuries by type that a neonatologist discovers as a result of the first examination of the child.

Soft tissue injuries

They represent damage to subcutaneous tissue, skin and muscles. These include a variety of abrasions and hemorrhages, most of which are not dangerous and heal quickly after local treatment. The consequences for the child may be more severe if there is a muscle injury. Most often, birth trauma affects the sternocleidomastoid muscle, in which fibers can be torn. Symptoms of the pathology are the appearance of a hematoma in the affected area, as well as a lump that is sharply painful when palpated. Sometimes these signs appear only after the child is discharged from the hospital, and in this case they are almost always accompanied by deviations in the normal position of the neck (torticollis, or tilting the head in the direction where the muscle is torn).

Another type of soft tissue injury is a cephalhematoma. It is an outpouring of blood under the periosteum of the head bone (usually the parietal bone). This pathology must be distinguished from a generic tumor - swelling of the skin and underlying tissue, which occurs due to severe compression of the area. Both types of pathologies go away on their own, so the child does not need therapy.

Skeletal injuries

The most common lesions are the cervical spine, which are associated with mechanical overload during childbirth. The vertebrae of the cervical spine are the most fragile and therefore quite vulnerable. The most common neck injuries are:

excessive stretching;
impacted subluxations;
twisting of the head and neck.

True dislocations are extremely rare, and infants with this pathology die almost immediately. Among the injuries to joints and bones, fractures are also observed (more often - a fracture of the clavicle without displacement, rarely - a fracture of the humerus, femur). Signs of a fracture:

swelling;
bruise;
pain in the affected area;
limitation of limb mobility;
a child's crying during passive movement of an arm or leg;
lack of necessary reflexes;
bone shortening;
bone deformation.

Usually, all the consequences of such injuries are reversible, so the child will not need medical supervision as he grows older.

Internal organ injuries

Such injuries are not common. In most cases, damage affects the liver, adrenal glands, and spleen. Hemorrhages in these organs do not manifest themselves for the first 2 days, but later a sudden deterioration in the baby’s condition is observed:

hematoma rupture;
increase in the area of hemorrhage;
anemia;
malfunction of the damaged organ;
bloating;
Ultrasound shows the presence of fluid in the peritoneum;
severe muscle hypotonia;
suppression of reflexes;
bowel failure;
decreased blood pressure;
vomit.

The consequences and prognosis depend on the severity of the injury. If the newborn does not die immediately, the prognosis will then be determined by how much the injured organ has retained its functionality. For example, after damage to the adrenal glands, the child most often subsequently develops chronic failure of these organs.

Nervous system injuries

The most severe birth injury is considered to be damage to the central nervous system. Head injuries that are accompanied by intracranial hemorrhages caused by mechanical stress and hypoxia are especially life-threatening. The clinical picture largely depends on where the hemorrhage is localized and the extent to which cerebral circulation is impaired. Main symptoms:

stupor;
dilated eyes;
stiff neck;
suppression of reflexes;
inability to suck, swallow;
attacks of suffocation;
convulsions;
bulging fontanelles;
tremor;
oculomotor disorders;
vomit;
regurgitation;
increase in body temperature.

As the hematoma grows and it compresses different parts of the brain, all of the above symptoms become even more pronounced, and the newborn may fall into a coma. Usually, with serious hemorrhage, the baby dies in the first days of life.

Another severe type of nervous system injury is spinal cord injury. All segments of the spine in a newborn are well extensible, but the brain located in their canal is fixed below and above, and therefore is less mobile. Most often, spinal cord damage is found in the lower cervical spine or in the upper thoracic spine. Sometimes the spinal cord can rupture with visible integrity of the vertebrae, which is very difficult to detect even during an x-ray examination. Symptoms of this type of perinatal pathology:

faint cry;
impaired reflexes;
muscle hypotonia;
low physical activity;
lethargy;
bladder distension;
respiratory disorders;
violation of limb movements.

A child with a severe spinal cord injury may die from respiratory failure, but often the pathology slowly regresses and the baby’s condition improves. In most cases, various neurological disorders persist throughout the first years or throughout life.

Injuries to the peripheral nervous system damage the nerve roots or nerve plexuses (usually the facial, brachial, phrenic, and median nerves). Symptoms boil down to abnormal position of the head, neck, limbs, limitation of spontaneous movements, muscle hypotonia, absence of some reflexes, shortness of breath, cyanosis, bulging of the chest. If treatment is started immediately after birth, recovery occurs in most cases. With bilateral phrenic nerve paresis, on the contrary, death is recorded in half of the cases.

In pediatric practice, there are many situations where the consequences of a birth injury are discovered after the child is discharged or several months after birth. Symptoms of injury may include:

weak muscle tone or hypertonicity;
low activity;
lack of movement in one of the limbs;
twitching of arms, legs;
inability to straighten limbs;
frequent crying for no reason;
weak sucking reflex;
food falling out of the mouth;
constant regurgitation;
pale skin;
tongue sticking out;
leakage of feces, urine;
sleeping with your head thrown back;
failure to comply with time-regulated skills (does not sit, does not walk, etc.).

After a year of life, birth injuries can manifest themselves with the following clinical picture: abnormal head size, frequent hysterics, crying, hyperactivity, lethargy, dysfunction of the musculoskeletal system, mental abnormalities, different lengths of limbs, convulsions, paresis. It should be remembered that only early seeking help will help the child become a full-fledged member of society or significantly improve his condition.

Consequences and complications of injuries in newborns

As a result of trauma, the child often dies in the first days after birth. If the baby survives, his future health greatly depends on the severity of the injury and the adequacy of treatment. Consequences in older age can manifest themselves in the form of delays in physical and mental development, allergies, spinal diseases, enuresis, diseases of the ENT organs, and increased intracranial pressure. Manifestations of the so-called psychoorganic syndrome are often diagnosed - intellectual disability, convulsions, neuroses, seizures, mental retardation, etc. Often these pathologies develop against the background of hydrocephalus of the brain.

Diagnosis of birth trauma

Among the methods for identifying birth injuries, which are used both in the perinatal period (up to 7 days after birth) and in the first year of life and beyond:

examination of the newborn;
palpation of the head, neck, limbs;
Ultrasound and radiography;
MRI, CT;
functional tests;
consultations with narrow specialists.

Treatment of birth injuries in newborns

Damage to the skin requires treatment with local antiseptics (iodine, alcohol) to prevent infection. As a rule, minor injuries heal by 5-10 days after birth. Muscle ruptures and hematomas are treated by providing a corrective position for the child, eliminating the incorrect position of the limbs, head, neck, prescribing physical therapy, massage, and administering various absorbable drugs. Sometimes in the first half of life a baby needs surgical correction of a birth injury to a muscle.

For fractures, standard treatment is carried out, including:

immobilization of limbs using splints, Deso bandages;
tight swaddling;
traction (traction);
physiotherapy;
massage.

Injury to internal organs during childbirth requires treatment of each syndrome separately, as well as hemostatic therapy. If the adrenal glands are damaged, hormonal treatment is performed; if hemorrhage ruptures in any organ, urgent surgical intervention is necessary. In the future, the baby may need lifelong therapy with hormonal drugs, but often children feel satisfactory.

For brain damage, treatment options may include:

subdural puncture to pump out blood flowing from the cerebral arteries;
use of absorbable, diuretic drugs;
brain surgery (bypass surgery);
treatment with antibiotics (with the development of inflammation of the meninges).

For spinal cord injuries, treatment comes down to immobilization of the affected area, pain relief, dehydration therapy, and the administration of hemostatic drugs and vitamins. After acute symptoms are relieved, physiotherapy, massage, gymnastics, wearing various ortho-devices, treatment with biostimulants, tissue regeneration accelerators, etc. are prescribed. Similar methods of therapy are recommended for the baby in case of damage to the nerve trunks of the peripheral nervous system.

Prevention of birth injuries in newborns

Unfortunately, it is impossible to completely prevent birth injuries. But to reduce its likelihood, obstetricians should promptly identify pregnant women at risk for perinatal pathology and competently apply various techniques and manipulations during childbirth. It is advisable for a woman to plan a pregnancy before treatment or correction of chronic diseases, and also to register for pregnancy on time.

