Birth injury and birth injuries
Obstetrics And Gynecology / / April 30, 2016
Birth injury is a disruption of tissues or organs of the fetus during childbirth, occurs as a result of local action of mechanical forces on the fetus.
in the perinatal period may cause changes that resemble birth trauma in their clinical and morphological manifestations.These include bleeding in the brain and its membranes, under the capsule of the liver and other organs, as well as necrosis (heart attacks), formed in connection with hypoxia, hemorrhagic diathesis or other causes.To refer to them in the literature accepted generic term damage (birth injury - English, geburtsschaden -. It).
Considerable difficulties arise in determining the nature of damage such as bleeding in the membrane and the brain and spinal cord material.According to the cumulative ratio of traumatic and non-traumatic brain hemorrhage and soft shell is 1:10.
There are also obstetric trauma , which arises as a result of various obstetric manipulations at the wrong conduct of birth.
In recent years, the number of cases of
Causes birth trauma
Birth injury may occur when the discrepancy between the size of the mother of the pelvis and fruit, especially its head.From the mother's cause of non-compliance may be narrowing of the pelvis, pelvic tumor or cervical bone, soft tissue stiffness in the birth canal.From the fruit can cause inconsistencies appear overly large head (giant fruit ,null, hydrocephalus, macrocephaly with Chondrodystrophy), with an increase in abdominal ascites or significant amounts of liver and spleen.Injuries can occur when anomalies previa.Thus, if the injured parietal previa, 4.1% of children and at 14.4% pelvic, when inserting the personal injury is 35.7%, and 100% at lobnom-.
Development birth trauma contribute to acute and chronic diseases and pregnant intoxication, pathological course of pregnancy, as well as prematurity and postmaturity fruit.In these cases, a violation of the fruit expressed in particular in the insufficient formation of elastic fibers and collagen fibers of incompleteness.Impetuous or, conversely, prolonged labor when the weakness of labor, multiple pregnancy also contribute to birth injury.Hypoxia different origin during delivery, accompanied by venous congestion, swelling to the loosening of the tissues, reduces the mechanical strength and leads to their rupture.
Pathogenesis birth trauma can be understood by taking into account the biomechanics of the birth of the fetus.In the process of delivery to the fetus, there are two forces.One of them - the pressure of the bottom and sides (body) of the uterus, which tightly covers the fruit, straightens the spine and promotes the fetus through the birth canal.This is facilitated by tension abdominals and diaphragm mothers.Another force impedes the progress of the fetus.It is caused by resistance fetal presenting part from the soft and bony parts of the tribal cocoa.Some important active movements of the fetus.
With cephalic presentation as a result of the forces mentioned head moving in the pelvic cavity, rotates ( "screwed into the basin") and is subject to configuration.Configuration is offset skull bones relative to each other.When this takes the form of the head to facilitate its passage through the birth canal, while reducing its volume, hardly occurs.Configuration is expressed more intensively than significant and long-acting forces on the head and the higher the displaceability (extensibility, flexibility) joints that connect the bones of the skull.If the configuration is performed within a certain range, and not too fast, soft tissue damage is not accompanied by stretching.The origin of the most common injuries - the gap cerebellar tentorium - the principal value, apparently, has said "screwing" head in the pelvic cavity.This changes the relative position of the right and left halves of the head and, in particular, temporal bones pyramids.The result is a hyperextension stretched between cerebellar tentorium and its rupture.What matters is also an increase in the cranio-caudal and fronto-occipital head size.What is happening at the same time pulling the sickle of the brain leads to a contraction gallop up and injury as a sickle, and charted.
breech when you need to quickly remove the fruit, the likelihood of birth trauma of the head above.In addition, under these conditions possible neck injury organs.
analysis require special rare cases of tribal skull injuries in children learned by Caesarean section.Intracranial hemorrhage and other damage are without traumatic and hypoxic or other nature.There are also real injury (torn cerebellar tentorium), formed when a cesarean section is performed in the first stage of labor when the head is inserted.
birth injury and damage to the head the most important pathogenetic common disorder of cerebral circulation in the form of dystonia, edema, venous hyperemia and hemorrhage.In the limited space of the skull there is a rise in intracranial pressure, which further worsens the blood and cerebrospinal fluid, causes degeneration and death of neurons and can lead to "brain death."You should not exaggerate the role of mechanical thanatological "infringement of the medulla oblongata" streamed blood or tonsils of the cerebellum.
Pathogenesis birth injuries
in the pathogenesis of birth injuries are significant acute and chronic hypoxia, circulatory disorders, infections, blood clotting changes, congenital heart disease with hypertension, a large circle, brain aneurysms and other blood vessels.Often develop a brain hemorrhage, focal swelling, necrosis.At the same neurological changes are associated not only with common disorders of cerebral circulation, but also with focal brain lesions.It must be borne in mind that cerebral hemorrhage or membranes may occur both during birth and in the first few days after birth.
lifetime birth trauma
sign of postmortem trauma education is the lack of bleeding in her area.However, the presence of hemorrhage are not always talking about his lifetime.The fact that the fetus died in utero, continues to be exposed to generic forces.This can lead to injury.At the same time despite the cardiac arrest, the movement continues for some blood vessels of the fetus by the heightened pressure on his torso under reduced pressure to nascent head.Posthumously hemorrhage possible, as in the blood vessels of the fetus, who died during hypoxia phenomena, the blood remains liquid.Education haemorrhage due to birth injury stillbirth happens in the event that traumatized the presenting part, especially the head.Frequent, in particular, subdural hemorrhage in postmortem cerebellum tentorium break.Symptoms of post-mortem nature of the injury in this case are the small size of the hemorrhage, is located in the gap area.