Content:

At birth, children can receive birth trauma - serious damage to organs and tissues. They also include a holistic response of the body to these disorders. No one is immune from them, but if there is such a threat, doctors do everything possible to prevent any, even the slightest, injury to the baby. However, the delivery process until the very end is unpredictable and can go completely differently than planned. That is why, even with modern medical technology and highly qualified doctors, the percentage of birth injuries is quite high. This is explained by a variety of factors.

Too much when a baby is born is completely unpredictable. The organisms of the mother and the child can behave differently, and medical omissions are not excluded. The reasons can be both external and internal factors. According to statistics, birth trauma in newborns is due to the following indicators.

"Maternal" factors:

• early or late age of a woman;
• hyperactivity, uterine hypoplasia,
• preeclampsia;
• narrow pelvis;
• cardiovascular, gynecological, endocrine diseases;
• occupational hazards (if a woman, for example, worked in the chemical industry);
• post-term pregnancy.

Fetal pathologies:

• large sizes;
• prematurity;
• abnormal (with a reversal) position of the fetus;
• asphyxia;
• asynclitic (incorrect) or extensor insertion of the head.

Abnormalities of labor:

• protracted labor;
• discoordinated or strong, as well as weak labor.

Obstetrics errors:

• rotation of the fetus on the leg;
• the use of forceps (this is the main cause of birth trauma to the central nervous system in children, since not only the baby's limb is often damaged, but also the spine with the spinal cord);
• vacuum extraction of the fetus;
• C-section.

Very often, birth trauma of newborns is caused by a combination of several unfavorable factors at once, which disrupt the normal course of labor. As a result of an undesirable set of circumstances, some internal organs or vital functions of the fetus are disrupted, and in varying degrees... Some of them are so serious that they are diagnosed immediately. However, in some cases, they can manifest themselves only over time.

According to statistics... In Russia, according to statistics, 18% of births end with injuries to the baby. But, given the problems of diagnostics in maternity hospitals, statisticians assure that the official figure is significantly underestimated.

Signs

In hospitals, childbirth injuries are diagnosed in a child only when their signs are literally visible to the naked eye and represent open injuries of a mechanical nature:

• fractures;
• breaks;
• tears;
• dislocations;
• hemorrhages (hematomas);
• compression.

Since birth injuries in children require, in some cases, a forensic prosecutor's investigation due to the detection of medical errors, neonatologists and pediatricians are not very active in diagnosing them. Therefore, most often the symptoms are detected after discharge from the hospital and are explained by pathologies. intrauterine development or improper care of a newborn in the first days of his life.

Symptoms of soft tissue damage:

• scratches, petechiae (punctate hemorrhages), abrasions, ecchymosis (bruises);
• tumors;
• absence, its painlessness, is often accompanied by jaundice and anemia.

Signs of injury to the skeletal system:

• swelling and swelling;
• inability to perform active movements with the injured limb;
• pain syndrome, due to which the child often cries a lot;
• the main signs of intracranial birth trauma are muscle weakness, temperature drops, attacks of suffocation, uncoordinated movements of the limbs, their trembling, convulsions, spontaneous eye movement, bulging fontanelle, drowsiness, weak cry;
• deformities, shortening of the limbs.

Symptoms of trauma to internal organs:

• bloating;
• , atony;
• depressed physiological reflexes;
• constant profuse regurgitation;
• arterial hypotension;
• vomit.

Signs of CNS disorders:

• lethargy, areflexia;
• muscle hypotension;
• weak cry;
• diaphragmatic breathing;
• vegetative disorders: sweating, vasomotor reactions;
• shortness of breath, cyanosis, swelling of the chest;
• congestive pneumonia;
• asymmetry of the face, mouth;
• displacement of the eyeball;
• difficulty in sucking.

Most of the symptoms of birth trauma in a baby do not appear immediately, but only 4-5 days after birth. It often happens that the mother writes off the lethargy and drowsiness for the usual state of the crumbs, and in the meantime, there is damage to any internal organ. It is possible to make the correct diagnosis only after a comprehensive examination and passing the appropriate tests. They will depend on the type of birth injury.

On a string to the world... The charming crooked smile of Hollywood actor Sylvester Stallone is nothing more than a consequence of a serious birth injury. As well as a severe speech defect, which the artist had to get rid of for a long time.

Kinds

Depending on the cause and nature of the injury, there are various types of birth trauma, the main classifications of which are two.

Classification # 1 (for reasons)

1. If the provoking factors were precisely intrauterine pathologies and fetal abnormalities, a neonatal birth trauma in a child is diagnosed. In some cases, it can be prevented if it is detected in advance by means of ultrasound.
2. Spontaneous trauma occurs during normal labor.
3. Obstetric trauma is caused by certain physical actions, manipulations of the doctor.

Classification No. 2 (for damage)

1. Damage to soft tissues: skin, muscles, subcutaneous tissue, tumor, cephalohematoma.

2. Injury to the osteoarticular system: fractures, cracks of the clavicle, femur, humerus, epiphysiolysis of the shoulder, subluxation of the joints, damage to the bones of the skull.

3. Disorders in the work of internal organs: hemorrhages in the liver, adrenal glands, spleen.

4. Birth trauma CNS:

• more often than others, intracranial birth trauma is diagnosed, since the soft bones of the skull cannot withstand the compression and pressure of the birth canal;
• spinal cord
• peripheral nervous system(Duchenne-Erb paralysis, Dejerine-Klumpke, paresis of the diaphragm, facial nerve).

Each of the injuries is dangerous for the baby's life and does not go away without consequences. Particularly often diagnosed with a birth trauma to the head, which paves the way for the entire body and is thus crushed or broken. The result is a dysfunction of the central nervous system, which is practically not amenable to treatment. Much less often, such cases occur with a cesarean section, but it does not guarantee 100% safe removal of the baby from the mother's womb.

Facts... In 90% of women who have children with cerebral palsy, delivery was artificially induced or accelerated.

Is a cesarean section a salvation?

According to statistics, birth injuries during cesarean section are rare, but not excluded. It seems that with a planned, well-thought-out operation, any surprises can be avoided, but nature makes its own adjustments here too. Doctors explain this by various factors:

1. Strong compression of the child during the passage of the birth canal starts the work of his cardiovascular and respiratory systems. With cesarean, this mechanism is absent, the restructuring of the body for functioning outside the uterus occurs in other, unnatural ways, which further affects the development of the child's central nervous system.
2. Themselves can lead to birth injuries.
3. The technique of the operation does not exclude mechanical damage to the fetus.