Birth trauma of newborns is a pathological condition that developed during childbirth and is characterized by damage to the tissues and organs of the child, accompanied, as a rule, by a disorder of their functions. Factors predisposing to the development of birth trauma in newborns are incorrect position of the fetus, discrepancy between the size of the fetus and the main parameters of the pregnant woman’s bony pelvis (large fetus or narrowed pelvis), features of intrauterine development of the fetus (chronic intrauterine hypoxia), prematurity, postmaturity, duration of labor (as rapid, or fast and protracted labor).

The immediate cause of birth trauma is often incorrectly performed obstetric aids when turning and extracting the fetus, applying forceps, a vacuum extractor, etc.

There are birth injuries of soft tissues (skin, subcutaneous tissue, muscles), skeletal system, internal organs, central and peripheral nervous systems.

Birth trauma of soft tissues:

Damage to the skin and subcutaneous tissue during childbirth (abrasions, scratches, hemorrhages, etc.), as a rule, are not dangerous and require only local treatment to prevent infection (treatment with a 0.5% alcohol solution of iodine, application of an aseptic dressing); they usually disappear after 5-7 days.

More severe injuries include muscle damage.
One of the typical types of birth injuries is damage to the sternocleidomastoid muscle, which is characterized by either hemorrhage or its rupture; the latter usually occurs in the lower third of the muscle. Such damage most often develops during childbirth in the breech presentation, but also occurs when forceps are applied and other manual aids are used. In the area of injury and hematoma, a small, moderately dense or doughy consistency, slightly painful tumor on palpation is determined.

Sometimes it is diagnosed only at the end of the 1st week of the child’s life, when torticollis develops. In this case, the child’s head is tilted towards the damaged muscle, and the chin is turned in the opposite direction. A hematoma of the sternocleidomastoid muscle should be differentiated from congenital muscular torticollis.
Treatment consists of creating a corrective position that helps eliminate pathological tilt and rotation of the head (rollers are used), the use of dry heat, and potassium iodide electrophoresis; at a later date, massage is prescribed. As a rule, the hematoma resolves after 2-3 weeks. muscle function is completely restored. If there is no effect from conservative therapy, surgical correction is indicated, which should be performed in the first half of the child’s life.

One of the manifestations of birth trauma in newborns is cephalhematoma, hemorrhage under the periosteum of any bone of the cranial vault (usually one or both parietal, less often the occipital). It must be differentiated from a birth tumor, which is a local swelling of the skin and subcutaneous tissue of the newborn, is usually located on the presenting part of the fetus and occurs as a result of prolonged mechanical compression of the corresponding area.

Birth tumor usually occurs during prolonged labor, as well as during obstetric aids (application of forceps). Unlike cephalhematoma, the birth tumor extends beyond one bone, it has a soft-elastic consistency, fluctuations and a ridge along the periphery are not observed; the birth tumor disappears after 1-2 days and does not require special treatment.

Children who have suffered a birth injury to soft tissues, as a rule, fully recover and do not require special dispensary observation in the clinic.

Birth trauma of the skeletal system:

Birth trauma to the skeletal system includes cracks and fractures, of which the most common are injuries to the collarbone, humerus and femur. They are caused by incorrectly performed obstetric care. A clavicle fracture is usually subperiosteal and is characterized by a significant limitation of active movements, a painful reaction (crying) with passive movements of the arm on the affected side, and the absence of the Moro reflex.

With light palpation, swelling, tenderness and crepitus are noted over the fracture site. Fractures of the humerus and femur are diagnosed by the absence of active movements in the limb, pain reaction during passive movements, the presence of swelling, deformation and shortening of the damaged bone. For all types of bone fractures, the diagnosis is confirmed by x-ray examination.

Treatment of a clavicle fracture consists of short-term immobilization of the arm using a Deso bandage with a roll in the axillary region or by tightly swaddling the outstretched arm to the body for a period of 7-10 days (the child is placed on the opposite side). Fractures of the humerus and femur are treated by immobilizing the limb (after repositioning if necessary) and traction (usually using an adhesive plaster). The prognosis for fractures of the clavicle, humerus and femur is favorable.

Rare cases of birth trauma in newborns include traumatic epiphysiolysis of the humerus, which is manifested by swelling, pain and crepitus on palpation in the area of the shoulder or elbow joints, and limitation of movements of the affected arm. With this damage, flexion contracture in the elbow and wrist joints often develops in the future due to paresis of the radial nerve. The diagnosis is confirmed by x-ray of the humerus. Treatment consists of fixing and immobilizing the limb in a functionally determined position for 10-14 days, followed by physiotherapeutic procedures and massage.

Children who have suffered a birth injury to the bones, as a rule, fully recover and do not require special dispensary observation in the clinic.

Birth trauma of internal organs:

It is rare and, as a rule, is a consequence of mechanical effects on the fetus due to improper management of labor and the provision of various obstetric aids. However, disruption of the functioning of internal organs is also often noted in cases of birth trauma of the central and peripheral nervous system. It is manifested by a disorder of their function with anatomical integrity. The liver, spleen and adrenal glands are most often damaged as a result of hemorrhage in these organs. During the first two days, no obvious clinical picture of hemorrhage in the internal organs is noted (“light” interval).

A sharp deterioration in the child’s condition occurs on the 3-5th day due to bleeding due to hematoma rupture, increasing hemorrhage and depletion of hemodynamic compensation mechanisms in response to blood loss. Clinically, this is manifested by symptoms of acute posthemorrhagic anemia and dysfunction of the organ into which the hemorrhage occurred. When hematomas rupture, abdominal distention and the presence of free fluid in the abdominal cavity are often noted. A pronounced clinical picture is hemorrhage in the adrenal glands, which often occurs with breech presentation. It is manifested by severe muscle hypotonia (up to atony), suppression of physiological reflexes, intestinal paresis, drop in blood pressure, persistent regurgitation, and vomiting.

To confirm the diagnosis of birth injury of internal organs, a survey radiograph and ultrasound examination of the abdominal cavity are performed, as well as a study of the functional state of the damaged organs.

Treatment consists of hemostatic and syndromic therapy. In case of hemorrhage into the adrenal glands and the development of acute adrenal insufficiency, replacement therapy with glucocorticoid hormones is necessary. In case of hematoma rupture or intracavitary bleeding, surgical intervention is performed.

The prognosis of birth trauma to internal organs depends on the volume and severity of organ damage. If the child does not die during the acute period of birth injury, its subsequent development is largely determined by the preservation of the functions of the affected organ. Many newborns who have suffered hemorrhage into the adrenal glands subsequently develop chronic adrenal insufficiency.

In case of birth trauma of internal organs, the pediatrician monitors the child’s condition 5-6 times during the first month of life, then once every 2-3 weeks. up to 6 months, then once a month until the end of the first year of life (see Newborn, Perinatal period). In case of hemorrhage in the adrenal glands, it is necessary to observe a pediatrician, endocrinologist and determine the functional state of the adrenal glands.

Birth trauma of the central nervous system:

It is the most severe and life-threatening for the child. It combines pathological changes in the nervous system that differ in etiology, pathogenesis, localization and severity, resulting from the impact of mechanical factors on the fetus during childbirth.

These include intracranial hemorrhages, injuries to the spinal cord and peripheral nervous system due to various obstetric pathologies, as well as mechanical damage to the brain that develops as a result of compression of the skull by the bones of the mother’s pelvis during the passage of the fetus through the birth canal. Birth trauma to the nervous system in most cases occurs against the background of chronic fetal hypoxia caused by an unfavorable course of pregnancy (toxicosis, threat of miscarriage, infectious, endocrine and cardiovascular diseases, occupational hazards, etc.).

Intracranial hemorrhages:

There are 4 main types of intracranial hemorrhages in newborns: subdural, primary subarachnoid, intra- and periventricular, intracerebellar. Trauma and hypoxia play a major role in their pathogenesis. Various types of intracranial hemorrhages, as well as the main pathogenetic mechanisms of their development, can be combined in one child, but in the clinical symptom complex one of them always dominates and the clinical symptoms depend, accordingly, not only on the disturbance of cerebral circulation, but also on its localization, as well as on the severity of mechanical brain damage.

