Birth trauma refers to those injuries sustained during labor and delivery. Despite skilled and competent obstetric care, some may be unavoidable. Factors predisposing infants to injury include macrosomia, prematurity, cephalopelvic disproportion, dystocia, prolonged labor, and abnormal presentation. In 1988, birth injuries ranked eight as major causes of neonatal mortality and caused 4.6 deaths per 100,000 live births. The clinician who cares for newborn infants must be familiar with the conditions caused by birth injury. Injuries are known to occur to the soft tissues, head, eyes, ears, vocal cords, neck and shoulder, spine and spinal cord, intra-abdominal organs, extremities, and genitalia. Although many are mild and self limited, others are serious and potentially lethal.
Figure 4.1. Severe molding of die head following an occipitoposterior presentation. The mobile skull bones and brain deform to comply with pressure in die birth canal. Note the flattened forehead and long occiput. It resolves spontaneously and needs no intervention.
Figure 4.2. Persistent occipitoposterior presentation with marked molding and a caput succedaneum. A caput succedaneum occurs as a result of the presenting part pressing against the partly dilated cervix whose constricting rim obstructs the return flow of venous flood and lymph from the scalp leading to edema. The distribution crosses suture lines (compare with cephalhematoma) and is usually present at birth.
Figure 4.3. Caput succedaneum with prolonged labor. In a caput succedaneum the tissues involved are those encircled by the "girdle of contact" formed by the maternal passages. The location indicates the intrauterine lie of the fetus. In breech delivery there may be similar edema and bruising of the perineum, buttocks, or genitalia. These are really an equivalent of caput succedaneum.
Figure 4.4. "Blisters" of the skin following prolonged labor over a caput succedaneum in an infant at the age of 1 day following prolonged labor. Aspiration of the material was sterile.
Figure 4.5. A large caput (chignon) following vacuum extractor delivery. The word "chignon" refers to the localized area of scalp edema caused by the suction of the cup of the vacuum extractor. Most cases resolve spontaneously but if associated widi perinatal asphyxia there may be necrosis of the chignon leading to ulceration of die scalp.
Figure 4.6. "Caput ring." In rare cases with persistent strong contractions and a slowly dilating cervix, necrosis of die scalp may occur in the area of a caput due to pressure ischemia occurring during a prolonged labor.
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