So in children even after cesarean doctors diagnose cranial injuries, displacement of several cervical vertebrae at once, retinal hemorrhages and other injuries. Those young mothers who deliberately insist on the operation in the absence of medical indications for it should understand that it is not always possible to protect the baby from injury in this way.

Keep in mind! With a caesarean section, the doctor makes a 25 cm long transverse incision in the uterus. And the average circumference of the shoulders in most babies is at least 35 cm. Accordingly, obstetricians have to make an effort to remove them. Therefore, birth trauma of the cervical spine is so common in children born through this operation.

Care

Young mothers should keep in mind the peculiarities of caring for children who have suffered a birth trauma in order to minimize its negative consequences. Treatment is very diverse, as it depends on the type of damage, the degree of their severity, aggravating factors. If the injury is very serious, and the woman does not have a medical education, nurses are often invited, who know how to professionally care for such children.

If the skeletal system (limbs) is damaged

1. No special care required.
2. Constant observation by the local pediatrician.
3. Surgeon's control in the first 2 months of the baby's life.
4. Exclude re-damage to the bone.
5. 2 weeks after giving birth, an X-ray is taken and a conclusion is made about the bone fusion.

Spine injury

1. Regular exercise therapy classes.
2. Continuous dispensary observation.
3. Therapeutic and prophylactic massage.
4. Spinal cord injury is very dangerous, but with proper care, babies live a long time: you need to take measures to prevent pressure ulcers, carry out constant treatment of the urinary system and various infections, and periodically take the child for examinations to detect uropathy.

In case of soft tissue injury

1. Leaving is not difficult.
2. An exception breastfeeding within 3-5 days. They are given expressed milk to drink.
3. Abrasions are treated with a brilliant green solution.
4. Complete rest.
5. Control of external symptoms birth trauma.

Internal organ damage

1. Syndrome treatment.
2. Constant supervision of a pediatrician.

Intracranial injury

1. Sparing regime.
2. In case of a serious condition, the child should be in the incubator (specially equipped incubator).
3. In the presence of convulsions, respiratory failure, asphyxia, any movement of the child is excluded. It will be necessary to provide him with maximum immobility.
4. Skin processing, feeding, swaddling are done in the crib.
5. Any head injury during childbirth (both internal and external) involves spoon or pipette feeding, possibly tube feeding.

Massage

Exercise therapy and therapeutic massage are of great importance for injuries of the spine and limbs, cerebral palsy. They strengthen weakened muscles, improve blood circulation and metabolic processes in the affected area, restore coordination of movements, fight limitation of mobility or curvature of the spine, and have a general strengthening effect on the body. Parents of affected babies should know the features of baby massage for birth injuries and learn it in order to help the baby at home.

1. For the procedure, heated oils are used (preferably olive or fir).
2. To relax damaged or atrophied muscles, stroking, felting, shaking, light vibration are used.
3. To stimulate them - planing, deep stroking, kneading, rubbing with weights, shading.
4. The techniques of tapping and squeezing are strictly prohibited.
5. The massage is performed on the back, neck area, arms (starting from the shoulder), legs (starting from the hip), chest, and abdomen.
6. The duration of the procedure is from 5 to 15 minutes.
7. The course includes 20-35 sessions.
8. 4 to 6 courses are required per year.
9. In addition to the classic one, segmental or acupressure massage can be prescribed.

If the damage is serious and entailed irreversible consequences, the child needs professional care, in particular, a birth brain injury requires neurosurgical care in a hospital. The period in the first 1-5 months of a baby's life is especially difficult. If he was provided with timely, competent help from doctors, proper care from parents, the body will recover as much as possible and return to normal, as much as possible. However, a lot here depends on the severity of the deviation. For example, a birth injury to the neck of a newborn without CNS damage can be completely neutralized. But if the nerve endings are damaged, the consequences cannot be avoided even with full care.

On a note... The use of any stimulants during childbirth (prostaglandins, kelp, antiprogestogens, cans, oxytocin), as well as a puncture of the bladder, often leads to damage to the baby's central nervous system. Moreover, in 90% of cases, it is not detected at the time of delivery, but is diagnosed by a neurologist later.

Consequences

Complications and consequences of birth trauma are of varying degrees. With timely diagnosis, professional treatment and proper care, they can be avoided. But some processes turn out to be irreversible and significantly affect the functioning of the brain, while threatening not only health, but also the life of the baby. The most common and severe consequences are called:

• - dropsy of the brain;
• intracranial pressure surges;
• retardation in mental and physical development, cerebral palsy (these are the most frequent and dangerous consequences of a birth traumatic brain injury, when the child's central nervous system is damaged);
• decrease or complete absence of some reflexes;
• to whom;
• fatal outcome;
• limb spasms;
• tachycardia;
• muscle atrophy;
• enuresis;
• hyperactivity, rapid excitability, increased nervousness;
• paralysis;
• diseases: bronchial asthma, food allergies, eczema, neurodermatitis, deformation of the spinal column (this is most often caused by birth trauma of the spine), paresis, disturbances in the work of the cardiovascular system.

Parents of babies with birth trauma should be extremely attentive to such babies and be patient as much as possible. If the lesions of the central nervous system are superficial and are not accompanied by total changes in the work of the brain and spinal cord, recovery is possible with complex treatment and careful care. Despite this, many of these babies in the future - 95% delay in mental, motor, speech development, muscle tone disorders. The consequences of birth trauma are often very, very distant.

For your information... Early clamping of the umbilical cord is one of the causes of encephalopathy and mental retardation in children.

Prophylaxis

To avoid such negative and very life-threatening consequences for the baby, prevention of birth injuries is carried out even in the neonatal period by both parents and doctors:

• planning conception and pregnancy in advance;
• timely treatment of diseases in both parents;
• a healthy lifestyle for the mother during pregnancy;
• full, balanced nutrition of a woman;
• instant elimination of infections picked up during pregnancy;
• receiving professional medical care;
• regular consultations with a gynecologist.