Subdural hemorrhages:

Depending on the location, there are: tentorial hemorrhages with damage to the direct and transverse sinuses of the vein of Galen or small infratentorial veins; occipital osteodiastasis - rupture of the occipital sinus; rupture of the falciform process of the dura mater with damage to the inferior sagittal sinus; rupture of the connecting superficial cerebral veins. Subdural hematomas can be unilateral or bilateral; they may be combined with parenchymal hemorrhages resulting from hypoxia.

Tentorial hemorrhages:

Tentorial rupture with massive hemorrhage, occipital osteodiastasis, damage to the inferior sagittal sinus is characterized by an acute course with the rapid development of symptoms of compression of the upper parts of the brain stem such as stupor, eye deviation to the side, anisocoria with a sluggish reaction to light, the “doll’s eyes” symptom, muscle rigidity back of the head, opisthotonus pose; unconditioned reflexes are suppressed, the child does not suck or swallow, attacks of asphyxia and convulsions are observed.

If the hematoma grows, symptoms of compression of the lower parts of the brain stem appear: coma, dilated pupils, pendulum-like eye movements, arrhythmic breathing. In the subacute course of the pathological process (hematoma and smaller rupture), neurological disorders (stupor, excitability, arrhythmic breathing, bulging of the large fontanelle, oculomotor disorders, tremor, convulsions) occur at the end of the first day of life or after several days and persist for several minutes or hours. Death, as a rule, occurs in the first days of a child’s life from compression of the vital centers of the brain stem.

Convexital subdural hematomas caused by rupture of the superficial cerebral veins are characterized by minimal clinical symptoms (restlessness, regurgitation, vomiting, tension of the large fontanelle, Graefe's symptom, periodic increase in body temperature, signs of local brain disorders) or their absence and are detected only during an instrumental examination of the child.

The diagnosis of subdural hematoma is established on the basis of clinical observation and instrumental examination. Rapidly growing brainstem symptoms suggest a hematoma of the posterior cranial fossa resulting from a rupture of the tentorium cerebellum or other disorders. If neurological symptoms are present, a convexital subdural hematoma can be suspected.

Lumbar puncture in these cases is not advisable, because it can provoke herniation of the cerebellar tonsils into the foramen magnum in the case of a subdural hematoma of the posterior cranial fossa or the temporal lobe into the notch of the tentorium of the cerebellum in the presence of a large unilateral convexital subdural hematoma. Computed tomography is the most adequate method for diagnosing subdural hematomas; they can also be detected using ultrasound. During transillumination of the skull, the subdural hematoma in the acute period is contoured by a dark spot against the background of a bright glow.

In case of severe ruptures of the tentorium cerebellum, falciform process of the dura mater and occipital osteodiastasis, therapy is not effective and children die as a result of compression of the brain stem. In case of subacute course of the pathological process and slow progression of stem symptoms, surgical intervention is performed to evacuate the hematoma. In these cases, the outcome depends on the speed and accuracy of diagnosis.

For convexital subdural hematomas, patient management tactics can be different. In case of a unilateral hematoma with signs of displacement of the cerebral hemispheres, massive hematomas with a chronic course, a subdural puncture is necessary to evacuate the spilled blood and reduce intracranial pressure. Surgical intervention is necessary if the subdural puncture is ineffective.

If neurological symptoms do not increase, conservative treatment should be carried out; dehydration and resorption therapy, as a result of which after 2-3 months the formation of so-called contracting subdural membranes occurs and the child’s condition is compensated. Long-term complications of subdural hematoma include hydrocephalus, seizures, focal neurological symptoms, and delayed psychomotor development.

Subarachnoid hemorrhages:

Primary subarachnoid hemorrhages are the most common. They occur when vessels of various sizes are damaged within the subarachnoid space, small venleptomeningeal plexuses or connecting veins of the subarachnoid space. They are called primary in contrast to secondary subarachnoid hemorrhages, in which blood enters the subarachnoid space as a result of intra- and periventricular hemorrhages and aneurysm rupture.

Subarachnoid hemorrhages are also possible with thrombocytopenia, hemorrhagic diathesis, and congenital angiomatosis. With primary subarachnoid hemorrhages, blood accumulates between separate areas of the brain, mainly in the posterior cranial fossa and temporal regions. As a result of extensive hemorrhages, the entire surface of the brain is covered with a red cap, the brain is swollen, and the vessels are filled with blood. Subarachnoid hemorrhages can be combined with small parenchymal hemorrhages.

Symptoms of subarachnoid hemorrhage:

Symptoms of neurological disorders depend on the severity of the hemorrhage, combination with other disorders (hypoxia, hemorrhages of other locations). More common are mild hemorrhages with clinical manifestations such as regurgitation, hand tremors, anxiety, and increased tendon reflexes. Sometimes neurological symptoms may appear only on the 2-3rd day of life after the baby is put to the breast.

With massive hemorrhages, children are born with asphyxia, they experience anxiety, sleep disturbances, general hyperesthesia, stiffness of the neck muscles, regurgitation, vomiting, nystagmus, strabismus, Graefe's symptom, tremor, convulsions. Muscle tone is increased, tendon reflexes are high with an expanded zone, all unconditioned reflexes are clearly expressed. On the 3-4th day of life, Harlequin syndrome is sometimes noted, manifested by a change in the color of half the newborn’s body from pink to light red; the other half is paler than normal. This syndrome is clearly detected when the child is positioned on his side. A change in body color can be observed within 30 seconds to 20 minutes; during this period the child’s well-being is not disturbed. Harlequin syndrome is considered a pathognomonic sign of traumatic brain injury and asphyxia of the newborn.

The diagnosis is made based on clinical manifestations, the presence of blood and increased protein content in the cerebrospinal fluid. During transillumination of the skull in the acute period, there is no halo of luminescence; it appears after the resorption of the blood as a result of the progression of hydrocephalus.

To clarify the localization of the pathological process, computed tomography and ultrasound examination are performed. Computed tomography of the brain reveals the accumulation of blood in various parts of the subarachnoid space, and also excludes the presence of other hemorrhages (subdural, intraventricular) or atypical sources of bleeding (tumors, vascular abnormalities). The neurosonography method is not very informative, with the exception of massive hemorrhages reaching the Sylvian fissure (thromb in the Sylvian fissure or its expansion).

Treatment of subarachnoid hemorrhage:

Treatment consists of correcting respiratory, cardiovascular and metabolic disorders. Repeated lumbar punctures to remove blood should be performed according to strict indications and very carefully, slowly removing cerebrospinal fluid. With the development of reactive meningitis, antibacterial therapy is prescribed. If intracranial pressure increases, dehydration therapy is necessary. The progression of hydrocephalus and the lack of effect of conservative therapy is an indication for surgery (bypass surgery).

The prognosis depends on the severity of neurological disorders. In the presence of mild neurological disorders or asymptomatic course, the prognosis is favorable. If the development of hemorrhage was combined with severe hypoxic and (or) traumatic injuries, children, as a rule, die, and the few survivors usually experience serious complications such as hydrocephalus, convulsions, cerebral palsy (see Infantile paralysis), speech and mental delay development.

Intraventricular and periventricular hemorrhages:

Intraventricular and periventricular hemorrhages are most typical for premature babies born with a body weight of less than 1500 g. The morphological basis of these hemorrhages is the immature choroid plexus located under the ependyma lining the ventricles (germinal matrix). Until the 35th week of pregnancy, this area is richly vascularized, the connective tissue framework of the vessels is insufficiently developed, and the supporting stroma has a gelatinous structure. This makes the vessel very sensitive to mechanical stress, changes in intravascular and intracranial pressure.

Causes:

High risk factors for the development of hemorrhages are prolonged labor, accompanied by deformation of the fetal head and compression of the venous sinuses, respiratory disorders, hyaline membrane disease, various manipulations performed by the midwife (suction of mucus, replacement blood transfusion, etc.). In approximately 80% of children with this pathology, periventricular hemorrhages break through the ependyma into the ventricular system of the brain and blood spreads from the lateral ventricles through the foramina of Magendie and Luschka into the cisterns of the posterior cranial fossa.

The most typical localization of the forming thrombus is in the region of the occipital cistern magna (with limited spread to the surface of the cerebellum). In these cases, abliterative arachnoiditis of the posterior cranial fossa may develop, causing obstruction through cerebrospinal fluid circulation. Intraventricular hemorrhage can also involve the periventricular white matter of the brain and be combined with cerebral venous infarctions, which are caused by compression of the venous outflow pathways by the dilated ventricles of the brain.

