Topic 9. Childbirth injuries. Classification. Extracranial hemorrhage. Intracranial birth injuries. Damage to
the sternocleidomastoid muscle. Paresis (paralysis) of the facial nerve. Spinal cord injury. Lesions of the
humeral plexus. Bone fracture. Soft tissue damage. Diagnosis. Clinic. Treatment.
Given the real possibilities to prevent injuries to a large number of newborns during childbirth,
limited treatment options and potentially serious consequences of this pathology, the problem of birth
injuries has become not only medical but also social. That is why it is especially relevant today.
In general, birth injuries are found in 2-3% of newborns, and most of these babies have a clavicle
fracture.
Childbirth injury is a mechanical damage to tissues and organs in a newborn baby that occurs during
childbirth.
The purpose of the lesson - to learn to diagnose birth injuries on the basis of a comprehensive assessment
of clinical data and the results of additional examination of newborns; make a plan for their examination,
treatment and rehabilitation.
LEARNING TASKS
The student must know:
- the epidemiology of birth injuries;
- the main risk factors for birth injuries;
- the main clinical forms of birth injuries (craniocerebral, spinal, peripheral nervous system, skeletal
system, soft tissues, etc.);
- the most important clinical syndromes that can occur in newborns with birth trauma;
- modern principles of prevention and treatment of birth injuries;
- emergencies caused by various clinical forms of birth injuries, and the principles of emergency care.
The student must be able to:
- collect medical history and conduct an objective examination of the newborn;
- make a preliminary diagnosis of birth trauma based on clinical data;
- appoint a plan for additional examination to confirm preliminary diagnosis;
- evaluate the results of additional examinations;
- make a treatment plan for a newborn with various clinical forms of birth trauma.
SUMMARY OF THE MATERIAL
Childbirth injury is defined as a lesion of the newborn (dysfunction or structure) caused by adverse
mechanical forces (such as compression or stretching) during childbirth. Such a lesion cannot always be
prevented.
Etiology and pathogenesis
The main reason is the action of mechanical factors during childbirth. Mechanical damage causes
swelling, disruption of integrity, tissue destruction, bleeding and, as a consequence, dysfunction of the
organ (organs).
Frequency and risk factors
The average overall incidence of birth injuries is approximately 3%, although this figure can vary
widely depending on obstetric practice, level of diagnosis, determination used, and so on. More than 90%
of all birth injuries are clavicle fractures.
Major risk factors: first delivery, small mother size, pelvic abnormalities, macrosomia or large head
size, clinically narrow pelvis, fetal misalignment, abnormal fetal presentation (especially buttocks), fetal
abnormalities, dehydration, weakness of labor with stimulation, difficult removal of the shoulders,
prolonged or rapid labor, use of obstetric care during childbirth (manual care, obstetric rotation, forceps,
vacuum extraction, etc.), significant prematurity, multiple pregnancy.
Cesarean section without labor does not prevent all possible injuries.
A newborn at increased risk of birth injury should be carefully examined, paying particular attention
to motor activity, symmetry of structures and functions, function of cranial nerves, integrity of the
integuments and neurological status.