Doctors should take into account during childbirth any pathologies and abnormalities in the development of the fetus, identified during pregnancy. This greatly reduces the risk of injury to the baby. Professionalism and competent, well-coordinated actions of obstetricians in case of any deviation that has arisen is a guarantee of a safe, successful delivery.

- various damage to the fetus arising in the process of childbirth. Among birth traumas of newborns, there are injuries of soft tissues (skin, subcutaneous tissue, muscles), skeletal system, internal organs, central and peripheral nervous system. Birth trauma of newborns is diagnosed taking into account the obstetric and gynecological history of the mother, the characteristics of the course of labor, examination data of the newborn and additional studies (EEG, ultrasound, radiography, ophthalmoscopy, etc.). Treatment of birth injuries of newborns is carried out differentially, taking into account the type and severity of the injury.

General information

The birth trauma of newborns is understood as a violation of the integrity of the tissues or organs of the child, due to the mechanical forces acting during childbirth. Birth injuries are diagnosed in 8-11% of newborns. Birth trauma of newborns is often combined with birth trauma to the mother (ruptures of the vulva, vagina, perineum, uterus, urogenital and vaginal-rectal fistulas, etc.). Birth trauma of newborns can have a serious impact on the further physical health and intellectual development of the child. All this makes birth traumatism one of the most pressing problems of obstetrics and gynecology, neonatology and pediatrics, pediatric neurology and traumatology.

Classification of birth injuries of newborns

Depending on the location of the damage and the predominant dysfunction, the following types of birth trauma of newborns are distinguished:

1. Birth trauma of soft tissues(skin, subcutaneous tissue, muscles, birth tumor, cephalohematoma).

2. Birth injuries of the osteoarticular system(cracks and fractures of the clavicle, humerus and femur; traumatic epiphyseolysis of the humerus, subluxation of the C1 and C2 joints, damage to the bones of the skull, etc.).

3. Birth trauma of internal organs(hemorrhages in internal organs: liver, spleen, adrenal glands).

4. Birth trauma of the central and peripheral nervous system in newborns:

• intracranial birth injury (epidural, subdural, subarachnoid, intraventricular hemorrhage)
• birth trauma of the spinal cord (hemorrhage in the spinal cord and its membranes)
• birth injury of the peripheral nervous system (damage to the brachial plexus - Duchenne-Erb paresis / paralysis or Dejerine-Klumpke paralysis, total paralysis, diaphragm paresis, facial nerve damage, etc.).

Causes

Analysis of the causes of birth trauma in newborns allows us to distinguish three groups of factors that increase the likelihood of its occurrence: related to the mother, to the fetus, as well as to the course and management of childbirth.

Predisposing "maternal" factors can be early or late reproductive age, gestosis, a narrow pelvis, hypoplasia or hyperactivity of the uterus, diseases of a pregnant woman (cardiovascular, endocrine, gynecological, etc.), post-term pregnancy, occupational hazards, etc.

The most extensive group of causes leading to birth trauma of newborns are the circumstances associated with the fetus. Pelvic presentation of the fetus, oligohydramnios, abnormal (asynclitic or extensor insertion of the head), prematurity, large fetal size, fetal malformations, intrauterine hypoxia and asphyxia, etc. can provoke birth trauma.

Anomalies of labor can lead to a birth trauma of a newborn: prolonged or rapid labor, delivery with weak labor, uncoordinated or excessively strong labor. A serious group of causes of birth trauma of newborns is the incorrect or unreasonable use of obstetric benefits (turning the fetus on the leg, applying obstetric forceps, using a vacuum extractor, caesarean section and etc.).

As a rule, when birth trauma occurs in newborns, there is a combination of a number of unfavorable factors that disrupt the normal biomechanics of childbirth.

Different types of newborn injuries

Birth injuries of soft tissues

The most common manifestations of birth trauma in newborns are damage to the skin and subcutaneous tissue. These include scratches, abrasions, petechiae, ecchymosis on various parts of the body. Such damage is detected by visual examination of the newborn by a neonatologist; they are usually not dangerous and only require local antiseptic treatment and aseptic dressing. Minor birth injuries of soft tissues disappear by the end of the first week of a newborn's life.

A type of birth trauma of newborns is a birth tumor, which is characterized by local swelling of the soft tissues of the head. The generic tumor has a soft-elastic consistency, bluish color with multiple petechiae and ecchymosis. Its occurrence is usually associated with prolonged labor in the cephalic presentation or the imposition of obstetric forceps. A generic tumor does not require treatment; it disappears on its own in 1-3 days.

A more severe type of birth trauma of newborns is damage (hemorrhage, rupture) of the sternocleidomastoid muscle, usually its lower third. In this case, a small tumor of moderately dense or doughy consistency is determined at the site of injury. Damage to the sternocleidomastoid muscle may not be detected immediately, but after about a week, when the child develops torticollis. In the treatment of birth trauma of the sternocleidomastoid muscle in newborns, corrective head position using rollers, dry heat, electrophoresis of potassium iodide, massage are used; if ineffective - surgical correction.

Cephalohematoma, as a type of birth trauma of newborns, is characterized by hemorrhage under the periosteum of the parietal or occipital bones of the skull. Typical signs of cephalohematoma are elastic consistency, absence of pulsation, painlessness, fluctuation, presence of a roller along the periphery. In the future, newborns with cephalohematoma may experience jaundice caused by increased extravascular bilirubin production. Cephalohematoma decreases in size by 2-3 weeks of life, and completely resolves by the end of 6-8 weeks. Complications of subperiosteal birth trauma of newborns include anemia, calcification and suppuration of cephalohematoma. Children with large (more than 6 cm in diameter) cephalohematomas need an x-ray of the skull to exclude bone fractures. Since cephalohematomas in premature infants are often associated with intrauterine mycoplasmosis, PCR or ELISA diagnostics are required.

In most cases, birth injuries of soft tissues in newborns go away without consequences.

Birth injuries of the skeletal system

Among birth injuries of the osteoarticular system in newborns, damage to the clavicle and bones of the limbs is more common. They always refer to purely obstetric types of injuries. Subperiosteal fractures of the clavicle without displacement are usually detected 3-4 days after delivery by the presence of a spindle-shaped dense swelling - forming callus. A displaced clavicle fracture is accompanied by the inability to perform active movements, pain, crying with passive arm movement, swelling and crepitus over the fracture site.

