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TRAUMATIC BIRTH INJURIES

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traumatic birth injuries

By Kelechi Maryjane Nnamuka

On 11 Jul, 2022

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TRAUMATIC BIRTH INJURIES

The period in which conception takes place through pregnancy, down to labor, delivery, and childbirth, is a very beautiful yet delicate and demanding experience.

What are traumatic birth injuries?

These are distress experienced by the mother and infant during or after childbirth. These can be physical, emotional, or even psychological. Birth injuries are also damages that occur as a result of physical pressure during the birthing process, usually during transit through the birth canal.

During pregnancy, a lot of complications can occur, which can be dangerous to both mother and child. some of these may include, Antepartum hemorrhage, placenta complications (placenta previa, placenta abruption), Ectopic pregnancy, pre-eclampsia, eclampsia, malpresentation, malpositioning, anemia, preterm labor, pregnancy-induced hypertension, etc

During labor and delivery also, there are likely to be complications which case, if not managed properly, can affect mother and child. These may include prolonged labor, cephalopelvic disproportion, fetal distress, cervical dystonia, Asphyxia neonatorum, cord prolapse, etc.

Traumatic Birth Injuries In Mothers.

1. Perineal/ vaginal tear

Vaginal tears during labor, likewise called perineal cuts or tears, happen when the child’s head is getting through the vaginal opening and is either excessively huge for the vagina to extend around, or the head is a typical size, yet the vagina doesn’t extend as easily. These sorts of tears are relatively normal.

Types of perineal/vaginal tear.

  • First degree: Small tears affecting only the skin, which usually heals quickly and without treatment.
  • Second degree: Tears affecting the perineum muscle and skin. These usually require stitches.
  • Third degree: Tears affecting the muscle of the perineum, the skin, and the fourchette
  • Fourth degree: also known as obstetric anal sphincter injuries (OASI), extends into the muscle that controls the anus (anal sphincter). These deeper tears are to be repaired in the operating theatre.Postpartum hemorrhag

2. Postpartum hemorrhage

Postpartum hemorrhage (PPH) is severe bleeding of the vagina after childbirth. This condition is so serious that it could lead to death if proper treatment and care are not given. PPH can occur just after delivery or up to 12 weeks after childbirth. Early detection and immediate treatment can lead to a full recovery.

Types of postpartum hemorrhage.

  • Primary postpartum: A hemorrhage occurs within the first 24 hours after delivery.
  • Secondary or late postpartum hemorrhage: Occurs 24 hours to 12 weeks postpartum.

Causes of postpartum hemorrhage

  • Trauma: Such as Episiotomy, macrosomia (>4kg), and caesarean section.
  • Tone: Such as placenta previa, uterine relaxant, previous PPH, and multiple pregnancies.
  • Tissue: Such as Retained placenta, placenta accreta, and Retained product of conception.
  • Such as Pre-eclampsia,placenta abruption,anti-coagulation.

3. Ruptured/prolapsed Uterus

Uterine rupture is the unconstrained tearing of the uterus that may result in the fetus being pushed into the peritoneal cavity. Uterine rupture is rare. It can occur during late pregnancy or active labor.

Uterine rupture most often occurs along healed scar lines in women who have previously had cesarean deliveries. Uterine prolapse happens when pelvic floor muscles and ligaments stretch and weaken and no longer adequately provide support for the uterus. This results in the uterus slipping down into or protruding out of the vagina. Uterine prolapse is not age-restricted.

Post partum depression
Post partum depression

4. Postnatal depression (PPD)

PPD is a complicated blend of changes in physic, emotion, and behaviour that happen in some women postpartum. As implied by the DSM-5, a manual used in the diagnosis of mental disorders, PPD is a  type of major depression that begins in the period of 4 weeks after delivery. The diagnosis of postpartum depression is based on the length of time between delivery and onset of symptoms and the severity of the depression.

Postpartum depression is connected to chemical, social, and mental changes that happen while having a child. The term portrays a scope of physical and profound changes that many new moms experience. PPD can be treated with drugs and direction.

Signs and Symptoms

Postpartum symptoms may be hard to detect. These include:

  1. Trouble sleeping
  2. Appetite changes
  3. Severe fatigue
  4. Lower libido
  5. Frequent mood changes
  6. Having little to no interest in your baby
  7. Often crying with no clear reason
  8. Depressed mood
  9. Severe anger and crankiness
  10. Loss of pleasure
  11. Feelings of worthlessness, hopelessness, and helplessness
  12. Thoughts of death or suicide
  13. Thoughts of hurting someone else
  14. Trouble concentrating or making decisions

 

Traumatic Birth Injuries In Babies
Traumatic Birth Injuries In Babies

Traumatic Birth Injuries In Babies

Brain damage: This occurs when cells in the brain are damaged or destroyed. Unfortunately, during childbirth, many children suffer from permanent brain damage.

Causes

The brain can become damaged from;

  1. lack of oxygen to the neonatal brain(hypoxia)
  2. Neonatal jaundice of kernicterus
  3. physical head injuries while exiting the birth canal
  4. Viral/bacteria infection.

