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BIRTH TRAUMA/INJURIES EXAM LATEST UPDATED
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BIRTH TRAUMA/INJURIESDefined as those sustained during labor and delivery (can even occur
with a 'normal' labor and delivery).
What causes birth injuries?
Birth injuries are most often caused by a prolonged labor, which is
normally due to either maternal uterine dysfunction or cephalopelvic
disproportion (i.e., when an infant's presenting part is larger than the
mother's pelvis).
What causes a difficult birth?
Dystocia, or a difficult birth, can be caused by large infants, multifetal
gestation, difficult presentation, or congenital abnormalities in the infant
leading to difficult delivery.
What cause birth injuries to a newborn?
Instruments used for fetal monitoring during the laboring phase or during
delivery of the infant can also cause birth injuries to a newborn.
Are BIRTH TRAUMA/INJURIES mild or severe?
May be mild and require just monitoring and no intervention or may be
severe enough to cause neonatal death, still-birth, or a number of other
morbidities
Remember to assess parenteral reaction/perception to any
____________________________sustained by their newborn.
trauma or injury
Many birth traumas and injuries are avoidable due to?
available antepartum and intrapartum diagnostic testing and cesarean
sections.
Soft tissue injuries to a newborn are usually?
Bruises and abrasions received during a difficult delivery or during
intrauterine fetal monitoring.
Nursing care is focused on what regarding injuries?
,Providing education and reassurance to the parents regarding injuries
and reinforcing that their infant will heal quickly without long-term
sequela.
Description of the Soft Tissue Injury: Lacerations
Although uncommon, lacerations can occur during a cesarean section
delivery due to the sharp instruments used during the surgery.
Description of the Soft Tissue Injury: Scleral hemorrhages or facial
petechiae
Scleral hemorrhages or facial petechiae can be seen after a difficult
delivery due to the sudden release of pressure on the infant's head or to
an infant born with nuchal cord after it is released.
Description of the Soft Tissue Injury: Bruising or abrasions
Forceps used with difficult deliveries and intrauterine fetal monitoring
can lead to bruising or abrasions on an infant's face and scalp.
Description of the Soft Tissue Injury: Circular bruising or petechiae
Well-defined circular bruising or petechiae on the infant's occiput can be
seen after the use of vacuum while trying to suction the infant from the
birth canal. Although such injuries are thought to be caused due to
trauma during delivery, any infant with notable petechiae should be
assessed for possible underlying abnormalities, such as a bleeding
disorder or infection, to rule out possible causes for the petechiae.
SOFT TISSUE INJURY TREATMENT?
Usually minimal - just supportive care, no intervention may be required.
• Question if underlying bleeding disorder or if potential systemic illness.
• Monitor for possible hyperbilirubinemia with bruising and petechiae.
• Instruct parents and support emotionally.
Potential causes of head trauma?
Internal fetal monitoring; CPD, forceps; vacuum extractor; abnormal
presentations; nuchal cord; precipitous birth; exogenous oxytocin
stimulation; external or internal version; inexperienced practitioners; fetal
macrosomia; multifetal deliveries; shoulder dystocia; cesarean delivery;
primiparous delivery
There are three main types of scalp trauma (not including skull fractures)
that can occur to an infant during a difficult birth.
Cephalhematoma
Caput Succedaneum
Subgaleal Hemorrhage
Cephalhematoma (13)
, 1. A cephalhematoma forms when a blood vessel is broken during
delivery and bleeds into the area between the bone and periosteum.
2. The boundaries of a cephalhematoma are clear and do not extend
beyond the suture lines, which is different from a caput succedaneum.
3. A cephalhematoma usually occurs over one or both of the parietal
bones, infrequently over the occipital bone, and rarely over the frontal
bone.
4. Occurs because of the pressure of birth. Swelling can be absent or
small at birth and increases in size on day 2 or 3.
5. No treatment is needed for an uncomplicated hematoma; the blood is
usually absorbed between 2 weeks and 3 months.
6. A cephalhematoma with severe blood loss requires further evaluation
as hyperbilirubinemia can occur during resolution.
7. In addition, a cephalhematoma can also cause infection so the infant
must be monitored closely for increasing swelling, redness, or
tenderness to the area.
8. Although uncommon, a cephalhematoma can be associated with a
skull fracture.
9. Calcification can occur during the healing phase, which may lead to
an abnormal head shape.
10. Complications - anemia; possible hypotension; secondary
hyperbilirubinemia; infection; associated skull fracture.
11. Resolution - slow over weeks to several months.
12. Resolution - slow over weeks to several months.
13. Management - most just observation (especially neurological) and
scalp swelling precautions, possible daily head circumferences, treat
hyperbilirubinemia if present, r/u possible bleeding DO, x-ray if skull
fracture suspected, educate/reassure parents.
Caput Succedaneum (13)
1. Caput succedaneum is the most commonly observed infant scalp
trauma occurring during delivery.
2. Caput succedaneum is most often benign and without long-term
complications.
3. The infant will present with vaguely-outlined edema over the area of
scalp that presented during delivery.
4. The edema is a collection of serum, blood, or both that is accumulated
in the tissue above the bone.
5. No specific treatment is needed, and swelling resolves without
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