A type of birth trauma to the skeletal system of newborns is traumatic epiphyseolysis of the humerus. Its manifestations are soreness, swelling and crepitus in the area of ​​the shoulder or elbow joints, limitation of the range of motion in the affected arm. The outcome of such an injury may be paresis of the radial nerve, the formation of flexion contracture in the joints. Treatment consists of limb immobilization, physiotherapy, massage.

Birth trauma to internal organs

Damage to internal organs occurs as a result of mechanical impact on the fetus during an abnormal course of childbirth. The most common hemorrhages are in the liver, spleen and adrenal glands. Clinical manifestations of birth trauma of internal organs in newborns develop on the 3-5th day due to internal bleeding. When a hematoma ruptures, bloating occurs, intestinal paresis, muscle hypotension (or atony), inhibition of physiological reflexes, arterial hypotension, persistent regurgitation and vomiting develop.

If there is a suspicion of a birth trauma to the internal organs of the newborn, an overview X-ray of the abdominal cavity, ultrasound of the abdominal organs and ultrasound of the adrenal glands are performed. Treatment consists in carrying out hemostatic and symptomatic therapy; if necessary - laparoscopy or laparotomy with revision of internal organs.

With hemorrhage into the adrenal glands, the child may develop acute or chronic adrenal insufficiency. The prognosis for birth trauma of internal organs in newborns is determined by the volume and severity of the lesion, the timeliness of detecting the damage.

Birth trauma of the central and peripheral nervous system

Injuries to the nervous system in newborns constitute the most extensive group of birth injuries. Within the framework of this review, we will focus on the birth trauma of the spinal cord and peripheral nervous system; detailed characteristics of intracranial birth injuries of newborns will be given in the corresponding article.

Spinal cord birth injuries in newborns can include hemorrhage, sprain, compression or rupture of the spinal cord at various levels, associated with or without a fracture of the spine. Severe injuries are characterized by the clinic of spinal shock: lethargy, muscle hypotonia, areflexia, weak cry, diaphragmatic breathing. The death of children can occur from respiratory failure. In more favorable cases, there is a gradual regression of the phenomena of spinal shock; hypotension is replaced by spasticity; vegetative disorders (vasomotor reactions, sweating), trophic changes in muscle and bone tissue develop. Mild birth injuries in newborns are accompanied by transient neurological symptoms: changes in muscle tone, reflex and motor reactions.

The diagnosis is facilitated by examination of the child by a pediatric neurologist, X-ray or MRI of the spine, electromyography, lumbar puncture and examination of cerebrospinal fluid. Treatment of birth trauma of the spinal cord in newborns includes immobilization of the damaged area, dehydration and antihemorrhagic therapy, rehabilitation measures (orthopedic massage, exercise therapy, electrical stimulation, physiotherapy).

Birth injuries of the peripheral nervous system in newborns combine damage to the roots, plexuses, peripheral and cranial nerves.

Taking into account the localization of paresis of the brachial plexus (obstetric paresis), it can be superior (proximal), inferior (distal) or total. Upper Duchenne-Erb paresis is associated with damage to the plexuses and roots, originating in the C5-C6 segments, which is accompanied by dysfunction of the proximal upper limb. In this case, the child assumes a characteristic position with the hand brought to the body, unbent at the elbow joint, turned inward at the shoulder and pronated into the forearm; bent in the palm of the hand and head bent to the sore shoulder.

With the lower obstetric paresis of Dejerine-Klumpke, plexuses or roots, originating from C7-T1, are affected, resulting in a dysfunction of the distal part of the hand. Manifestations include muscle hypotonia, hypesthesia, limitation of movement in the wrist and elbow joints, fingers, and the symptom of a “clawed paw”. With a total type of obstetric paresis, the hand is completely inactive, muscle hypotonia is sharply expressed, and muscle atrophy develops early.

The diagnosis and localization of damage is clarified using electromyography. Treatment of birth trauma of the brachial plexus in newborns consists in the immobilization of the hand with a splint, massage, exercise therapy, physiotherapy (applications of ozokerite, paraffin, electrical stimulation, electrophoresis), drug therapy.

With paresis of the diaphragm, the newborn develops shortness of breath, paradoxical breathing, cyanosis, swelling of the chest on the affected side. The detection of paresis is facilitated by fluoroscopy and chest x-ray, in which the high standing and inactivity of the dome of the diaphragm is determined. Against this background, children may develop congestive pneumonia. Treatment of a birth injury consists of percutaneous stimulation of the phrenic nerve; if necessary - mechanical ventilation until adequate spontaneous breathing is restored.

Facial nerve paresis is associated with damage to the trunk or branches of the facial nerve. In this case, the child has facial asymmetry, lagophthalmos, upward displacement of the eyeball when screaming, asymmetry of the mouth, difficulty in sucking. Birth trauma in newborns is diagnosed on the basis of clinical signs, electroneurography, recording of evoked potentials. Often, paresis of the facial nerve goes away without special treatment; in other cases, thermotherapy, drug therapy is carried out.

More rare types of birth trauma of newborns include injuries of the pharyngeal, median, radial, sciatic, peroneal nerves, and lumbosacral plexus.

Prophylaxis

Prevention of birth injuries in newborns involves assessing the risk of their occurrence even at the stage of pregnancy, the most careful attitude to the child during childbirth, and refusal to use unjustified benefits for fetal extraction and operative delivery.

Childbirth does not always go well for both the mother and the baby. For various reasons, during the delivery process, birth trauma of newborns can occur - damage to the spine (more often the cervical spine), head, bones, internal organs. Diagnosis and treatment of pathologies such as birth trauma of newborns must be timely and adequate. Otherwise, the consequences can become very serious - from problems with intelligence and physical disability to the death of a child.

In obstetric practice, the trauma of a newborn in childbirth is understood as a violation of the integrity of the organs, tissues, skeleton of the child, which is caused by the influence of mechanical forces. Perinatal pathology is widespread and very urgent problem: injuries of varying severity are diagnosed in 11% of babies born. In 50% of cases, they are combined with injuries to the mother during childbirth, including rupture of the genitals, the formation of fistulas.