Symptoms:

Hemorrhage usually develops in the first 12-72 hours of life, but may subsequently progress. Depending on the extent and speed of spread, 3 variants of its clinical course are conventionally distinguished - fulminant, intermittent and asymptomatic (low-symptomatic). With lightning-fast hemorrhage, the clinical picture develops over several minutes or hours and is characterized by deep coma, arrhythmic breathing, tachycardia, and tonic convulsions. The child’s eyes are open, the gaze is fixed, the reaction of the pupils to light is sluggish, nystagmus, muscle hypotonia or hypertension, bulging of the large fontanel are observed; metabolic acidosis, decreased hematocrit, hypoxemia, hypo- and hyperglycemia are detected.

The intermittent course is characterized by similar, but less pronounced clinical syndromes and an “undulating course, when a sudden deterioration is followed by an improvement in the child’s condition. These alternating periods are repeated several times over 2 days until the condition stabilizes or death occurs. With this variant of the pathological process, pronounced metabolic disorders are also observed.

Asymptomatic or low-symptomatic course is observed in approximately half of children with intraventricular hemorrhage. Neurological disorders are transient and mildly expressed, metabolic changes are minimal.

The diagnosis is made based on an analysis of the clinical picture, the results of ultrasound and computed tomography. It is believed that there are only 4 pathognomonic clinical symptoms: a decrease in hematocrit for no apparent reason, no increase in hematocrit during infusion therapy, bulging of a large fontanelle, a change in the child’s motor activity. Ultrasound examination of the brain through the large fontanel allows one to determine the severity of hemorrhage and its dynamics.

Intraventricular hemorrhage:

With intraventricular hemorrhage, echo-dense shadows are found in the lateral ventricles - intraventricular thrombi. Sometimes blood clots are detected in the 1st and 4th ventricles. Ultrasound examination also makes it possible to trace the spread of hemorrhage to the substance of the brain, which can be observed until the 21st day of the child’s life. The resolution of the thrombus lasts 2-3 weeks, and a thin echogenic rim (cyst) forms at the site of the echo-dense formation.

Hemorrhage into the germinal matrix:

Hemorrhage into the germinal matrix also leads to destructive changes with the subsequent formation of cysts, which most often form in the periventricular white matter of the brain - periventricular cystic leukomalacia. After the acute period, the ultrasound picture of intraventricular hemorrhage manifests itself as ventriculomegaly, reaching a maximum at 2-4 weeks. life. Ultrasound examinations of the brain are recommended to be carried out on the 1st and 4th days of a child’s life (about 90% of all hemorrhages are detected during these periods).

Computed tomography for diagnostic purposes is performed in cases where there is a suspicion of the simultaneous presence of a subdural hematoma or parenchymal hemorrhage. When blood penetrates into the subarachnoid space, lumbar puncture provides valuable information about the presence of hemorrhage: an admixture of blood is detected in the cerebrospinal fluid, an increase in the content of protein and red blood cells (the degree of increase in protein concentration, as a rule, correlates with the severity of the hemorrhage), and the pressure is increased.

In the acute period, measures are taken to normalize cerebral blood flow, intracranial and blood pressure, and metabolic disorders. It is necessary to limit unnecessary manipulations with the child, monitor the mode of pulmonary ventilation, especially in premature infants, constantly monitor pH, pO2 and pCO2 and maintain their adequate levels to avoid hypoxia and hypercapnia. If intraventricular hemorrhage has developed, progressive hydrocephalus is treated; repeat lumbar punctures are prescribed to remove blood, reduce intracranial pressure and monitor the normalization of cerebrospinal fluid.

Drugs that reduce the production of cerebrospinal fluid are also used enterally, such as diacarb (50-60 mg per 1 kg of body weight per day), glycerol (1-2 g per 1 kg of body weight per day). If ventriculomegaly does not increase, then Diacarb is prescribed in courses of 2-4 weeks. at intervals of several days for another 3-4 months. and more. In cases of progression of hydrocephalus and ineffectiveness of conservative therapy, neurosurgical treatment (ventriculoperitoneal shunting) is indicated.

Intra- and periventricular hemorrhage:

Mortality among newborns with intra- and periventricular hemorrhages is 22-55%. Surviving children form a high-risk group for developing complications such as hydrocephalus, delayed psychomotor development, and cerebral palsy. A favorable prognosis is assumed for mild hemorrhages in 80% of patients, for moderate hemorrhages in 50%, and for severe hemorrhages in 10-12% of children.

The highest, but not absolute, criteria for an unfavorable prognosis for children with intra- and periventricular hemorrhages are the following features of the acute period: extensive hematomas involving the brain parenchyma: lightning-fast onset of clinical manifestations with bulging of the large fontanel, convulsions, respiratory arrest; posthemorrhagic hydrocephalus that does not stabilize spontaneously; simultaneous hypoxic brain damage.

Hemorrhages in the cerebellum:

Cerebellar hemorrhages occur as a result of massive supratentorial intraventricular hemorrhages in full-term infants and hemorrhages in the germinal matrix in preterm infants. Pathogenetic mechanisms include a combination of birth trauma and asphyxia. Clinically, they are characterized by a rapid progressive course, as with subdural hemorrhages in the posterior cranial fossa: respiratory distress increases, hematocrit decreases, and death quickly occurs. A less acute course of the pathology, manifested by atony, areflexia, drowsiness, apnea, pendulum-like eye movements, and strabismus, is also possible.

The diagnosis is based on identifying brain stem disorders, signs of increased intracranial pressure, ultrasound data and computed tomography of the brain.

Treatment consists of emergency neurosurgical intervention for early decompression. With progressive hydrocephalus, shunting is performed, which is indicated for approximately half of children with intracerebellar hemorrhages.

The prognosis of massive hemorrhages in the cerebellum is usually unfavorable, especially in premature infants. Survivors exhibit disorders caused by destruction of the cerebellum: ataxia, motor awkwardness, intention tremor, dysmetria, etc.; in cases of blockage of the cerebrospinal fluid pathways, progressive hydrocephalus is detected.

Atypical intracranial hemorrhages in newborns can be caused by vascular abnormalities, tumors, coagulopathies, and hemorrhagic infarction. The most common type of hemorrhagic diathesis is vitamin K-deficiency hemorrhagic syndrome, hemophilia A, isoimmune thrombocytopenic purpura of newborns.

Hemorrhagic disorders in newborns can also be caused by congenital thrombocytopathy due to the mother's prescription of acetylsalicylic acid and sulfonamide drugs before birth, while the hemorrhages are mainly subarachnoid and mild. Neonatal intracranial hemorrhages can cause congenital arterial aneurysms, arteriovenous anomalies, coarctation of the aorta, brain tumors (teratoma, glioma, medulloblastoma).

Spinal cord injury in newborns:

Spinal cord injury is the result of mechanical factors (excessive traction or rotation) during the pathological course of labor, leading to hemorrhage, stretching, compression and rupture of the spinal cord at various levels. The spine and its ligamentous apparatus in newborns are more extensible than the spinal cord, which is fixed above by the medulla oblongata and the roots of the brachial plexus, and below by the cauda equina. Therefore, damage is most often found in the lower cervical and upper thoracic regions, i.e. in places of greatest mobility and attachment of the spinal cord. Excessive stretching of the spine can cause the brainstem to descend and become wedged into the foramen magnum. It should be remembered that the spinal cord can be severed due to a birth injury, but the spine is intact and no pathology is detected during an X-ray examination.

Neuromorphological changes in the acute period are reduced mainly to epidural and intraspinal hemorrhages; spinal injuries are very rarely observed - these can be fractures, displacements or separations of the epiphyses of the vertebrae. Subsequently, fibrous adhesions are formed between the membranes and the spinal cord, focal zones of necrosis with the formation of cystic cavities, and a violation of the architectonics of the spinal cord.

Clinical manifestations depend on the severity of the injury and the level of damage. In severe cases, the picture of spinal shock is expressed: lethargy, adynamia, muscle hypotonia, areflexia, diaphragmatic breathing, weak cry. The bladder is distended, the anus is gaping. The child resembles a patient with respiratory distress syndrome. The withdrawal reflex is clearly expressed: in response to a single injection, the leg bends and extends several times in all joints (oscillates), which is pathognomonic for spinal cord damage. There may be sensory and pelvic disorders. Subsequently, two types of pathological process are distinguished. Less commonly, the state of spinal shock persists, and children die from respiratory failure. More often, the symptoms of spinal shock gradually regress, but the child remains hypotensive for weeks or months.

