Birth trauma

Abstract

Due to the intrinsic nature of the mechanical forces involved and the bony boundaries of the birth passage, the process of birth is naturally traumatic for the infant. Even under optimal conditions, injuries such as greenstick fracture of clavicle and subdural haemorrhages are seen in children born by normal spontaneous vaginal delivery. Furthermore, subdural haematoma has been documented in utero even before the initiation of labour. Added to this are the trauma caused by the mechanical forces applied by the obstetrician in delivering the baby. It is no surprise that the exact cause of a particular trauma in a newborn, with associated emotional and medico-legal sensitivities, may at times be far from clear or certain. The risk factors for birth injuries include macrosomia, prematurity, instrumental delivery, breech and other abnormal presentations, prolonged second stage of labour and precipitous delivery. These risk factors are well recognised and efforts such as decreased use of forceps and more pre-emptive Caeserean sections have helped in reducing the incidence of birth trauma over the years. However, as mentioned above, due to the nature of labour itself, the overall incidence of birth injuries still remains at over 1% in most studies. Birth trauma caused by intrinsic and applied mechanical forces during labour are discussed in this chapter, in order of anatomical location. We have focussed mostly on the diagnosis and management of the most common mechanical injuries reported during labour. © 2009 Springer Berlin Heidelberg.