WHO classification of birth injuries (IUCN-X)
Intracranial tissue rupture and hemorrhage due to birth injury
- Subdural hemorrhage due to birth injury
- Brain hemorrhage due to birth injury {{1} } - Hemorrhage in the ventricle of the brain due to birth
trauma
- Subarachnoid hemorrhage due to birth trauma
- Rupture of the pons-cerebellar tent due to birth trauma
- Other intracranial ruptures and hemorrhages due to birth trauma
Other birth injuries of the central nervous system
- Brain edema due to birth injury
- Facial nerve damage due to birth injury
- Facial nerve palsy due to birth injury
- Damage to other cranial nerves due to birth injury
- Damage to the spine and spinal cord due to birth injury
Birth damage to the scalp
- Cephalohematoma due to birth injury
- Hair damage part of the head due to birth trauma
- Hemorrhage under the aponeurosis due to birth trauma
- Hematoma of the scalp due to birth trauma
- Damage to the scalp due to the use of monitor sensors during childbirth
Childbirth skeletal injury
- Fracture of the skull due to birth injury
- Fracture of the femur due to birth injury
- Fracture of other long bones due to birth injury
- Fracture of the clavicle due to birth injuries
- Damage to other parts of the skeleton due to birth trauma
Peripheral Nervous System Injury
- Erb's Paralysis from Childbirth Injury
- Klumpke's Paralysis from Childbirth Injury
- Diaphragmatic Nerve Paralysis from Childbirth Injury
- Other Shoulder Plexus Injuries
- Maternity injuries of other parts of the peripheral nervous system
- Maternity injuries of the peripheral nervous system, unspecified
Other birth injuries
- Liver damage due to birth injuries
- Spleen injuries due to birth injuries
- Damage to the sternoclavicular-mammary muscle due to birth injuries
- Maternity eye injury
- Maternity trauma of the face
- Damage to external genitalia due to birth trauma
- Subcutaneous fat necrosis due to birth trauma
The clinical diagnosis should indicate the severity of the lesion, as well as the period of the clinical
course of labor.
There are the following periods of labor trauma: acute (from 7-10 days from birth to 1 month); early
recovery (2-4 months of life); late recovery (from the 5th month of life to 1-2 years).
The most important clinical syndromes

Neurological lesions: disturbance of consciousness; convulsions; violation of muscle tone;
violation of reflex activity; focal symptoms; motor disorders; general depression or
irritability; other specific and general symptoms
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Hemorrhagic: hemorrhagic shock and other hemodynamic disorders; posthemorrhagic
anemia
Peritonitis
Acute adrenal insufficiency
Motor disorders: asymmetric restriction of motor activity; asymmetric decrease in muscle
tone.
Damage to bone and soft tissues: violation of the integrity of the skin (wounds, tears,
erosions); hemorrhages, hematomas, ecchymoses, petechiae.
Extracranial hemorrhage
Childbirth tumor. Subcutaneous fluid accumulation, sometimes hemorrhagic. Swelling is present
immediately after birth, localized on the anterior part of the head, has no clear boundaries, is not limited to
bone edges (cranial sutures), dense; there is no fluctuation. The general condition of the child is not
disturbed. The course is benign, the transudate is resorbed within a few days after birth, no intervention is
required.
Cephalohematoma. Hemorrhage under the periosteum due to rupture of superficial veins. The
frequency can reach 2.5-3%.
The tumor appears within 4 hours. after the birth of a child; always limited by cranial sutures (the
roller is palpated along the edge of the bone). Fluctuation is determined. In the absence of significant
anemia and concomitant injuries, the child's general condition is not impaired.
Large cephalohematoma may be accompanied by the development of anemia and significant
hyperbilirubinemia. In 5-20% of cases it can be combined with fractures of the skull.
Additional examination (radiography of the skull, CT) is required only in the presence of
neurological symptoms (especially seizures). Absorbed within 2 months. Sometimes calcification can last for
months or years.
In the vast majority of cases, only observation, assessment of the severity (spread) of jaundice and
phototherapy (reduces the level of indirect bilirubin in the blood) are required. If the hemoglobin level
decreases to 100 g / l (hematocrit ≈ 30%), erythromass transfusion is required. Hematoma puncture is
contraindicated because of the significant risk of infection. In addition, the removal of blood reduces iron
stores in the body of the child.
Hemorrhage under the aponeurosis. Hemorrhage under the aponeurosis of the scalp is most often
associated with vacuum extraction of the fetus or with the use of forceps during childbirth. Because the
subaponeurotic space covers the entire surface of the head, extending from the orbits to the back of the
neck and laterally to the ears, it can accumulate a significant amount of blood.