Classification of birth injuries

Conventionally, all traumatic injuries of a child in childbirth are divided into:

• mechanical (due to external influences);
• hypoxic (due to mechanical influence, the child develops hypoxia, asphyxia, which cause injury to the central nervous system).

In newborns, birth trauma can affect different areas of the body. Depending on its localization, there is such a classification:

1. Injury to bones, joints. This includes all cracks, fractures of the femur, clavicle, humerus, head bones, etc.
2. Soft tissue injury. These are damage to the skin, muscles, the appearance of generic tumors, cephalohematomas.
3. Internal trauma. The group includes hemorrhages in any organs of the peritoneum.
4. Injury to the nervous system, or any damage to the nerve trunks, brain, spinal cord.

The latter group is subdivided into the following types of neonatal trauma during childbirth:

• intracranial birth injury;
• trauma to the peripheral nervous system;
• spinal cord injury.

Intracranial birth trauma includes subdural, intraventricular, subarachnoid, epidural hemorrhages.

In addition, it is customary to differentiate the types of birth trauma according to the degree of responsibility of the obstetric service:

1. Spontaneous. Occurs in complicated or routine childbirth due to circumstances beyond the control of the doctor.
2. Obstetric. It appears due to the actions of the midwife, including the correct ones.

Causes of birth trauma

In many respects, birth traumatism is due to the fact that a pregnant woman belongs to a risk group for one or another indicator. Thus, age has a significant effect on the outcome of childbirth. future mother... The optimal age for the first delivery is 20-25 years, since such women have much less chronic diseases and a history of abortions. The consequences of childbirth can be associated with trauma to the mother and baby if they occur over the age of 30 (for repeated pregnancies- over 35 years old).

Perinatal pathology occurs more often in the presence of such risk factors:

• improper placement of the fetus during childbirth;
• clinically, anatomically narrow pelvis of the mother;
• large fetus, or low weight of its body;
• intrauterine oxygen starvation of the fetus;
• premature, premature fetus;
• weakness of labor;
• rapid childbirth;
• fetal malformations such as hydrocephalus;
• a history of bone injuries in a pregnant woman.

Mother's diseases - pathologies of the heart, blood vessels, diabetes mellitus, gynecological disorders, as well as complications of the course of pregnancy (gestosis, polyhydramnios, placental abruption) also negatively affect the nature of childbirth. Birth trauma to newborns often occurs due to the unjustified use of obstetric instruments and benefits (emergency caesarean section, forceps, etc.). Usually, serious damage to the fetus (for example, severe intracranial birth trauma) appears when several adverse factors are combined that can cause disruptions in the biomechanics of the delivery.

The immediate cause of mechanical birth trauma is a difficult rotation of the fetus, its extraction with the help of a vacuum, forceps. Hypoxic injuries occur if there is suffocation (acute end of oxygen supply) or prolonged oxygen starvation of the baby with the accumulation of carbon dioxide in his tissues. Their causes are associated with the tightening of the umbilical cord knot, the accumulation of mucus in the mouth, the sinking of the tongue, which is recorded against the background of abnormalities in the labor process as a result of abnormalities in labor or the actions of a midwife.

Birth injuries during cesarean section are diagnosed three times more often than during natural childbirth. This is mainly due to the "can effect": when the baby is artificially removed from the uterus, negative intrauterine pressure is formed behind its body. As a result, the created vacuum interferes with the normal exit of the child, and the surgeon has to make significant efforts to pull the newborn out. As a result, injuries to the cervical spine are common, especially in premature babies with weakened bones and ligaments.

Symptoms of birth trauma in newborns

Immediately after birth, the clinical picture of perinatal pathology can be very different from that after a certain period of time. The following are the main signs of injury by type that a neonatologist detects as a result of the first examination of a child.

Soft tissue injuries

They are damage to the subcutaneous tissue, skin and muscles. These include a variety of abrasions, hemorrhages, and most of them are not dangerous and heal quickly after local treatment. The consequences for the child may be more severe if the muscles are injured. Most often, birth traumatism affects the sternocleidomastoid muscle, in which a rupture of fibers can occur. Symptoms of pathology are the appearance of a hematoma in the affected area, as well as a seal, which is sharply painful when palpating. Sometimes these signs appear only after the child is discharged from the hospital, and in this case they are almost always accompanied by deviations in the normal position of the neck (torticollis, or tilting the head in the direction where the muscle is torn).

Another type of soft tissue injury is cephalagematoma. It is an outpouring of blood under the periosteum of the head bone (usually parietal). It is necessary to distinguish this pathology from a generic tumor - edema of the skin and the tissue located under it, which occurs due to strong compression of the area. Both types of pathologies are similar on their own, so the child does not need therapy.

Skeletal injury

Most often, there are lesions of the cervical spine, which are associated with mechanical overload during childbirth. The vertebrae of the cervical spine are the most fragile and therefore quite vulnerable. The most common neck injuries are:

• excessive stretching;
• impacted subluxations;
• twisting of the head, neck.

True dislocations are extremely rare, and babies with such a pathology die almost immediately. Among the injuries to the joints and bones, fractures are also observed (more often - a fracture of the clavicle without displacement, rarely - a fracture of the humerus, femur). Signs of a fracture:

• swelling;
• bruise;
• soreness in the affected area;
• limitation of limb mobility;
• crying of a child with passive movement of the arm, leg;
• lack of the necessary reflexes;
• shortening of the bone;
• deformation of the bone.

Usually, all the consequences of such injuries are reversible, so the child will not need dispensary supervision as he grows up.

Internal injuries

Such injuries are not common. In most cases, damage affects the liver, adrenal glands, and spleen. Hemorrhages in these organs do not manifest themselves for the first 2 days, but later there is a sudden deterioration in the baby's condition:

• ruptured hematoma;
• an increase in the area of ​​hemorrhage;
• anemia;
• malfunctions of the damaged organ;
• bloating;
• by ultrasound - the presence of fluid in the peritoneum;
• severe muscle hypotension;
• suppression of reflexes;
• bowel failure;
• lowering blood pressure;
• vomit.

The consequences and prognosis depend on the severity of the injury. If the newborn does not die immediately, then the prognosis will be determined by how much the injured organ has retained its functionality. For example, after damage to the adrenal glands, the child subsequently develops chronic insufficiency of these organs.

