By birth, injuries include a group of diseases that occur in newborns during pregnancy or childbirth and is characterized by the variety of causes and manifestations.
What is a Birth Injury?
Birth injuries can be divided into mechanical and hypoxic. By the mechanical forms of birth injuries include:
- generic tumor
- cephalhematoma (bleeding under the periosteum of the skull bones),
- bleeding in the muscles
- a broken bone
- nerve damage.
For hypoxic birth, injuries are lesions of the brain and spinal cord, as well as the internal organs resulting from asphyxia or hypoxia of the fetus and newborn.
Risk Factors of Birth Injury
- prematurity;
- the low mass of the fetus;
- overweight fetus;
- birth pathology transient, prolonged;
- forceps.
Causes of Birth Injury
Mechanical injuries are due to the child's size mismatch and the birth canal. On the part of the child - a large fruit, diabetic fetopathy anomalies position (facial, parietal and breech, transverse position), post-term pregnancy, fetal malformations (fetal hydrocephalus), and others. His mother's side - old age, pelvic anomalies (narrow or flat rachitic pelvis, exostosis (bone or osteochondral proliferation of non-neoplastic nature on the surface of the bone), trauma with damage to the pelvis).
Hypoxic birth injuries occur as a result of hypoxia, asphyxia or fetus and newborn. Under asphyxia or asphyxia meant the sharp cessation of oxygen, and under hypoxia - long repeated limit of oxygen with excess carbon dioxide in the body and other oxidized products. The reason for cessation of oxygen can be, for example, the umbilical cord wrapped around the neck, making it difficult to breathe or oral accumulated slime, or tongue fuse, closing the trachea.
Birth injury to a greater or lesser extent in every child there. It occurs as a result of the generic process of mechanical interaction mother and fetus. Birth trauma, or post-natal condition, in some cases, can increase the adaptive capacities of the child, while in others (after exhaustion of compensatory mechanisms and the onset of pathological processes) to lower them.
Manifestations of Birth Injury
The generic tumor is a swelling of soft tissues presenting a part of the birth canal (usually the head) of the child as a result of venous stasis during the passage through the birth mother's ways, often with punctate hemorrhages in the skin. More common in children nulliparous mothers during prolonged eruption of the head, in larger children. Swelling disappears within 1-2 days.
Cephalohematoma is bleeding under the periosteum of the flat bones of the skull. The mechanism of injury is to shift the skin together with the periosteum and rupture vessels during movement of the child's head through the birth canal. Blood in cephalohematoma accumulates gradually and thus the tumor appeared during or shortly after birth, continues to increase during the first 2-3 days of life.
The most common bleeding in the muscle is bleeding in the sternocleidomastoid muscle. This injury usually occurs when the breech or at birth with forceps or manual extraction of the fetus. Blood poured out of the vagina muscles or muscle itself. In the area of the damaged muscle is felt small, moderately dense consistency or testator tumor the size of a walnut to that of plum, which often appears only at the end of the first - the beginning of the 2nd week of life. Later develops torticollis - baby's head is tilted to the affected side and the chin to the opposite. Bleeding into other muscles are very rare.
Bone fractures often occur in heavy labor and obstetric interventions. One of the most common skeletal injuries is a broken collarbone. He observed at 0.03-0.1% of newborns, is possible even in spontaneous labor without providing obstetrical benefits. Produced fracture from large fruits, breech with a tilting handles. Contribute to violent fracture or weak labor, belated turn shoulders, narrow hips in mothers. Most often there is a fracture of the right clavicle. Usually this subperiosteal fracture in the middle third of the clavicle, without bias. Fractures of the humerus and femur are rare, they arise from the downgrade handles at the head or foot of breech presentation.
Nerve damage can be the central and peripheral origin. The most commonly affected facial nerve and the nerves of the brachial plexus. Nerve paralysis observed during prolonged labor due to prolonged pressure on the nerve during the passage of the birth canal and in the application of tongs and for fractures of the temporal bone.
Especially detrimental effect lack of oxygen has on the brain cells, they simply die. Therefore, the longer a child had asthma, the harder it will be consequences. Nerve cells that make up the fabric that makes up the substance of the brain begin to die within 5-7 minutes after the cessation of oxygen in the blood. The consequence of the death of nerve cells is the intellectual deficiency of varying degrees of severity - from mild mental retardation to severe retardation.
The main clinical significance has intracranial birth injuries, accompanied by damage to the central nervous system: brain edema and intracranial hemorrhages. They result from both mechanical and hypoxic damage. Distinguish an easy, moderate to severe intracranial birth injury; The latter leads to the death of the newborn in the first hours (days) after birth or to the development of persistent organic changes in the central and peripheral nervous system (mental retardation, paralysis, paresis, and so on. d.). In the acute phase of intracranial trauma show signs of central nervous system excitation newborn: general anxiety, scream, palpitations convulsive breathing, seizures, tremor of limbs is observed, insomnia, etc., combined with inhibition of sucking and swallowing reflexes. The period of excitation is replaced by the state of oppression general lethargy, loss of muscle tone, weak cry, pallor of the skin, the baby sleeps, wakes up for feeding, often regurgitation. Characterized by frequent bouts of asphyxia secondary.
In older children transferred birth trauma is most often seen:
- headache ,
- fatigue,
- dizziness,
- scoliosis and posture disorders.
Prevention of Birth Injury
The main method of birth injury prevention is the timely elimination of health problems in the future mother. Unfortunately, women are thinking about pregnancy is often not up to it, and even during, and preliminary treatment in such cases can not speak.
Forecast of birth injury
Prognosis of the disease depends not only on the severity of the injury but also from the prescribed treatment and the timely treatment. With timely diagnosis and proper treatment, the outcome will be favorable. Full recovery occurs in 70-80% of children.
In some cases, the child can observe residual effects: tearfulness, fussiness, autonomic disorders, etc. In the case of inadequate treatment or late diagnosis heavier possible outcome:. Cerebral palsy, mental retardation, and others.
What can the doctor do?
The birth injury is detected in most cases in the hospital. Immediately the following treatment. It is best to provide maximum comfort to the newborn (it is not applied to the chest and fed expressed breast milk through a tube), if necessary - an ice pack to his head, oxygen therapy, vitamins, glucose, cardiac and vascular, drugs that reduce the excitability of the central nervous system, Antihemorrhagic means.
What can you do?
Children who experience birth trauma, require observation pediatrician, neurologist, and orthopedist.
A child with intracranial birth trauma is under medical supervision in a hospital. He appointed various procedures auxiliary procedures and special medication. It is aimed at the absorption of hemorrhage. Besides medicines child appointed physiotherapy, massage, gym. Children have good resilience, so the brain returns to normal. If intracranial birth trauma complicated by cerebral palsy or epilepsy, that these children are watching in specialized clinics. If there are no serious complications, the observation is conducted district neurologist.
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