Swelling and spongy swelling of the soft tissues of the head appear in the first 2 hours. after the
birth of a child, however, become apparent after 24 hours. The child responds by shouting to the touch of
the head. (The child lies on his back.)
The hematoma may grow gradually or rapidly. In the latter case, the eardrums may turn forward,
periorbital edema, ecchymosis, tachycardia, respiratory disorders may occur, and shock may develop.
Absorption of blood and reduction of edema occur slowly.
A child who is progressing symptoms of hemorrhage requires hospitalization in the intensive care
unit and intensive monitoring of vital signs, hemoglobin (hematocrit) in the blood and head circumference.
If the amount of hemoglobin decreases to 100 g / l and / or the head circumference progressively increases
and a symptom of shock appears, erythromass 0 (I) Rh (-) is immediately transfused. Vitamin K is
administered. Repeated transfusions are indicated if the hemoglobin content in the blood decreases to 80 g
/ l. Treat hyperbilirubinemia (phototherapy). If the integrity of the skin is violated, antibiotics are
prescribed.
Intracranial birth injuries
Hemorrhages in the meninges are more common and much less common in the brain tissue. Severe
brain injury can cause the dura to rupture the sinuses, and of course in such cases, babies are stillborn. The
rupture of the superficial veins of the brain occurs at the point of their confluence with the upper
longitudinal sinus, and blood accumulates in the subdural space. One of the early signs of intracranial
hemorrhage, regardless of their location, is anxiety and motor excitability. Soon these conditions change to
drowsiness and lethargy, hypothermia develops. Respiratory rhythm is disturbed or apnea occurs. Cyanosis
appears. Explosion of the umbilicus is detected with significant hemorrhage. Convulsions are an important
and typical sign of intracranial hemorrhage; by nature they can be focal or generalized. In severe cases,
coma and death develop. Focal neurological symptoms depend on the location of the hemorrhage.
Intracranial hemorrhage is classified based on their location.
Epidural hemorrhage. They are very rare and usually occur due to damage to the skull bones. Blood
collects between the skull and the dura mater (so-called internal cephalohematoma). Small epidural
hematomas are asymptomatic, larger - may be clinically manifested by focal clonic seizures, mydriasis on
the side of the hemorrhage, congestion at the base of the eye.
Clinical signs of subdural hematomas depend on their location relative to the cerebellar tent, as
well as on the size and rate of formation. Children with supratentorial hemorrhages often have so-called
"light gaps". Their general condition after birth may be satisfactory, but within a few days it worsens. There
is increased agitation or depression, frequent convulsions and partial or complete damage to the nerve that
moves the eyes. Stasis on the fundus and mydriasis on the side of the hematoma are possible. Sometimes
there is a change in spontaneous motor activity on the opposite side and focal convulsions. In children with
large hematomas, brain dislocation and trunk disruption may occur. In this case, the fundus often shows
the phenomena of stagnation, as well as foci of hemorrhage. Diaphanoscopy reveals a decrease in the halo
of the glow on the side of the hematoma. Probable diagnosis is given by computed tomography or NMR
tomography. In the case of subtentorial hemorrhage, there are usually no light intervals, the severity of the
condition increases against the background of symptoms from the brain stem.
Subarachnoid hemorrhage. They are usually detected immediately after the birth of a child. Note
the increased excitability, general restlessness in the form of revived spontaneous motor activity, increased
tendon-periosteal and basic unconditional reflexes, tremors, sometimes convulsions, tremors. Also
characterized by the presence of severe meningeal symptoms, especially stiff neck muscles. Cerebrospinal
fluid is usually bloody or xanthochromic. Intracerebral hemorrhages occur mainly in premature infants,
their clinic depends on the size and location of hematomas.
Example of diagnosis: "Intracranial birth trauma: subdural hemorrhage, convulsive syndrome;
acute period ".