Nervous system injury

The most severe birth injury is considered to be damage to the central nervous system. Head injuries accompanied by intracranial hemorrhages, which are caused by mechanical stress and hypoxia, are especially life-threatening. The clinical picture largely depends on where the hemorrhage is localized and to what extent cerebral circulation is impaired. The main symptoms are:

• stupor;
• dilated eyes;
• stiff neck;
• suppression of reflexes;
• inability to suck, swallow;
• asthma attacks;
• convulsions;
• bulging fontanelles;
• tremor;
• oculomotor disorders;
• vomit;
• regurgitation;
• increased body temperature.

With an increase in hematoma and compression of various parts of the brain by it, all of the above symptoms become even more pronounced, and the newborn may fall into a coma. Usually, with a serious hemorrhage, the baby dies in the first days of life.

Another severe type of nervous system injury is spinal cord injury. All segments of the spine in a newborn are well extensible, but the brain located in their canal is fixed from below and from above, therefore it is less mobile. Most often, spinal cord injury is found in the lower cervical spine, or in the upper thoracic region. Sometimes the spinal cord can rupture when the integrity of the vertebrae is visible, which is very difficult to detect even during an X-ray examination. Symptoms of this type of perinatal pathology:

• weak cry;
• violation of reflexes;
• muscle hypotension;
• low physical activity;
• lethargy;
• distension of the bladder;
• respiratory disorders;
• violation of limb movements.

A child with severe spinal cord injury can die of respiratory failure, but often the pathology slowly regresses, and the baby's condition improves. In most cases, various neurological disorders persist during the first years or throughout life.

With injuries of the peripheral nervous system, nerve roots or nerve plexuses are damaged (more often - the facial, brachial, phrenic, median nerve). Symptoms are reduced to an abnormal position of the head, neck, limbs, limitation of spontaneous movements, muscle hypotension, lack of part of the reflexes, shortness of breath, cyanosis, chest swelling. If treatment is started immediately after birth, in most cases, recovery occurs. In case of bilateral phrenic nerve paresis, on the other hand, death is recorded in half of the cases.

In pediatric practice, there are many situations when the consequences of a birth trauma are discovered after the child is discharged or several months after birth. Symptoms of an injury can include:

• weak muscle tone, or hypertonicity;
• low activity;
• lack of movement in one of the limbs;
• twitching of arms, legs;
• inability to straighten limbs;
• frequent crying for no reason;
• weak sucking reflex;
• dumping food out of the mouth;
• constant regurgitation;
• pallor of the skin;
• sticking out the tongue;
• leakage of feces, urine;
• sleep with your head thrown back;
• non-observance of the skills regulated by the terms (does not sit, does not walk, etc.).

After a year of life, birth trauma can manifest itself in the following clinical picture: abnormal head size, frequent tantrums, crying, hyperactivity, lethargy, disruption of the musculoskeletal system, mental abnormalities, different lengths of limbs, convulsions, paresis. It should be remembered that only seeking help early will help a child become a full-fledged member of society or significantly improve his condition.

Consequences and complications of neonatal trauma

As a result of trauma, the child often dies in the first days after childbirth. If the baby survived, his future health is highly dependent on the severity of the injury and the adequacy of treatment. The consequences at an older age can manifest itself in the form of a lag behind the physical, mental development, allergies, diseases of the spine, enuresis, diseases of the ENT organs, increased intracranial pressure. The manifestations of the so-called psycho-organic syndrome are often diagnosed - intellectual disability, convulsions, neuroses, seizures, mental retardation, etc. Often these pathologies develop against the background of cerebral hydrocephalus.

Diagnosis of birth traumatism

Among the methods for detecting birth trauma, which are used both in the perinatal period (up to 7 days after birth) and in the first year of life and older:

• examination of the newborn;
• palpation of the head, neck, limbs;
• Ultrasound and radiography;
• MRI, CT;
• functional tests;
• consultations of narrow specialists.

Treatment of birth injuries of newborns

Skin injuries require treatment with local antiseptics (iodine, alcohol) to prevent infection. As a rule, minor injuries heal by 5-10 days after childbirth. Muscle ruptures and hematomas are treated by providing a corrective position for the child, eliminating the incorrect position of the limbs, head, neck, prescribing physiotherapy, massage, and administering various absorbable drugs. Sometimes in the first six months of life, an infant needs surgical correction of a birth injury to a muscle.

For fractures, the standard treatment is:

• immobilization of limbs with splints, Dezo bandages;
• tight swaddling;
• traction (traction);
• physiotherapy;
• massage.

Injury in childbirth of internal organs requires the treatment of each syndrome separately, as well as hemostatic therapy. If the adrenal glands are damaged, hormonal treatment is performed, and if the foci of hemorrhage rupture in any organ, urgent surgical intervention is necessary. In the future, the baby may need lifelong therapy with hormonal drugs, but often children feel satisfactory.

With brain damage, treatment methods can be as follows:

• subdural puncture for pumping blood out of the cerebral arteries;
• the use of absorbable, diuretic drugs;
• brain surgery (bypass surgery);
• antibiotic treatment (with the development of inflammation of the meninges).

With spinal cord injuries, treatment is reduced to immobilizing the affected area, anesthetic, dehydration therapy, to the introduction of hemostatic drugs, vitamins. After the removal of acute symptoms, physiotherapy, massage, gymnastics, wearing various orthotic devices, treatment with biostimulants, tissue regeneration accelerators, etc. are prescribed. Similar methods of therapy are recommended for the baby and for damage to the nerve trunks of the peripheral nervous system.

Prevention of birth trauma of newborns

Unfortunately, it is impossible to completely prevent birth injuries. But to reduce its likelihood, obstetricians should promptly identify pregnant women from risk groups for perinatal pathology, correctly apply various methods and manipulations during childbirth. It is advisable for a woman to plan a pregnancy before treatment or correction of chronic diseases, as well as to get registered on time for pregnancy.

The birth process of newborns is always associated with a certain risk. Any mistakes made by a doctor, or features of the female body cause consequences that significantly impair the quality adult life person. A birth trauma to the head causes many brain injuries.

Causes of damage

Traumatization occurs with mechanical stress during birth, as a result of which the structure of tissues is disrupted. In other words, they talk about such a phenomenon when newborns have injuries that have arisen during their birth. The doctor's mistakes do not always affect the likelihood of a birth injury. Often, injuries are formed due to an improper lifestyle of a pregnant woman, the structural features of the woman's pelvis, the position of the fetus, and for a number of other reasons.

