The term "birth trauma" in obstetrics is usually used to designate any damage to organs and systems of the newborn as well as the mother. There are many kinds of such pathologies, and each of them represents a certain danger.
Types of birth trauma
All injuries, when delivered, can be divided into:
- trauma of the newborn;
- trauma of the woman in childbirth.
More often damage during passage through the birth canal receives a fruit. Among the common injuries of the baby:
- Damage to soft tissue - abrasions, scratches, damage to subcutaneous tissue, muscle, birth canal, cephalothorem.
- Birth injuries of the musculoskeletal system: cracks and fractures of the clavicle, femurs, shoulder, subluxation of the joints, damage to the skull bones.
- Injuries of internal organs: hemorrhages in the liver, adrenals, spleen.
- Damage to the central nervous system: intracranial birth trauma, spinal cord injury.
- Injuries of the peripheral nervous system: damage to the brachial plexus - Duchene-Erba paresis / paralysis or Dejerine-Clumpke paralysis, total paralysis, diaphragm paresis, damage to the facial nerve.
Among the damages received by a woman in the process of giving birth, it is necessary to distinguish:
- stretching and tearing of the vagina;
- ruptures of the perineum;
- violation of the integrity of the uterus, cervix.
Birth injuries in newborns
Neonatal trauma is more often caused by a violation of the process of delivery, the tactics of giving birth. Because of this, skin damage, subcutaneous fat is a frequent manifestation of birth trauma. Among them are:
Such damage is detected by visual inspection of the newborn. The internal organs and systems are very dangerous. A feature of them is the absence of symptoms for several days and even weeks. To identify them, additional research methods are required. The outcome depends on the time of treatment and the detection of birth trauma.
Birth trauma in the mother
Trauma at childbirth at the mother arise due to misconduct, as well as large fetal sizes. Vulvar ruptures occur more often in the region of the labia minora, the clitoris and represent small cracks or tears. Injuries of the vagina in the lower third of it often combine with the rupture of the perineum, and if the upper part is injured, the vaginal and cervical vault is injured. The middle third of the vagina, due to its high ability to stretch, is rarely injured. The rupture of the perineum occurs mainly in the second stage of labor.
Birth trauma - causes
Analysis of possible causes of pathology made it possible to identify 3 main groups of factors provoking a violation:
- associated with the condition of the mother;
- conditioned by the state of the fetus;
- related to the mechanism of the birth process, the so-called "obstetric trauma."
So, among the predisposing "maternal" factors, obstetricians are often called:
- early or, conversely, late reproductive age;
- anatomically narrow pelvis;
- uterine hypoplasia ;
- diseases of the pregnant: cardiovascular disorders, endocrine, gynecological diseases;
- a premature pregnancy;
- harmful working conditions.
A large group of causes that cause birth trauma in children are those that are directly related to the baby. So, violations are often cited:
- pelvic presentation;
- water scarcity ;
- wrong positioning of the head in the small pelvis;
- large size of the fetus;
- intrauterine hypoxia ;
- abnormalities of intrauterine development;
Among the anomalies of labor, due to which there is, among other things, the birth trauma of the cervical spine, it is necessary to distinguish:
- fast or, conversely, prolonged labor;
- carrying out of rhythm stimulation in the absence of labor activity;
- non-coordinated generic activity;
- unreasonable use of obstetric aids (turn on the leg, the imposition of obstetric forceps, the use of an extractor).
Fractures in childbirth
This kind of trauma in childbirth in a child is caused in most cases by an incorrect obstetric manual. Most often, there is damage to the clavicle, bones of the hands or feet (depending on the type of presentation). Subperiosteal fractures of the clavicle are detected by physicians on day 2-3 after delivery. By this time a dense swelling, a callus is formed at the site of the lesion. Due to the displacement of the bone, the toddler can not perform active movements with handles, but when he tries to passively, he begins to cry.
Fracture of the shoulder or hip is accompanied by the lack of movement of the legs, there is swelling, deformation, the damaged limb is shortened. In case of trauma of this type, a gypsum bandage is applied with a preliminary repositioning of the injured limb. In case of a fracture of the collarbone, the baby is put on the Dezo bandage, in addition to the mother, it is recommended to carry out a tight swaddling of the newborn baby.