During this period, it is almost impossible to determine a clear level of damage and, accordingly, the difference in muscle tone above and below the site of injury, which is explained by the immaturity of the nervous system, stretching of the spinal cord and roots along the entire length, and the presence of multiple diapedetic hemorrhages. Then hypotension is replaced by spasticity and increased reflex activity. The legs assume a “triple flexion” position, and a pronounced Babinski symptom appears. Neurological disorders in the upper extremities depend on the level of damage.

If the structures involved in the formation of the brachial plexus are damaged, hypotonia and areflexia persist; if pathological changes are localized in the mid-cervical or upper cervical regions, then spasticity gradually increases in the upper extremities. Autonomic disorders are also noted: sweating and vasomotor phenomena; Trophic changes in muscles and bones may be expressed. With mild spinal injury, transient neurological symptoms are observed, caused by hemocerebrospinal fluid dynamics disorders, edema, as well as changes in muscle tone, motor and reflex reactions.

The diagnosis is established on the basis of obstetric history (breech birth), clinical manifestations, examination results using nuclear magnetic resonance, and electromyography. Spinal cord injury can be combined with damage to the spine, so X-rays of the suspected area of injury and examination of cerebrospinal fluid are necessary.

Treatment consists of immobilization of the intended area of injury (cervical or lumbar); in the acute period, dehydration therapy is carried out (diacarb, triamterene, furosemide), antihemorrhagic drugs are prescribed (vicasol, rutin, ascorbic acid, etc.). In the recovery period, orthopedic regimen, exercise therapy, massage, physiotherapy, electrical stimulation are indicated. Aloe, ATP, dibazole, pyrogenal, B vitamins, galantamine, proserine, xanthinol nicotinate are used.

If the child does not die in the acute period of spinal cord injury, then the outcome depends on the severity of anatomical changes. With persistent neurological disorders, children require long-term rehabilitation therapy. Prevention involves the correct management of labor in a breech presentation (see Breech presentation of the fetus) and in case of incoordination of labor, prevention of fetal hypoxia, the use of cesarean section to prevent hyperextension of its head, and identification of surgically correctable lesions.

Peripheral nervous system injury:

Peripheral nervous system injury includes injury to roots, plexuses, peripheral nerves, and cranial nerves. The most common injuries are to the brachial plexus, phrenic, facial and median nerves. Other types of traumatic injuries to the peripheral nervous system are less common.

Brachial plexus injury in children:

Brachial plexus palsy occurs as a result of CV-ThI root injury and has an incidence of 0.5 to 2 per 1000 live births. Injury to the brachial plexus (obstetric paresis) is observed mainly in children with large body weight, born in the breech or leg presentation. The main cause of injury is obstetric care provided when the upper limbs of the fetus are thrown back and the shoulders and head are difficult to remove. Traction and rotation of the head with fixed shoulders and, conversely, traction and rotation of the shoulders with a fixed head lead to tension in the roots of the lower cervical and upper thoracic segments of the spinal cord over the transverse processes of the vertebrae. In the vast majority of cases, obstetric paresis occurs due to fetal asphyxia

Pathomorphological examination reveals perineural hemorrhages, pinpoint hemorrhages in nerve trunks and roots; in severe cases - rupture of the nerves forming the brachial plexus, separation of the roots from the spinal cord, damage to the substance of the spinal cord.

Depending on the location of the damage, paresis of the brachial plexus is divided into upper (proximal), lower (distal) and total types. The upper type of obstetric paresis (Duchenne-Erb) occurs as a result of damage to the upper brachial fascicle of the brachial plexus or cervical roots originating from the CV-CVI segments of the spinal cord. As a result of paresis of the muscles that abduct the shoulder, rotate it outward, raise the arm above the horizontal level, flexors and supinators of the forearm, the function of the proximal part of the upper limb is impaired.

The child's arm is brought to the body, extended, internally rotated in the shoulder, pronated in the forearm, the hand is in a state of palmar flexion, the head is tilted towards the sore shoulder. Spontaneous movements are limited or absent in the shoulder and elbow joints, dorsiflexion of the hand and movements in the fingers are limited; muscle hypotonia is noted, and the biceps brachii reflex is absent. This type of paresis can be combined with injury to the phrenic and accessory nerves.

Obstetric paresis:

The lower type of obstetric paresis (Dejerine-Klumpke) occurs as a result of a decrease in the middle and lower primary bundles of the brachial plexus or roots originating from the CVII-ThI segments of the spinal cord. As a result of paresis of the flexors of the forearm, hand and fingers, the function of the distal arm is impaired. Muscle hypotonia is noted; movements in the elbow, wrist joints and fingers are sharply limited; the hand hangs down or is in the position of the so-called clawed paw. Movement in the shoulder joint is preserved. On the side of the paresis, Bernard-Horner syndrome is expressed, trophic disorders may be observed, Moro and grasping reflexes are absent, and sensory disturbances in the form of hypoesthesia are observed.

The total type of obstetric paresis is caused by damage to the nerve fibers originating from the CV-ThI segments of the spinal cord. Muscle hypotonia is pronounced in all muscle groups. The child's arm hangs passively along the body; it can easily be wrapped around the neck - a symptom of a scarf. Spontaneous movements are absent or insignificant. Tendon reflexes are not evoked. The skin is pale, the hand is cold to the touch. Bernard-Horner syndrome is sometimes expressed. By the end of the neonatal period, muscle atrophy usually develops.

Obstetric paresis is most often unilateral, but can also be bilateral. In severe paresis, along with injury to the brachial plexus nerves and the roots that form them, the corresponding segments of the spinal cord are also involved in the pathological process.

The diagnosis can be established during the first examination of the newborn based on characteristic clinical manifestations. Electromyography helps to clarify the location of the damage.

Treatment should begin from the first days of life and be carried out continuously in order to prevent the development of muscle contractures and train active movements. The hand is given a physiological position with the help of splints, splints, massage, exercise therapy, thermal (ozokerite, paraffin, hot wraps) and physiotherapeutic (electrical stimulation) procedures are prescribed; medicinal electrophoresis (potassium iodide, proserin, lidase, aminophylline, nicotinic acid). Drug therapy includes B vitamins, ATP, dibazol, proper-mil, aloe, proserin, galantamine.

With timely and correct treatment, limb functions are restored within 3-6 months; The recovery period for moderate paresis lasts up to 3 years, but often compensation is incomplete; severe obstetric paralysis leads to a permanent defect in hand function. Prevention is based on rational, technically competent management of childbirth.

Paresis of the diaphragm (Cofferat syndrome):

Paresis of the diaphragm (Cofferat syndrome) is a limitation of the function of the diaphragm as a result of damage to the roots of the CIII-CV phrenic nerve due to excessive lateral traction during childbirth. Paresis of the diaphragm may be one of the symptoms of congenital myotonic dystrophy. Clinically manifested by shortness of breath, rapid, irregular or paradoxical breathing, repeated attacks of cyanosis, bulging of the chest on the side of the paresis. In 80% of patients, the right side is affected; bilateral involvement is less than 10%. Paresis of the diaphragm is not always clinically expressed and is often detected only with chest X-ray. The dome of the diaphragm on the side of the paresis stands high and is not very mobile, which in newborns can contribute to the development of pneumonia. Paresis of the diaphragm is often combined with injury to the brachial plexus.

The diagnosis is made based on a combination of characteristic clinical and radiological findings.

Treatment consists of providing adequate ventilation until spontaneous breathing is restored. The child is placed in a so-called rocking bed. If necessary, perform artificial ventilation and percutaneous stimulation of the phrenic nerve.

The prognosis depends on the severity of the lesion. Most children recover within 10-12 months. Clinical recovery may occur before the radiological changes disappear. With bilateral damage, mortality reaches 50%.

Facial nerve paresis:

Facial nerve paresis is a traumatic injury during childbirth to the trunk and (or) branches of the facial nerve. Occurs as a result of compression of the facial nerve by the promontorium of the sacrum, obstetric forceps, and with fractures of the temporal bone. In the acute period, swelling and hemorrhage are detected in the sheaths of the facial nerve.

