Birth Injuries

Subject: Midwifery III (Theory)

Overview

The passage of the fetus via the narrow birth canal may necessitate the use of a tool and may result in minor or severe birth trauma. Among newborns with serious injuries, a few may have still births, a few may die during the first week of life, and the remainder of the babies who survive may be intellectually impaired. Injuries to the head, intracranial damage, and hemorrhage are the most common types of injuries. Preterm babies are more vulnerable to brain damage and hemorrhage due to a lack of protection provided by their fragile skull bones and wide sutures, as well as the delicate nature of the cerebral veins and tissue. Treatment and treatment include using an incubator nursery to deliver oxygen and maintain temperature and humidity, feeding through a nasogastric tube, and monitoring fluid balance.

The fetus travels through the narrow birth canal, which occasionally necessitates the use of an instrument and can result in minor or severe birth injuries. Among newborns with serious injuries, a few may have stillbirths, a few may die during the first week of life, and the remainder of the babies who survive may be mentally impaired.

Predisposing factors

  • Pregnant woman
  • Maternal pelvic abnormalities, cephalopelvic disproportion, and reduced maternal stature
  • Extensive or brief labor
  • Deep, transverse stoppage of the presenting section of the fetus's descent
  • Oligohydramnios
  • Atypical presentation (breech)
  • Use of forceps in the mid cavity or vacuum extraction
  • Extractions and versions
  • Infants born with low birth weight or with extreme preterm
  • Macrosomia details
  • Fetal abnormalities with a large fetal head

Types of injuries

  1. Injuries to the head
  2. Intracranial injury and hemorrhage

The delicate organs of the body are the meninges, brain, and big cerebral vein. These essential organs are protected by the skull bone. During labor, the fetus travels via a small birth canal. The form of the skull may change as a result of excessive or rapid compression of the fetal head during delivery.

Causes

  • Preterm babies are more vulnerable to brain damage and hemorrhage due to a lack of protection provided by their fragile skull bones and broad sutures, as well as the delicacy of the cerebral veins and tissue.
  • Trauma: Compression and stretching in molding cause trauma.
    • Excessive fetal head compression is caused by a constricted pelvis, occipital—posterior posture, and a big infant.
    • Breech delivery, as well as rapid compressions of the fetal head, hasten labor.
    • As in breech delivery, there is an upward compression as well as a face presentation.
  • Delivered as a tool.

Clinical features

  • Baby is unable to breathe on his own.
  • In severe situations, the newborn is startled during birth, and his or her eyeballs roll upward.
  • The trunk and limbs may be rigid, with the hand clenched, and limpness is prevalent. A darting adder, similar to a tongue movement, is noticed.
  • Difficult grunting expiration after most owing to mucous express. When apnea and cyanosis attack, the breathing becomes shallow, fast, and erratic.
  • Worried and apprehensive expression, eyes wide open for an extended amount of time beginning with a knowing look, sunken eyes, inflexible neck, and spongy fontanel.

Treatment and management

  • The baby should be nursed in a calm, warm, and well-ventilated environment.
  • Maintain airway cleanliness by sucking promptly after birth to eliminate the secretion that occludes the throat.
  • It is recommended to use an incubator nursery to deliver oxygen while also maintaining temperature and humidity.
  • If the infant's respiration fails, cover him or her properly and maintain him or her on one side rotates.
  • Bathing, weighing, and measuring the newborn should all be avoided since they may cause convulsions.
  • Feeding through a nasogastric tube is preferable; the fluid balance must be maintained if necessary via a parenteral route.
  • To avoid additional bleeding caused by hypoprothrombinemia, provide 1mg of vitamin K intravenously.
  • Antibiotics will be given as needed as a preventative measure.
  • Anticonvulsant medication may be required to avoid convulsions.
  • If an extensive hematoma forms, a subdural hematoma can be aspirated through the lateral angles of the anterior fontanelle. A clot may require surgical removal.
Things to remember
  • The fetus passes through the narrow birth canal, which occasionally necessitates the use of an instrument and can result in minor or severe birth injuries.
  • Among newborns with serious injuries, a few may have stillbirths, a few may die during the first week of life, and the remainder of the babies who survive may be mentally impaired.
  • Prima gravida, Cephalopelvic disproportion, small maternal stature, maternal pelvic abnormalities, prolonged or quick labor, deep, transverse arrest of descent of the presenting part of the fetus, Oligohydramnios, Versions and extractions, and Fetal macrosomia are all risk factors for damage.
  • Injuries to the head, intracranial damage, and hemorrhage are examples of injuries.
  • Preterm babies are more vulnerable to brain damage and hemorrhage due to a lack of protection provided by their fragile skull bones and broad sutures, as well as the delicacy of the cerebral veins and tissue.
  • Treatment and maintenance include using an incubator nursery to deliver oxygen and control temperature and humidity, feeding through a nasogastric tube, maintaining fluid balance, and administering medication via a parenteral route if necessary.
  • Anticonvulsant medication may be required to avoid convulsions.
Questions and Answers

When a fetus needs to be delivered with an instrument because the birth canal is so tiny, it could result in minor or major birth trauma. A small percentage of newborns with serious injuries may suffer stillbirths, a smaller percentage may pass away during the first week of life, and the remainder of the babies who survive may have mental retardation.

Factors Predisposing to Injury Include the Following:

  • Primary pregnancy
  • Maternal pelvic abnormalities, short stature, and cephalopelvic disproportion.
  • Fast or prolonged labor
  • The presenting portion of the fetus' descent was stopped deeply and transversally.
  • Oligohydramnios.
  • Strange presentation (breech).
  • Use of vacuum extraction or mid-cavity forceps.
  • Extractions and versions.
  • Severe prematurity or an infant with a very low birth weight.
  • Macrosomia fetal.
  • Enormous fetal head
  • Abnormalities in fetuses.

Treatment and Management Includes

  • The baby should be nursed in a calm, cozy, and airy environment.
  • Maintain the cleanliness of the airway and suction as soon as the baby is born to eliminate any secretions that may be obstructing the pharynx.
  • It is best to use an incubator nursery to maintain the temperature and humidity while supplying oxygen.
  • If breathing fails, properly wrap the baby and keep them facing one way.
  • Limit how much you handle the infant; avoid bathing, weighing, and measuring because doing so could create convulsions.
  • Feeding using a nasogastric tube is advised; fluid balance must be maintained. Parenteral feeding may also be essential.
  • In order to stop further bleeding caused by hypoprothrombinemia, provide 1 mg of vitamin K intravenously.
  • Antibiotics for prevention should be given as needed.
  • Convulsion may require the use of an anticonvulsant.
  • If there is an excessive amount of hematoma, it might be aspirated through the lateral angles of the anterior fontanelle. A clot might need to be surgically removed.

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