Features of the structure of the head of a newborn

The structure of the head in newborns has several significant differences. This part of the body is the largest before birth. In most cases, the fetus moves with its head in front. As a result, she experiences maximum loads. She manages to maintain her previous shape due to two qualities:

• elasticity;
• elasticity.

The fontanelles influence the development of the first quality. These structures are cavities between the bones of the skull filled with a dense membrane. The latter is formed from the hard shell of the brain and periosteum. Newborns have four fontanelles.

The increased elasticity of the child's skull is also due to the structural features of the seams made of connective tissue. This structure provides a relatively free passage of the head through the birth canal. When the child's skull is under stress, it deforms slightly, while eliminating the likelihood of injury to tissues and the brain.

Birth trauma in newborns appears with strong squeezing. This effect leads to damage to the structural elements and tissues of the skull. After birth, the head remains deformed.

Risk factors

Such damage occurs under the influence of three specific factors. Let's consider them in more detail:

Extension of the head also leads to brain damage in newborns. More often the skull is injured under the influence of a group of factors. Development congenital abnormalities promotes a cesarean section performed before the onset of labor. When the fetus is forcibly removed, negative pressure is formed inside the uterus. To reach the child, the doctor has to make an effort. And if the position of the hands is unsuccessful, the likelihood of injury is high.

Clinical picture

There is a general classification of birth injuries. The latter are subdivided into:

In addition, birth injuries are usually classified into the following types:

1. Spontaneous. It occurs for reasons not attributable to the actions of the doctor.
2. Obstetric. The injury was caused by the mistaken actions of the doctor who delivered the baby.

The clinical picture depends on the location of the pathological disorders and their severity. Postpartum symptoms appear either immediately or after a certain time (sometimes even after several years).

The short-term effects of head trauma to a child are of the following types:

Congenital brain injuries include hemorrhages of various types. Head injury during labor often leads to the formation of intracranial hemorrhages. Because of this, brain functions are impaired, as indicated by:

As the condition worsens and the size of the intracranial hematoma increases, the child's mood changes: he constantly screams, is in an agitated state. In extreme cases, death is possible.

Recovering a newborn

It is possible to detect a skull injury in a newborn only after a comprehensive examination using ultrasound, MRI and other devices. The recovery of a child after such injuries is carried out mainly in a hospital setting, where children are provided with the most sparing regimen.

In the presence of small abrasions, the affected area is treated with a solution of brilliant green, and the child is prescribed antibiotics to prevent infection of the body (Amoxicillin). The same drugs are used for various edema.

Most often, cephalohematoma gradually resolves without medical intervention. The process takes about two months. In rare cases, ossification of the formation occurs, which leads to deformation of the child's skull. To prevent this, in severe cases, cephalohematomas are removed within the first 10 days of life. The procedure is carried out using two special needles. Subgaleneurotic hematomas are also removed through a small incision made in the scalp.

Surgical intervention is indicated if multiple fractures have been identified during head examination. During the operation, the doctor restores the shape of the skull by means of an elevator, which is inserted into the skull. Removal of blood clots is performed using a craniotomy. The procedure is indicated for multiple lesions. Craniotomy involves the phased removal of blood through punctures.

In order to avoid negative consequences in case of birth trauma to the head, the child is prescribed:

1. Compensatory therapy with the use of mechanical ventilation in the mode of moderate hyperventilation.
2. Decongestant therapy. The drugs are Dexamethasone, Furosemide, Euphyllin.
3. Hemostatic therapy. Dicinon is introduced.
4. Anticonvulsant therapy. Sibazon, Phenobarbital are prescribed.
5. Metabolic therapy. Piracetam, Curantil are used.

Possible consequences

Complications of birth trauma to the skull are of a varied nature. In the event of brain damage, the parents of the newborn may eventually face:

• lagging behind intellectual development child;
• neuroses;
• epilepsy.

With hydrocephalus, there is a gradual accumulation of cerebrospinal fluid in the ventricles of the brain. With such a pathology, the child's head circumference is actively increasing. Symptoms suggestive of hydrocephalus include:

In the future, there are frequent headaches and epileptic seizures. Hydrocephalus leads to a lag in intellectual development, which becomes noticeable after several years. This problem can be identified by the following criteria:

• aggressive or indecisive behavior;
• difficulties with adaptation in society;
• isolation;
• unsteady attention;
• problems remembering information;
• the child is late to start holding his head.

Birth trauma to the skull can lead to the development of oligophrenia, characterized by an inability to acquire new skills and a lack of critical thinking. The defeat of the central nervous system is complicated by the following pathologies:

Epilepsy is considered a severe consequence of birth trauma. It occurs against the background of oxygen starvation, which causes disruption of the work of brain cells. Seizures are a characteristic feature of epilepsy.

Cerebral palsy develops as a result of brain damage and is characterized by impaired motor and speech functions, developmental delay. It is possible to identify such a complication by the following symptoms:

• long preservation of primary reflexes;
• improper gait;
• speech problems;
• hearing and vision impairment;
• convulsions;
• mental retardation.

Often, such violations cause the appearance of:

• paralysis;
• muscle atrophy;
• headaches;
• limb spasms;
• dysfunction of the speech apparatus;
• delays in physical development.

Birth injuries are common. Due to head injuries, multiple complications occur, manifested in the form of a violation of intellectual and physical development, disorders of the central nervous system and others. Birth trauma can be fatal. To avoid the development of severe complications, the elimination of the consequences is carried out during the first days of the child's life. Therefore, parents at this time need to be extremely careful in order to notice the symptoms of pathological changes in time.

The generic process does not always proceed favorably for both the woman in labor and the child. Birth trauma to newborns occurs due to various reasons. Timely and adequate diagnosis and then treatment of this pathology is extremely important. Otherwise, the consequences can become unpredictable: from intellectual problems to disability or even fetal death.

What is a birth trauma of a child, we will consider in more detail below. In obstetric practice, this concept means a condition of a child that is characterized by damage to the integrity of tissues, organs or the skeleton and causes a violation of their functions.

All fetal damage in the generic process is conventionally divided into:

• mechanical, that is, created by some kind of external stimulation;
• hypoxic, that is, occurring as a result of fetal asphyxia or hypoxia.