The clinical picture is characterized by facial asymmetry, especially when screaming, widening of the palpebral fissure (lagophthalmos, or “hare's eye”) When screaming, the eyeballs can move upward, and in a loosely closed palpebral fissure, the albumen is visible - Bell's phenomenon. The corner of the mouth is lowered in relation to the other, the mouth is shifted to the healthy side. Severe peripheral paresis of the facial nerve can make sucking difficult.

The diagnosis is made based on characteristic clinical symptoms. Differential diagnosis is made with congenital aplasia of the brainstem nuclei (Mobius syndrome), subdural and intracerebellar hemorrhages in the posterior cranial fossa, central paresis of the facial nerve, brain contusion, in which there are other signs of damage to the nervous system.

The course is favorable, recovery often occurs quickly and without specific symptoms. For deeper lesions, ozokerite, paraffin and other thermal procedures are applied. Consequences (synkinesis and contractures) rarely develop.

Pharyngeal nerve injury:

Injury to the pharyngeal nerve is observed when the fetus is in abnormal intrauterine position, when the head is slightly rotated and tilted to the side. Similar movements of the head can also occur during childbirth, leading to paralysis of the vocal cords. Lateral flexion of the head with hard thyroid cartilage causes compression of the superior branch of the pharyngeal nerve and its inferior recurrent branch. As a result, when the upper branch of the pharyngeal nerve is damaged, swallowing is impaired, and when the lower recurrent branch is damaged, the vocal cords close, which leads to dyspnea. Rotation of the head causes the face to be pressed against the walls of the woman's pelvis, so the facial nerve may be injured on the opposite side. If lateral flexion of the neck is pronounced, then damage to the phrenic nerve may be observed and, accordingly, paresis of the diaphragm occurs.

Diagnosis is based on direct laryngoscopy.

Treatment is symptomatic; in severe cases, tube feeding and tracheostomy are necessary. Noisy breathing and the threat of aspiration may persist throughout the first year of life and beyond. The prognosis is often favorable. Recovery usually occurs by 12 months. life.

Median nerve injury:

Injury to the median nerve in newborns can occur in 2 places - in the antecubital fossa and in the wrist. Both types involve percutaneous puncture of the arteries (brachial and radial, respectively).

The clinical picture in both cases is similar: the digital grasp of an object is impaired, which depends on the flexion of the index finger and the abduction and opposition of the thumb. A characteristic position of the hand is caused by weakness of flexion of the proximal phalanges of the first three fingers, the distal phalanx of the thumb, and also associated with weakness of abduction and opposition of the thumb. Atrophy of the eminence of the thumb is observed.

Diagnosis is based on characteristic clinical symptoms. Treatment includes applying a splint to the hand, exercise therapy, and massage. The prognosis is favorable.

Radial nerve injury:

A radial nerve injury occurs when the shoulder is fractured and the nerve is compressed. This may be caused by incorrect intrauterine position of the fetus, as well as difficult labor. Clinically, it is manifested by fat necrosis of the skin above the epicondyle of the radius, which corresponds to the compression zone, weakness of extension of the hand, fingers and thumb (dangling of the hand). The differential diagnosis is carried out with an injury to the lower parts of the brachial plexus, however, with damage to the radial nerve, the grasping reflex and the function of other small muscles of the hand are preserved. The prognosis is favorable; in most cases, hand function is quickly restored.

Injury to the lumbosacral plexus:

Injury to the lumbosacral plexus occurs as a result of damage to the roots LII-LIV and LIV-SIII during traction in a purely breech presentation; is rare. Characterized by total paresis of the lower limb; Knee extension is particularly impaired, and there is no knee reflex. Differentiate with sciatic nerve injury and dysraphic status. In the latter, skin and bone abnormalities are observed and the lesion is rarely limited to only one limb. The prognosis is often favorable; only mild motor impairment may persist after 3 years.

Sciatic nerve injury in newborns:

Injury to the sciatic nerve in newborns occurs as a result of improper intramuscular injections into the gluteal region, as well as when hypertonic solutions of glucose, analeptics, and calcium chloride are administered into the umbilical artery, which may result in the development of spasm or thrombosis of the inferior gluteal artery, which supplies blood to the sciatic nerve. It manifests itself as a violation of hip abduction and limitation of movement in the knee joint, sometimes necrosis of the buttock muscles is observed. In contrast to the injury to the lumbosacral plexus, flexion, adduction and external rotation of the hip are preserved.

The diagnosis is based on medical history, characteristic clinical symptoms, and determination of the speed of impulse transmission along the nerve. It should be differentiated from peroneal nerve injury. Treatment includes applying a splint to the foot, massage, exercise therapy, thermal procedures, medicinal electrophoresis, and electrical stimulation. The prognosis may be unfavorable in cases of improper intramuscular administration of drugs (long recovery period). With paresis of the sciatic nerve resulting from thrombosis of the gluteal artery, the prognosis is favorable.

Peroneal nerve injury:

Peroneal nerve injury occurs as a result of intrauterine or postnatal compression (during intravenous administration of solutions). The site of injury is the superficial part of the nerve located around the head of the fibula.

Foot drop is characteristic, caused by weakness in the dorsiflexion of the leg as a result of damage to the peroneal nerve. The diagnosis is based on typical clinical manifestations and determination of the speed of impulse transmission along the nerve. Treatment is the same as for sciatic nerve injury. The prognosis is favorable, recovery in most cases is observed within 6-8 months.

Tactics of management of children who have suffered birth trauma of the central and peripheral nervous system. These children are at risk of developing further neurological and mental disorders of varying severity. Therefore, they should be registered at the dispensary every 2-3 months in the first year of life. undergo examinations by a pediatrician and neurologist. This will allow timely and adequate implementation of treatment and correction measures in the early stages of development.

Treatment of cerebral palsy in children:

Treatment of children with cerebral palsy and severe motor impairment after brachial plexus injury should be carried out continuously for many years until maximum compensation of the defect and social adaptation are achieved. Parents take an active part in the treatment of the child from the first days of life. They should be explained that treating a child with damage to the nervous system is a long process that is not limited to certain courses of therapy; it requires constant training with the child, during which motor, speech and mental development are stimulated. Parents should be taught the skills of specialized care for a sick child, the basic techniques of therapeutic exercises, massage, and orthopedic treatment, which should be performed at home.

Mental disorders in children who have suffered a birth injury to the nervous system are expressed by various manifestations of psychoorganic syndrome, which in the late period of birth traumatic brain injury in children corresponds to an organic mental defect. The severity of this defect, like neurological symptoms, is associated with the severity and location of brain damage (mainly hemorrhages). It consists of intellectual disability, convulsive manifestations and psychopathic behavior patterns. In all cases, cerebrasthenic syndrome is necessarily detected. Various neurosis-like disorders may also be observed, and psychotic phenomena occasionally occur.

Intellectual disability due to birth trauma in newborns associated with damage to the nervous system manifests itself primarily in the form of oligophrenia. A distinctive feature of such mental retardation is the combination of mental underdevelopment with signs of organic personality decline (severe impairments of memory and attention, exhaustion, complacency and uncriticality), convulsive seizures and psychopathic-like behavior patterns are not uncommon. In milder cases, intellectual disability is limited to secondary mental retardation with a picture of organic infantilism.

With encephalopathy with a predominance of convulsive manifestations, various epileptiform syndromes, asthenic disorders and decreased intelligence are observed.

Among the long-term consequences of traumatic brain injury in children, psychopathic-like behavioral disorders with increased excitability, motor disinhibition and the detection of gross impulses are widespread. Cerebrasthenic syndrome is the most permanent and characteristic; it manifests itself in the form of protracted asthenic states with neurosis-like disorders (tics, fears, anuresis, etc.) and signs of organic mental decline. Psychotic disorders are observed rarely, in the form of episodic or periodic organic psychosis.

The general distinctive feature of mental disorders in birth traumatic brain injury (except for oligophrenia) is the lability of symptoms and the relative reversibility of painful disorders, which is associated with a generally favorable prognosis, especially with adequate treatment, which is mainly symptomatic and includes dehydration, resorption, sedation and stimulant (nootropic) therapy. Psychocorrectional and therapeutic-pedagogical measures are essential.

