Birth trauma to the vertebral arteries

Abstract

The necks of 60 infants dying in the perinatal period were examined histologically for evidence of birth trauma. The cases were selected at random from 213 stillborn and neonatal deaths occurring in 2,800 births. They included eight breech deliveries and three by caesarean section; 16 were stillborn. In 27 cases evidence was found of distortional trauma to the cervical spine in the form of extraand sub-dural haemorrhage, haemorrhage into joint capsules and torn ligaments and dura. A significant degree of traumatic damage to the spinal cord was found in only two cases, both breech deliveries. In nine cases there was bruising and tearing of spinal nerve roots. In 24 cases, following all methods of delivery, there were haemorrhages into the adventitial coat of one or both vertebral arteries. These haematomas were often of considerable size, narrowing the lumen of the vessel. They were thought to arise from tearing of the arterial twigs, supplying nerve roots and spinal cord, at their origins from the vertebral arteries. In one infant, who died 12 days after birth, the left vertebral artery was occluded by thrombus. The significance of stenosis of the cervical part of the vertebral arteries is discussed in relation to ischaemic damage to the brain stem and as a probable cause of cerebral lesions in many cases of cerebral palsy.