Functional dysfunctions can be observed in all possible areas of the body and, depending on the location, are classified as follows:

• injuries to bones, joints (cracks or fractures of the shoulder, clavicle, femur and skull);
• soft tissue damage ( skin covering or muscle, cephalohematoma, birth tumor);
• trauma to internal organs (hemorrhage in the abdominal organs);
• disorders of the nervous system (damage to the nerve trunk in the brain or spinal cord).

The last type of trauma in newborns is divided into the following types:

• defects of the peripheral nervous system;
• damage in the parts of the spinal cord.

There is also a classification of birth injuries based on the actions of the obstetrician team:

1. Spontaneous. It is formed in the process of standard or obstructed childbirth, independent of medical staff reasons.
2. Obstetric. Occurs as a result of certain practices of the midwife (both right and wrong).

Cervical trauma

The cervical region of a person is characterized by mobility, fragility and extreme sensitivity to all kinds of influences. In this regard, the cause of his injury may be too rough bending, careless stretching or violent rotation.

During the birth process, various types of neck disorders can occur:

1. Distraction.
2. Rotary.
3. Compression-flexion.

Rotational disruption of the neck occurs as a result of the actions of the obstetrician, aimed at helping the child to move through the birth canal. In the process of manipulations performed by hands or obstetric forceps, rotational movements of the head are carried out, which in some cases lead to subluxation of the first cervical vertebra (atlas) or to a defect in the articulation of the first and second vertebrae.

Occasionally, the atlas is displaced and the spinal canal narrows, which is accompanied by pressure on the spinal cord.

In some situations, at the time of natural childbirth and in the presence of a large fetus, obstetricians are required to make additional efforts that can cause separation of the vertebral bodies from the discs, rupture of ligaments in the neck or dysfunction of the spinal cord.

Flexion-compression injuries are most common in rapid labor, especially when the fetus is large enough. When a child moves along the birth canal, his head experiences resistance, which is why compression fractures of the vertebrae are not excluded.

Consequences of natal injuries of the cervical spine

A birth injury to the neck causes:

1. Osteochondrosis and scoliosis.
2. Decreased muscle tone with overall increased flexibility.
3. Weakness in the muscles of the shoulder girdle.
4. Clubfoot.
5. Headache.
6. Disorders in fine motor skills.
7. Vegetovascular dystonia.
8. High blood pressure.

Note! Three times more often birth injuries are recorded during the caesarean section than during the most natural childbirth. This is due to the so-called canning effect.

When the baby is artificially pulled out of the uterus, negative pressure is formed in it. The resulting vacuum interferes with the free exit of the newborn.

It takes considerable effort to pull it out. Such manipulations can cause damage to parts of the spine.

Intracranial injury

Intracranial birth trauma of newborns is a cerebral disturbance in brain activity of different location and degree of manifestation, which are formed during labor as a result of mechanical damage to the skull. The factors that can provoke injuries of this nature are conditionally divided into 2 groups:

1. Associated with the prenatal state of the child.
2. Depends on the characteristics of the birth canal in the mother.

Factors associated with the prenatal state of the child:

• embryopetopathy: defects in development with hemorrhagic syndrome, venous congestion in tissues;
• hypoxic condition of the fetus due to placental insufficiency;
• prematurity: tissue weakness, a small number of elastic fibers, excessive vascular permeability, liver immaturity, insufficient amount of prothrombin, soft cranial bones;
• post-term pregnancy: hypoxia, which has arisen against the background of involution of the placenta.

Factors that depend on the characteristics of the mother's birth canal:

• rigidity of tissues in the birth canal;
• irregular pelvis shape;
• insufficient volume of amniotic fluid;
• premature discharge of amniotic fluid.

In impaired blood circulation in the brain, an important role is played by the difference between the atmospheric pressure, which acts on the presenting part of the head, and the intrauterine pressure, which grows with the contraction of the uterus. In addition, dislocation syndrome is of particular importance in the pathogenesis of cerebral deviations.

The fundamental factor of genesis is mechanical damage to the contents of the skull. Even with a naturally occurring birth, there is some difficulty in blood circulation. And with pathological delivery, unfavorable factors are summed up and even a slight mechanical stimulation of the head can provoke intracranial hemorrhage in premature babies as a result of vascular damage or duplications of the lining of the brain.

Depending on the localization, hemorrhages are divided into:

• epidural (between the membranes of the brain and the bones of the skull);
• subdural (between the meninges and the brain substance);
• intraventricular (blood in the ventricles of the brain).

The consequences of birth trauma are characterized by a number of features: from minor deviations in development to serious pathologies. Often, due to hemorrhage in the internal organs, anemia develops. As a result of increased heat transfer and reduced heat production, the thermoregulation system is disrupted, and newborns suffer from rapid hypothermia.

Often, natal trauma causes hypoglycemia. Physiological loss of body weight is compensated for more slowly, signs of jaundice persist for a long time. In connection with a decrease in the specific and nonspecific immunity in newborns with intracranial injuries, infectious diseases (in particular, pneumonia) are common.

The child's recovery depends on the form and degree of brain damage and on the rationality and intensity of therapy in both the acute and recovery periods.

Fatalities occur in 3-10%, with cranial trauma accounting for 97% of all cases of fatal birth trauma.

Absolute recovery is possible. But as a rule, in 20 - 40% of children with hypoxic CNS lesions, residual symptoms are diagnosed:

• delay in physical, psycho-emotional and speech development;
• cerebrasthenic syndrome with neurosis-like symptoms;
• scattered microsymptoms in the foci;
• moderate hypertension (intracranial);
• hydrocephalus (compensated or progressive);
• epilepsy.

In 7% of children with post-hypoxic encephalopathy, severe organic damage to the central nervous system with pronounced movement disorders (cerebral palsy) and mental disorders up to oligophrenia is manifested.

Birth trauma in newborns is a common occurrence, and it is impossible to completely protect yourself from injuries during childbirth. But you can minimize the risks. It is necessary to timely identify pregnant women belonging to the risk group for perinatal pathology by obstetricians, as well as professional and competent use of various manipulations during childbirth. It is advisable for expectant mothers to plan conception after treatment of chronic diseases and to register for pregnancy in a timely manner.