Prevention is associated with preventing complications, improving pregnancy care and obstetric care.

Damage that occurs during childbirth is recorded in 5 to 10% of cases, which is accompanied not only by disturbances on the part of the child, but also by trauma to the mother (ruptures of the vagina, uterus, the formation of fistulas between the reproductive system and the intestines). 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.

Concept of disease

Birth trauma is defined as damage to the baby of varying localization and severity that occurs due to incorrect management tactics or pathology of labor. Disturbances can be triggered by mechanical (by squeezing or pulling the fetus) or hypoxic (by insufficient transport of oxygen into the body of the unborn child) factors.

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

Soft tissue injuries:

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

Injuries to bones and joints of a newborn:

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

Birth injuries of 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, the own shoulder, or uterine fibroids;
brachial plexus - occurs due to stretching of the neck and extraction of the fetus by the shoulder during gluteal or pronounced extension of the neck in a cephalic presentation. There are two types of plexus injuries: superior or Erb's palsy, which affects the muscles around the shoulder and elbow joints; lower or Klumpke's palsy, which causes 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 hyperextension of the cervical spine during breech presentation, difficulty in removing the head, and throwing back the handle.

There are two types of brain damage:

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

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

epidural - accumulation of blood between the skull and 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 into the soft tissue of the brain.

Internal organ injuries:

Abnormal course of labor leads to hemorrhage in:

spleen;
adrenal glands;
liver.

Causes and risk factors

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

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

It aggravates fetal damage and oxygen deficiency (hypoxia), which in some cases leads to hemorrhage even without vascular injury.

The provoking factors of this pathology are:

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

large fruit;
narrow pelvis;
abnormal development of the mother's pelvis;
uterine hypoplasia (underdevelopment).

Pathology of labor

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

Symptoms of the disease

Clinical manifestations - table

Type of pathology	Symptoms
Cephalohematoma	It manifests itself as a tumor-like soft formation that causes deformation of the skull. The skin over it is bluish. With large hematomas, jaundice occurs due to the breakdown of red blood cells.
Hemorrhages into internal organs	The resulting blood pools also break down over time, causing high bilirubin levels and yellowing of the skin. A newborn baby has an enlarged abdomen and bloating. The baby’s general condition deteriorates sharply, blood pressure decreases, vomiting appears and reflexes are inhibited.
Clavicle fracture	Lack of movement in the arm on the side of the fracture.
Fracture of the femur or humerus	The limb is brought to the body, swelling is observed, the child cannot actively move the leg or arm.
Subluxations and dislocations of the cervical vertebrae	The child's head is in an unnatural position: turned to the side and lowered.
Facial nerve injury	Stiffness of the facial muscles on the side of the injury, asymmetry of the lower jaw, drooping corner of the mouth.
The newborn's shoulder is brought to the body, and the forearm and palm are turned outward.
The innervation of the hand muscles is disrupted and the sensitivity of the inner surface of the hand is reduced. If the branch of the first thoracic nerve is involved in the process, then persistent drooping of the upper eyelid and constriction of the pupil occurs.
Traumatization of the phrenic nerve	The act of breathing is disrupted due to the failure of the innervation of the diaphragmatic muscle.
Damage to spinal cord segments	If violations occur above the level of the seventh cervical vertebra, they are fraught with death due to respiratory arrest. With injury below this segment, lethargy develops, which subsequently manifests itself only in incomplete restoration of sensory and motor function. The sphincters of the child's anus and bladder cannot be controlled. He has a weak, quiet cry, crying, and shallow breathing.
Traumatic brain injury (head compression, depressed skull fractures)	When palpating the skull under the doctor’s fingers, a stepwise deformation of the bones is felt, which are pressed inward, which also damages the brain tissue.
Hemorrhage into the membranes and tissue of the brain	In a full-term baby, trauma manifests itself as hyperexcitability, and in a premature baby - depression of the nervous system. The baby lags behind his peers in physical and mental development, seizures often occur, and the size of the head increases due to increased intracranial pressure.

Symptoms of birth injuries - photo gallery

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

Diagnosis of pathology

The 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 disruption of the integrity of the skin (non-invasive), and also do not cause even more harm when exposed.

To study the bones of the skull, its cavity and brain tissue, the following is used:

ultrasonography is a method for diagnosing brain structures that works on the principle of ultrasound and shows the condition and volume of the ventricles, gray matter, large vessels, the presence of hematomas, and the area of ischemia;
computed tomography or magnetic resonance therapy - examines and determines the integrity of the skull, the location of hemorrhages, the presence of cysts, vascular pathologies, and is also carried out in case of spinal cord damage;
electroencephalography - shows the functional state of the brain by recording biopotentials from the cortex;
Ophthalmoscopy is a mandatory method of examination for newborns. The position of the fundus corresponds to the degree of damage to brain tissue: swelling of the optic disc, dilatation of veins, hemorrhages in the retina are determined;
Lumbar and ventricular puncture are invasive test options in which a puncture is made into the spinal canal or ventricles to obtain cerebrospinal fluid (cerebrospinal fluid). It is used in cases of high intracranial pressure, hydrocephalus, intraventricular or epidural hemorrhage.

For fractures of the extremities the following is carried out:

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

To diagnose plexus or nerve injury:

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, dislocations, collarbones, subluxations of the cervical vertebrae);
Magnetic resonance imaging - shows damage to roots, nerve fibers and plexuses.

For hemorrhages in internal organs:

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

Treatment of birth trauma

During 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:

restoration of airway patency and adequate ventilation of the lungs;
elimination of hypovolemia (low volume of circulating blood);
maintaining 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 the child.

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

The following medications are 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 trauma 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 children.
Vikasol is used to stop bleeding Prozerin - improves neuromuscular conduction
Trental improves microcirculation of the newborn

When diagnosing fractures, the newborn's limb is immobilized using a plaster or elastic bandage.

Surgical intervention is performed if it is necessary to remove large hematomas or 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.

In case of Erb's or Klumpke's palsy, the limb is first immobilized so as not to further 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 limbs and reflexology are recommended.

Complications of birth trauma

Damage to the facial nerve, soft tissues and cephalohematoma do not require specific treatment and do not lead to consequences for the baby’s health.
Hemorrhage into the adrenal glands leads to chronic adrenal insufficiency.
Injuries to the brain and spinal cord are the most dangerous for the physical and mental health of a child: delayed psychomotor development, mental retardation, convulsions, paralysis, epilepsy, coma.
Death occurs due to hemorrhage in the respiratory center and uncontrolled intracranial pressure.

Injury prevention

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

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The birth process does not always proceed favorably for both the mother and the child. Birth trauma in newborns occurs due to various reasons. Timely and adequate diagnosis and then treatment of this pathology are extremely important. Otherwise, the consequences can become unpredictable: from intellectual problems to disability or even fetal death.

What is a birth trauma of a child, we will consider in more detail below. In obstetric practice, this concept refers to a condition of the child that is characterized by damage to the integrity of tissues, organs or skeleton and causes disruption of their functions.

All damage to the fetus during the birth process is conventionally divided into:

mechanical, that is, created by some external stimulation;
hypoxic, that is, occurring as a result of asphyxia or hypoxia of the fetus.

Functional disorders can be observed in various areas of the body and, depending on location, are classified as follows:

injuries of bones, joints (cracks or fractures of the humerus, clavicle, femur and skull);
soft tissue damage (skin or muscle, cephalohematoma, birth tumor);
injuries to internal organs (hemorrhages in the abdominal organs);
disorders of the nervous system (damage to the nerve trunk in the brain or spinal cord).

The last type of trauma in newborns is divided into the following types:

peripheral nervous system defects;
damage to the spinal cord.

There is also a classification of birth injuries based on the actions of the obstetric team:

Spontaneous. Formed during standard or difficult childbirth for reasons beyond the control of medical personnel.
Obstetrics. Occurs as a result of certain midwife techniques (both correct and incorrect).

Cervical injury

The human cervical region is characterized by mobility, fragility and extreme sensitivity to all kinds of influences. In this regard, the cause of its injury may be too rough bending, careless stretching or forced rotation.

During the birth process, various types of neck disorders can occur:

Distraction.
Rotary.
Compression-flexion.