 

1. Immediate Infant Brain Damage Symptoms

  1. Small head or skull.
  2. Large forehead.
  3. Malformed spine.
  4. Stiffness in the neck.
  5. Unusual or distorted facial features.
  6. Abnormal eye movement.
  7. Seizures.
  8. Excessive crying.

2. Cerebral palsy

Cerebral palsy (CP) alludes to a gathering of issues that influence muscle development and coordination. As a rule, cerebral palsy likewise influences vision, hearing, and sensation. “Cerebral” signifies having to do with the brain. “Palsy” signifies shortcomings or issues with body development.

Cerebral paralysis is the most well-known reason for motor handicaps in youth. As indicated by the Centres for Disease Control and Prevention (CDC), it influences 1 to 4 out of each, and every 1,000 youngsters confided in Sources around the world.

Some of the more common symptoms include:

  • Delays in reaching the motor skill milestones, such as rolling over, sitting up alone, or crawling
  • Difficulty walking
  • Variations in muscle tone, such as being too floppy or too stiff
  • Spasticity, or stiff muscles and exaggerated reflexes
  • Ataxia, or a lack of muscle coordination
  • Tremors or involuntary movements
  • Delays in speech development and difficulty speaking
  • Excessive drooling and problems with swallowing
  • Favoring one side of the body, such as reaching with one hand
  • Neurological issues, such as seizures, intellectual disabilities, and blindness.

Causes of cerebral palsy

  • In most cases, the exact cause of cerebral palsy is unknown. Other possible causes include:
  • Head injuries as a result of a fall
  • Intracranial hemorrhage, or bleeding into the brain
  • Brain infections, such as encephalitis and meningitis
  • Infections acquired in the wombs, such as German measles (rubella) and herpes simplex
  • Asphyxia neonatorum, or a lack of oxygen to the brain during labor and delivery
  • Gene mutations that result in atypical brain development
  • Severe jaundice in the infant

 

3. Erb’s palsy

Erb’s palsy is the name for a specific sort of physical injury to the brachial plexus nerves. It most often happens during labor, yet grown-ups can get it as well. The injury influences the development of your shoulder and arm — they may be deadened. Nonetheless, numerous babies who have this condition can recuperate on their own.

Erb’s palsy is a condition portrayed by arm weakness and loss of movement. It can happen both to babies and grown-ups. It’s commonly brought about by an actual physical issue during delivery or by traumatic downward force on the upper arm and shoulder, harming the brachial plexus. The brachial plexus is an organization of nerves close to the neck that give development and feeling to the shoulder, arm, hand, and fingers.

Causes of Erb’s Palsy

Erb’s palsy ordinarily happens when a newborn child’s neck is extended to the side joined with a downward force on the shoulder during a difficult delivery.

Sometimes, Erb’s palsy happens when a child is larger than expected – making delivery difficult. This can happen because of inadequately overseen maternal diabetes or gestational diabetes.

Signs and Symptoms

  • Loss of feeling in one arm
  • Partial or total paralysis of one arm
  • Weakness in one arm
  • Numbness in one arm
  • Limited motion of the arm

4. Asphyxia Neonatorum

Asphyxia neonatorum is a condition that happens when a child doesn’t get sufficient oxygen during childbirth. It can be fatal. It is also called perinatal asphyxia or birth asphyxia. Hypoxic-ischemic encephalopathy might be a consequence of serious asphyxia neonatorum.

Causes

  1. A variety of factors can cause birth asphyxia. These can relate to the pregnant person or the fetus, and they include:
  2. Umbilical cord prolapse: This birth complication occurs when the umbilical cord leaves the cervix before the baby.
  3. Compression of the umbilical cord
  4. Meconium aspiration syndrome: This syndrome occurs when a baby inhales a mixture of amniotic fluid and meconium, their first faeces.
  5. Premature birth: If a baby is born before 37 weeks, their lungs may not yet be fully developed, and they may be unable to breathe properly.
  6. Amniotic fluid embolism: Although a rare Source, this complication — in which amniotic fluid enters the pregnant person’s bloodstream and causes an allergic reaction — is very serious.
  7. Uterine rupture: Research Trusted Source has shown a significant association between tears in the muscular wall of the uterus and birth asphyxia.
  8. The placenta separates from the uterus: This separation can happen before birth.
  9. Infection during labor
  10. Prolonged or difficult labor
  11. High or low blood pressure in pregnancy
  12. Anaemia: In a baby with anaemia, the blood cells are not carrying enough oxygen.
  13. Not enough oxygen in the pregnant person’s blood: The level of oxygen may be insufficient before or during birth.

Signs and symptoms

Signs and symptoms of birth asphyxia can occur before, during, or just after birth. Before birth, a baby might have an abnormal fetal heart rate or low blood pH levels, which indicate excess acid.

