NASHVILLE BIRTH INJURY LAWYER
TIMOTHY L. MILES
(855) TIM-M-LAW (855-846-659)
[email protected]
(24/7/365)
Birth trauma frequently affects areas such as the head, neck, and shoulders. Less often, it can also impact the face, abdomen, and lower limbs. Below is a summary of the typical clinical conditions associated with traumatic events during birth.
Head trauma includes superficial lesions, extracranial and intracranial hemorrhages, and fractures of the skull bones.
Caput succedaneum refers to a frequent type of scalp swelling observed in newborns. This condition involves subcutaneous swelling and edema occurring between the skin and the periosteum, caused by local venous congestion resulting from pressure exerted by the birth canal on the presenting part. Since the edema lies above the periosteum, the swelling can extend across suture lines. Generally, no treatment is necessary, and it usually resolves within the first few days after birth. Although rare, complications may include skin bruising over the swollen area, which can lead to necrosis and result in scarring and hair loss, as well as the occasional onset of a systemic infection.
Fractures of the skull caused by birth trauma frequently occur due to instrumented vaginal delivery. Such fractures may be either linear or depressed, and they are typically asymptomatic unless there is an accompanying intracranial injury. To confirm the diagnosis, plain film radiographs of the skull are generally effective. However, if there is a concern for intracranial injury or neurological symptoms, it is advisable to perform a computed tomography (CT) scan or magnetic resonance imaging (MRI) of the brain.
Cephalohematoma refers to a localized accumulation of blood beneath the periosteum, caused by the rupture of blood vessels that extend from the skull to the periosteum. This swelling, confined by the periosteal attachment to the skull bones, typically does not extend across suture lines and is frequently unilateral.
It is particularly prevalent in deliveries that involve the use of forceps or vacuum assistance, affecting up to 2.5% of all birth. Generally, the condition resolves on its own within a period of 2 weeks to 3 months without the need for treatment. Nevertheless, there can be complications such as calcification, skull deformities, infection, and osteomyelitis.
Subgaleal hemorrhage refers to the accumulation of blood in the loose areolar tissue located between the galea aponeurotica and the periosteum of the skull. This type of injury typically occurs when the scalp is pulled away from the fixed bony calvarium, leading to the tearing or severance of the bridging vessels. The most frequent contributing factor to subgaleal hemorrhage is a challenging vaginal delivery that necessitates the use of forceps or a vacuum. It has been reported to arise in about 4 out of 10,000 spontaneous vaginal deliveries and 59 out of 10,000 vacuum-assisted deliveries.
Given that the subgaleal space is a significant potential area that spans the entire scalp from the anterior attachment of the galea aponeurosis near the frontal bones to the posterior attachment at the nape of the neck, there is a risk of substantial bleeding into this space, which could lead to acute hypovolemic shock, multi-organ failure, or even death. Management involves supportive care, emphasizing early detection and the restoration of blood volume through transfusions of blood or fresh frozen plasma to address the sudden hypovolemia. The hemorrhage is typically not surgically drained and is allowed to gradually resorb. In certain cases, especially if the extent of bleeding appears disproportionate to the birth trauma, an evaluation for bleeding disorders may be warranted.
Traumatic intracranial bleeding encompasses various types such as epidural, subdural, subarachnoid, intraventricular, and, although less common, intracerebral and intracerebellar hemorrhages.
Epidural hemorrhage is uncommon in newborns and typically occurs alongside linear skull fractures in the parietal-temporal area after a surgical delivery. Symptoms may include a bulging fontanelle, bradycardia, hypertension, irritability, changes in consciousness, hypotonia, and seizures. Diagnosis can be made using a CT or MRI of the head, which reveals a convex shape of the blood accumulation in the epidural space. Immediate neurosurgical treatment is crucial because the condition can worsen quickly.
Subdural Hemorrhage stands as the most prevalent type of intracranial bleeding among newborns. A significant risk factor for this condition is operative vaginal delivery, with the most frequent area of hemorrhage occurring over the cerebral convexities. Symptoms may present as a bulging fontanelle, changes in consciousness, irritability, respiratory depression, apnea, bradycardia, altered muscle tone, and seizures.
In some cases, subdural hemorrhages may be discovered incidentally in newborns who show no symptoms. The approach to treatment is determined by the location and severity of the bleeding. Surgical intervention is typically reserved for cases of extensive hemorrhage that lead to increased intracranial pressure and related clinical symptoms.
Subarachnoid Hemorrhage is the second most common type of neonatal intracranial hemorrhage and is usually the result of the rupture of bridging veins in the subarachnoid space. Operative vaginal delivery is a risk factor, and the infants are typically asymptomatic unless the hemorrhage is extensive. Ruptured vascular malformations are a rare cause of subarachnoid hemorrhages, even in the neonatal population. Treatment is usually conservative.
Intraventricular hemorrhage, while typically observed in premature infants, can also arise in term infants based on the severity and type of birth trauma.