A rotational violation of the neck occurs as a result of the actions of the obstetrician aimed at helping the child move through the birth canal. During manipulations performed by hand or obstetric forceps, circular movements of the head are performed, which in some cases lead to subluxation of the first cervical vertebra (atlas) or to a defect in the articulation of the first and second vertebrae.

Occasionally, the atlas becomes displaced and the spinal canal narrows, which is accompanied by pressure on the spinal cord.

In some situations, during natural childbirth and in the presence of a large fetus, obstetricians are required to make additional efforts, which can cause separation of the vertebral bodies from the discs, rupture of ligaments in the neck or disruption of the functioning of the spinal cord.

Compression-flexion injuries are most common in rapid labor, especially when the fetus is quite large. When a child moves through the birth canal, his head experiences resistance, which is why compression fractures of the vertebrae are possible.

Consequences of natal cervical injuries

Birth trauma to the neck causes:

Osteochondrosis and scoliosis.
Decreased muscle tone with overall increased flexibility.
Weakness in the muscles of the shoulder girdle.
Clubfoot.
Headache.
Impairments in fine motor skills.
Vegetovascular dystonia.
High blood pressure.

Note! Three times more often birth injuries are recorded during the cesarean section procedure than during the most natural childbirth. This is due to the so-called jar effect.

When a baby is artificially pulled out of the uterus, negative pressure is formed in it. The resulting vacuum prevents the free exit of the newborn.

It takes considerable effort to pull it out. Such manipulations can cause damage to the spine.

Intracranial injuries

Intracranial birth injury of newborns is a cerebral disorder in the activity of the brain that varies in location and degree of manifestation, which is formed during the birth act as a result of mechanical damage to the skull. Factors that can provoke injuries of this nature are conditionally divided into 2 groups:

Associated with the intrauterine state of the child.
Depending on the characteristics of the birth canal of the mother.

Factors associated with the intrauterine condition of the child:

embryofetopathy: developmental defects with hemorrhagic syndrome, venous congestion in tissues;
hypoxic condition of the fetus caused by placental insufficiency;
prematurity: tissue weakness, small number of elastic fibers, excessive vascular permeability, liver immaturity, insufficient amount of prothrombin, soft cranial bones;
post-term pregnancy: hypoxia that occurs against the background of placental involution.

Factors that depend on the characteristics of the mother’s birth canal:

tissue rigidity in the birth canal;
irregular pelvic shape;
insufficient volume of amniotic fluid;
premature discharge of amniotic fluid.

In the disturbance of blood circulation in the brain, an important role is played by the difference between the atmospheric pressure, which acts on the presenting part of the head, and the intrauterine pressure, which grows with contraction of the uterus. In addition, in the pathogenesis of cerebral abnormalities, dislocation syndrome is of particular importance.

The fundamental factor of genesis is mechanical damage to the contents of the skull. Even during a natural birth, some difficulty in blood circulation occurs. And with pathological delivery, unfavorable factors add up and even slight mechanical stimulation of the head can provoke intracranial hemorrhage in premature infants as a result of damage to blood vessels or duplications of the lining of the brain.

Depending on the location of hemorrhage, they are divided into:

epidural (between the membranes of the brain and the bones of the skull);
subdural (between the meninges and the substance of the brain);
intraventricular (blood in the ventricles of the brain).

The consequences of birth trauma are characterized by a number of features: from minor developmental deviations to serious pathologies. Often, due to hemorrhage in the internal organs, anemia develops. As a result of increased heat transfer and decreased heat production, the thermoregulation system is disrupted, and newborns suffer from rapid hypothermia.

Often, natal trauma causes hypoglycemia. Physiological loss of body weight is compensated more slowly, and signs of jaundice persist for a long time. Due to a decrease in specific and nonspecific immunity, infectious diseases (in particular pneumonia) are common in newborns with intracranial injuries.

The child’s recovery depends on the form and degree of brain damage and on the rationality and intensity of therapy in both the acute and recovery periods.

Fatalities occur in 3 - 10%, with traumatic brain injury accounting for 97% of all cases of fatal birth trauma.

Absolute recovery is possible. But as a rule, 20 - 40% of children with hypoxic CNS lesions are diagnosed with residual signs:

delay in physical, psycho-emotional and speech development;
cerebrasthenic syndrome with neurosis-like symptoms;
scattered microsymptoms in foci;
moderate hypertension (intracranial);
hydrocephalus (compensated or progressive);
epilepsy.

7% of children with posthypoxic encephalopathy exhibit severe organic damage to the central nervous system with pronounced motor disorders (cerebral palsy) and mental disorders up to mental retardation.

Birth trauma in newborns is a common occurrence, and it is impossible to completely protect yourself from trauma during childbirth. But you can reduce the risks as much as possible. It is necessary for obstetricians to timely identify pregnant women at risk for perinatal pathology, as well as professional and competent use of various manipulations during childbirth. It is advisable for expectant mothers to plan conception after treatment of chronic diseases and register their pregnancy in a timely manner.

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 trauma

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

In case of unfavorable course of labor, 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 phenomenon that occurs more often than it seems. Source: Flickr (Jonatan P.)

Classification and types

Existing classifications take various factors as the basis for differentiation.

Thus, birth injuries are divided into spontaneous And obstetric.

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

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

Hypoxic injuries are the result of oxygen starvation (hypoxia) or complete cessation of oxygen supply (asphyxia).

Mechanical birth injuries are divided into:

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

It is important! Birth injuries and injuries during childbirth are close, but not identical terms. Birth trauma is a broader concept that includes not only the traumatic impact factor itself, but also the subsequent reaction to it on the part of the child’s body.

Traumatic brain injuries

Damage to the skull and brain of the fetus is the most common type of birth injury and the most common cause of childhood disability and mortality in infancy.

This type of damage occurs due to compression of the fetal skull as it moves through 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 babies born naturally go through. During the normal course of labor, the bones of the fetal skull are displaced in such a way as to facilitate the birth 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:

hemorrhages into the brain with the formation of a hematoma;
mechanical damage to the meninges and brain bodies;
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 organ injuries

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

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

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

Photo 2. The success of childbirth largely depends on the correct assistance provided. Source: Flickr (away with words).

Skeletal injuries

Damage to fetal bone structures occurs with excessive force during obstetrics, less often - during physiological childbirth without obstetric care. The most common skeletal injuries that occur are:

shoulder fracture;
fracture of the femur.

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

Note! Caesarean section - removal of the fetus from the uterus through an incision in the anterior wall of the abdominal cavity - does not guarantee the absence of birth trauma. Sometimes during surgery various damage to the child’s bones occurs when the child is carelessly removed by the legs or arms.

Soft tissue injury

Damage to fetal tissue during childbirth – result of exposure to obstetric instruments. Soft tissue injuries include pressure, which results in the formation of 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 birth. In rare cases, complications occur in the form of suppuration, which is localized by incision and drainage.

Cervical and spine injuries

The fetal cervical spine experiences the maximum application of mechanical force during labor, 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, displacements and separations of the epiphyses of the vertebrae.

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

Causes of birth injuries in newborns

Causes of injury may be from the fetus and/or mother. Features of intrauterine development lead to conditions that cause pathological childbirth and trauma in the child:

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

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

Obstetric care during childbirth is also a common cause of birth injuries. Traction (forced extraction), rotation (rotation of the head or body), use of obstetric forceps and other impacts lead to various injuries described above.

Signs, symptoms and diagnosis of injury

The presence, nature and severity of birth trauma depending on its location can be determined using various methods.

Traumatic brain injuries, spinal and spinal cord injuries 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 fontanel and an increase in the volume of the head, vomiting or incessant regurgitation. To diagnose TBI, radiography and magnetic resonance/computed tomography of the head are used.
Internal organ injuries more difficult to detect and diagnose. The most common signs of this type of damage are a drop in blood pressure, constant regurgitation, and vomiting. An abdominal ultrasound is performed to confirm the diagnosis.
Bone fractures manifest themselves in severe pain, crepitation (crunching) of damaged bones upon palpation, limited mobility of the limbs, local swelling. If a fracture is suspected, an x-ray is required.

Treatment

Treatment methods for birth injuries depend on their severity and location. Not all types of injuries require medical attention and often go away on their own within a few days/weeks after birth.

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

In other cases need medical help:

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

Prevention of birth injuries

Prevention of injuries to the newborn during labor is in competencies of an obstetrician-gynecologist.

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

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