Signs in the baby at birth can indicate a lack of oxygen or blood flow. They include:

  1. Unusual skin tone
  2. The baby is silent and not crying
  3. Low heart rate
  4. weak muscle tone
  5. Weak reflexes
  6. Lack of breathing or difficulty breathing
  7. Amniotic fluid stained with meconium
  8. Seizures
  9. Poor circulation
  10. The baby is limp or lethargic
  11. Low blood pressure
  12. Lack of urination
  13. Abnormal blood clotting

What causes Traumatic birth injuries?

  • Large babies with a birth weight of over 8 pounds, 13 ounces (4,000grams).
  • Prematurity. Babies born before 37 weeks (premature babies have more fragile bodies and may be more easily injured).
  • Cephalopelvic disproportion.
  • Dystocia.
  • Prolonged labor.
  • Abnormal birthing presentation.
  • Maternal obesity.

What are the treatments for Traumatic Birth Injuries?

  1. Adaptive Equipment: Braces, wheelchairs, orthotics, strollers, and other equipment can help children with mobility issues
  2. Medication: certain medications can help treat birth injuries if mild.
  3. Occupational therapy: children can practice their fine motor skills to get better at brushing their teeth, dressing, bathing, and many more.
  4. Physical therapy: This helps children strengthen muscles, regain control over voluntary movement, and help improve mobility.
  5. Speech therapy: children with oral muscle issues and mental disabilities may benefit from working with a speech therapist to improve their communication skills.
  6. Surgery: Children with severe mobility issues such as foot, hips, leg, or spine problems may need surgery to correct movement problems.

How to prevent Traumatic Birth Injuries

The following are some of the most important ways to prevent birth injuries:

1. Providing proper prenatal care

Doctors should recommend a variety of prenatal tests, which are done to assess the health of both the mother and baby (which are in many ways interdependent). Prenatal testing can provide information about maternal conditions such as gestational diabetes,

pre-eclampsia, and infections. These tests can also help medical professionals recognize a wide variety of fetal tissues, such as intrauterine growth restriction (in which the baby is not growing properly), suboptimal positions (e.g., breech), umbilical cord problems, and heart rate abnormalities.

Early detection and appropriate management of these complications can often prevent serious birth injuries. Doctors must recognize factors that make a pregnancy high-risk; women with high-risk pregnancies should be referred to a maternal-fetal specialist and receive more extensive prenatal care and monitoring.

2. Detecting and addressing signs of fetal distress

Throughout pregnancy and during delivery, medical professionals should monitor the mother and baby for signs of fetal distress, which indicates that the baby is likely to be deprived of oxygen. Fetal distress signs include:

  • Decreased fetal movement
  • Abnormal fetal heart rate (as
  • indicated by fetal monitoring, a nonstress test, or a contraction stress test)
  • Abnormal amniotic fluid volume
  • Abnormal biophysical profile (BPP)
  • Doppler flow study abnormalities
  • Vaginal bleeding
  • Cramping
  • Insufficient or excessive maternal weight gain

3. Preventing premature birth and minimizing risks if it is inevitable

Premature babies often have underdeveloped organs, weak immune systems, and low birth weights. These factors increase the chances of birth injuries and subsequent neonatal brain damage/disabilities. Fortunately, doctors are often able to prevent premature birth. This entails recognizing and mitigating risk factors, such as incompetent cervix/cervical insufficiency. Three relatively common interventions are:

  • Cervical cerclage: a temporary stitch that helps keep the cervix closed until the baby is ready to be born
  • Progesterone: a hormone that is important to the maintenance of pregnancy
  • Magnesium sulfate: an inorganic salt that can suppress preterm labor

4. Recognizing when vaginal birth may be dangerous or impossible

In the following circumstances and indications, cesarean deliveries are recommended and, at times, even necessary.

  • Prolonged and arrested labor
  • Macrosomia
  • Cephalopelvic disproportion (CPD)
  • Placental abruption
  • Placenta previa
  • Uterine rupture
  • Umbilical cord compression (which can be caused by a variety of issues, including a cord prolapse)
  • Maternal infection
  • Fetal distress

5. Giving proper care to babies in NICU

Premature babies who have sustained birth injuries or have other health issues will typically spend time in the neonatal intensive care unit (NICU). NICU babies are fragile, so they must receive the best possible care. Unfortunately, medical professionals sometimes make mistakes in the NICU, which can have serious consequences. Among others, these mistakes include:

  • Resuscitation or breathing assistance errors
  • Failure to diagnose hypoxic-ischemic encephalopathy (HIE) and quickly provide therapeutically hypothermia
  • Failure to quickly diagnose and treat conditions such as infections, intracranial hemorrhages, neonatal seizures, hypoglycemia, anaemia, and jaundice
  • Other errors include medication mix-ups and problems with tubes, IVs, and central lines.

CONCLUSION.

Traumatic birth injuries may have negligible effect, however,  they could have devastating impact on mother, child or both.

Proper care, during pregnancy,  before/ during and after labour by trained healthcare professionals is one of the surest ways to eliminating or reducing birth traumas.

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