Birth injury to the spine
Birth injuries of the spine in infants occur infrequently. In this pathology can include various types of violations:
- bleeding in the spinal cord;
- compression of the spinal cord, rupture.
Birth injuries of the spinal cord may not be noticeable visually, but accompanied by a vivid clinical picture. There are signs of spinal shock:
- lethargy and muscle hypotension;
- absence of reflexes;
- weak prolonged cry;
- diaphragmatic breathing.
The development of this pathology is accompanied by a high risk of death of a newborn from respiratory failure. Such birth trauma, asphyxia at which it is unavoidable, can lead to the death of the baby. With a favorable development of events there is a gradual regression of the spinal shock. So, on replacement of a hypotension comes spasticity, there are vasomotor reactions, a sweating, the trophic of nervous and muscular tissues improves. Light injuries are accompanied by the appearance of neurological symptoms: changes in muscle tone, reflexes and motor reactions.
Intracranial birth trauma of newborns
Intracranial birth trauma is a consequence of the compression of the head by the birth canal. Violation occurs when the size of the fetus does not match the small pelvis or if the labor activity is disturbed (prolonged labor). Almost always intracranial injury is accompanied by a hemorrhage, which, depending on the site of localization, can be:
- epidural - internal cephalohematemata are located between the dura mater and the bones of the skull;
- subdural - hemorrhage is localized between the solid and arachnoid medulla;
- Subarachnoid - located in the subarachnoid space;
- Intraventricular - extends into the cavity of the lateral ventricles;
- parenchymatous - hemorrhage into the substance of the brain, which has the character of a hematoma;
- mixed - multiple hemorrhages in the membranes of the brain, ventricles, brain substance.
Birth injuries of the nervous system
During childbirth, damage to both the central and peripheral nervous system is possible. Often, the pathological process involved roots, plexus, peripheral and cranial nerves. Among the common lesions of the peripheral nervous system, there are often found:
- paresis of the brachial plexus;
- Duchenne-Erba paresis - associated with damage to the plexus and rootlets;
- the lower obstetric paresis of Dejerine-Klumpke - the plexus or roots are affected, which results in a disruption of the function of the distal arm.
Birth injuries of the central nervous system are determined at an early stage by the presence of characteristic symptoms:
- decreased muscle tone;
- restriction of the movements of the hands and feet;
- muscle atrophy;
- the appearance of dyspnea;
- respiratory failure.
Birth trauma - symptoms
The signs of birth trauma are so numerous that doctors unite them into several large groups - depending on which organs were damaged. Birth trauma of the head, for example, is accompanied by the following phenomena:
- sleep disturbance;
- stiffness (excessive tone) of the neck muscles;
- nystagmus (involuntary rapid rhythmic movements of the eyeballs);
- tremor (trembling) of various muscles, convulsions.
The main signs of soft tissue injuries are:
- abrasions, scratches;
About traumatization of the bone system say:
- restriction of active movements;
- a painful reaction (crying) with passive limb movements on the side of the lesion;
- deformation and shortening of damaged bone.
Birth trauma - diagnosis
Birth trauma of the cervical region does not cause difficulties in diagnosis - the head of the child is turned in the direction of damage, there is an increase in muscle tone from the opposite side. However, damage to the internal organs requires the conduct of hardware research methods. Among the methods used to determine:
- examination and palpation of limbs, head;
- Ultrasound of the proposed area of damage;
- functional tests.
Treatment of birth injuries
When a birth trauma is detected, childcare involves full monitoring and prevention of complications. Mom receives specific recommendations from doctors who must be fully respected. In general, the therapy of birth trauma is reduced to:
- prevention of infection of damaged soft tissues;
- carrying out of massage, medical gymnastics for increase of a tone of a musculature;
- immobilization of damaged limbs;
- surgical correction (in case of internal bleeding, torticollis, for example);
- syndromic treatment for damage to the nervous system.
Consequences of birth trauma
To ensure that children do not have physical and mental retardation after birth injuries, mothers must fulfill all the appointments they receive. However, the birth trauma is not always traceless. Many newborns who underwent hemorrhage to the adrenal glands subsequently develop chronic adrenal insufficiency. Injuries to the central and peripheral nervous system are the most dangerous, the prognosis and consequences depend on the severity of the neurological disorders.