Birth injuries

Introduction to birth injuries

Birth injuries are those suffered during childbirth. They include extensive caput succedaneum, cephalhaematoma, subgaleal haemorrhage, nerve palsies and fractures.
The presentation varies depending on type and site of injury.
Excessive traction may result in injury to the brachial plexus and may be associated with fracture or injury of the humerus or shoulder joint.

Causes of birth injuries

Birth injuries are caused by difficult delivery (including instrumental delivery)

Symptoms of birth injuries 

The following are the symptoms of birth injuries:

  • Swelling of head
  • Inability to move a limb properly
  • Pallor

Signs of birth injuries

Extensive Caput Succedaneum

  • Diffuse swelling of the presenting part of the scalp that may extend beyond cranial suture lines

Cephalhaematoma

  • Large swelling of the scalp that is restricted to one half and does not extend beyond the midline

Subgaleal haemorrhage

  • Diffuse swelling of the scalp which may result in a distorted shape of the head and face Severe pallor
  • Jaundice

Nerve injuries

  • Erbs Palsy – Whole upper limb does not move. There is movement only in the fingers
  • Klumpke’s Palsy – Fingers of the affected hand do not move (claw hand) but there is active movement in the arm and forearm

Fractures

  • Reduced movement of affected limb
  • Swelling of the affected limb
  • Abnormal position of limb
  • Pain and tenderness on movement of limb

Investigations

  • Haemoglobin level for subgaleal haemorrhage
  • Serum bilirubin if jaundiced X-ray of relevant part if fracture is suspected

Treatment for birth injuries

Treatment Objectives

The treatment objectives of birth injuries are:

  1. To arrest further bleeding treat complications of anaemia and jaundice
  2. To re-establish near normal movement in affected limb.
  3. To promote normal healing of fracture

Non-pharmacological treatment

A. Extensive caput succedaneum

  1. Reassure parents
  2. Leave swelling alone (spontaneous resolution over 3-4 days)

B. Cephalhaematoma

  1. Reassure parents
  2. Leave swelling alone (spontaneous resolution with time)
    • Do not perform incision and drainage
  3. Phototherapy if jaundiced

C. Subgaleal Haemorrhage

  1. Phototherapy if jaundice levels require this (See  ‘Neonatal Jaundice)

D. Nerve injuries

  1. Physiotherapy Fractures

E. Fracture

  1. May require splinting

Pharmacological treatment

A. Cephalhaematoma and Subgaleal haematoma

To reduce bleeding
Evidence Rating: [A]

  • Phytomenadione (Vitamin K), IM, 1 mg stat. even if baby received a dose at birth

To correct Anaemia if Hb < 12 gm/dl

  • Blood transfusion, 15-20 ml/kg

Referral Criteria

Refer severe cases to an appropriate specialist facility.