Intracerebral and intracerebellar hemorrhages are less common and occur as a result of occipital diastasis
The facial nerve is the cranial nerve most frequently impacted during traumatic births, occurring in approximately 10 out of every 1,000 live births. This injury typically results from pressure exerted on the facial nerve either by forceps or due to a pronounced maternal sacral promontory during the birthing process. Symptoms may include reduced movement or a complete loss of motion on the side of the face affected. It is important to distinguish facial nerve palsy from asymmetric crying facies, which is caused by congenital hypoplasia of the depressor anguli oris muscle, leading to a localized abnormality in mouth movement.
While there is a strong correlation with forceps delivery, facial palsy can also manifest in newborns without any visible trauma. The outlook for infants with traumatic facial nerve injuries is generally positive, with many experiencing spontaneous recovery within the first few weeks after birth.
These injuries occur in approximately 2.5 per 1000 live births and are caused by the stretching of cervical nerve roots during delivery. Typically, these injuries are unilateral, and several risk factors contribute, including macrosomia, shoulder dystocia, challenging deliveries, breech presentations, multiparity, and assisted deliveries.
Spinal cord injuries in newborns are rare and typically occur due to excessive pulling or twisting of the spinal cord during delivery. The clinical symptoms are influenced by the type and site of the injury. Injuries higher up (cervical/upper thoracic) are linked to increased mortality rates, while Diagnosis is made using ultrasonography or MRI of the spinal cord. Treatment focuses on alleviating clinical symptoms and ensuring cardiorespiratory stability as necessary.
Most of the fractures resulting from birth trauma are associated with difficult extractions or abnormal presentations. Clavicular fractures are the most common bone fracture during delivery and can occur in up to 15 per 1000 live births. The clinical presentation is significant for crepitus at the site of fracture, tenderness, and decreased movement of the affected arm with an asymmetric Moro reflex. Clavicular fractures have a good prognosis with spontaneous healing occurring in the majority of infants.
The humerus is the most common long bone to fracture during birth, which can be associated with a brachial plexus injury. The clinical presentation could be similar to a clavicular fracture with an asymmetric Moro reflex, inability to move the affected arm. Also, a significant deformity might be noted on the affected arm with swelling and tenderness at the fracture site. Rare conditions may involve a distal humeral epiphyseal separation due to birth trauma requiring expert orthopedic intervention. In general, immobilization for 3 to 4 weeks is necessary and often heals well without deformities.
Other fractures, such as femur fracture, rib fractures, can occur during birth but are rare. On the other hand, femur fractures are extremely rare in newborns and may be seen in difficult vaginal breech extraction deliveries. Diagnosis is made by clinical exam with tenderness, swelling, and deformity of the thigh and confirmed further on plain radiographs. Orthopedic consultation is the recommendation for long bone fractures for appropriate immobilization.
Subconjunctival hemorrhages (SCH) are superficial blood collections observed beneath the bulbar conjunctiva and are frequently found in infants who have experienced labor. These hemorrhages are thought to be caused by the rupture of subconjunctival capillaries due to venous congestion, which arises from elevated back pressure in the veins of the head and neck. Such injuries can occur as a result of factors like a nuchal cord or increased pressure in the abdominal or thoracic areas during uterine contractions.
SCH is typically a harmless condition in newborns and usually resolves on its own without any treatment. However, more severe ocular injuries may occur when delivery instruments, such as forceps, are used, leading to issues like corneal abrasions or vitreous hemorrhages. These injuries necessitate prompt medical attention and referral to an ophthalmologist to avoid potential long-term visual impairments.
Injuries to soft tissues that occur due to birth trauma can manifest as petechiae, bruises, ecchymoses, lacerations, and subcutaneous fat necrosis. The latter is believed to occur from ischemic damage to adipose tissue and is identified by the presence of soft, firm nodules felt beneath the skin. These abnormalities typically resolve over a span of several weeks.
One potential complication is hypercalcemia, which necessitates routine monitoring of serum calcium levels. There have been instances of unintended lacerations occurring during cesarean sections, with an Italian study indicating that such lacerations happen in about 3% of cesarean deliveries, and the rate is notably higher in emergency situations compared to planned cesarean procedures.
Birth-related trauma leading to injuries of the abdominal organs is rare and mainly involves bleeding into the liver, spleen, or adrenal glands. The symptoms observed will vary based on the extent of blood loss, which may manifest as paleness, bluish skin on the abdomen, abdominal swelling, and signs of shock. Management focuses on supportive care, including fluid resuscitation, with surgical procedures being necessary in some cases.
Contact Infant Birth Injury Lawyer Timothy L. Miles for a free case evaluation today If you believe you or you child suffered a birth injury cased by negligence or malpractice.
The call is free and so is the fee unless we win or settle your case so call today and see what an Infant Brain Ischemia Lawyer can do for you. (855) 846-6529 or [email protected].
Timothy L. Miles, Esq.
Law Offices of Timothy L. Miles
Tapestry at Brentwood Town Center
300 Centerview Dr. #247
Mailbox #1091
Brentwood,TN 37027
Phone: (855) Tim-MLaw (855-846-6529)
Email: [email protected]
Website: www.classactionlawyertn.com
NASHVILLE BIRTH INJURY LAWYER
TIMOTHY L. MILES
(855) TIM-M-LAW (855-846-659)
[email protected]
(24/7/365)