Treatment
Divided into 2 periods: treatment in acute and recovery periods. Treatment in the acute period
begins in the delivery room, as such children often need resuscitation. Immediately after first aid, it is
advisable to transfer such a baby to the neonatal treatment unit, and if available - neonatal intensive care,
where it is possible to provide monitoring of vital signs. First of all provide thermal protection and the
maximum rest. Enteral nutrition is not prescribed in severe cases.
Anticonvulsant, antihemorrhagic and dehydration therapy are the leading ones in the complex of
therapeutic measures. Of the anticonvulsants prescribed diazepam. Sodium oxybutyrate and magnesium
sulfate are also used in complex therapy. Of the antihemorrhagic drugs, vitamin K and ethamsylate are
most often used, and in the presence of indications - fresh-frozen plasma. Lasix and mannitol are used to
dehydrate to reduce cerebral edema in the absence of oliguria, hypotension, and significant physical
changes in the lungs.
In complex therapy an important place is occupied by the correction of the volume of circulating
blood in / in the introduction of infusion solutions to maintain cerebral circulation, homeostasis, partial and
complete parenteral nutrition. Full-term infants and premature infants weighing more than 1500 g begin
infusion of 10% glucose solution (60 ml / kg / day), to which is added 10% solution of Ca gluconate (200-300
mg / kg). The infusion rate is calculated for continuous administration during the day.
In the presence or continuation of seizures, elevated intracranial pressure is indicated lumbar
puncture.
Treatment of newborns in the recovery period is carried out in pathology departments or in
specialized neurological departments. Initiated treatment
continues. Surgical treatment of children with intracranial birth trauma is aimed at treating skull
injuries and evacuation of intracranial hematomas.
The prognosis of intracranial brain injury depends on the severity of brain damage, the presence or
absence of intracranial hemorrhage, their location. Children who have suffered a CNS birth injury need the
supervision of a pediatrician, neurologist, orthopedist in order to properly develop static, locomotor
functions, hearing, speech and vision.
Damage to the sternoclavicular-mammary muscle
This lesion is also called congenital or muscular curvature of the neck. The exact mechanism of
occurrence is unknown. The most probable is the postural effect of a certain restrictive intrauterine
position of the fetus. Crooked neck can also occur during childbirth due to overextension and muscle strain,
followed by hematoma formation, fibrosis and shortening.
Crooked neck is detected clinically after birth. A 1-2 cm thickening is palpated in the GCS area of the
muscle, the head is tilted towards the injury. More often, however, the problem is diagnosed at the age of
1-4 weeks. Facial asymmetry and hemihypoplasia on the affected side may also be detected.
About 10% of children with congenital crooked necks may also have congenital hip dysplasia, which
determines the need for careful objective examination to diagnose the problem in time.
The differential diagnosis includes abnormalities of the cervical spine, hemangiomas,
lymphangiomas, and teratomas.
Treatment is mostly conservative. Once diagnosed, it is important to start physiotherapy
immediately (the muscle is stretched several times a day). Recovery usually occurs within 3-4 months in
about 80% of cases. Surgery is required if the crooked neck persists after 6 months of physiotherapy.
Paresis (paralysis) of the facial nerve
The frequency can reach 1%. The most important risk factors are the imposition of middle forceps,
posterior facial presentation of the fetus, the presence of uterine fibroids, etc.
The most important clinical symptom is facial asymmetry, which becomes especially noticeable
when a child cries.
Central paresis is less common than peripheral. The nasolabial fold is smoothed and the corner of
the mouth is lowered on the side opposite to the affected area. The ability to wrinkle the forehead is not
impaired, the eye slits are symmetrical.
Peripheral type of paresis is manifested by obvious changes in one of the halves of the face. On the
affected side, the nasolabial fold is smoothed, the corner of the mouth is lowered and the eye is constantly
half-open (lagophthalmos). The baby cannot wrinkle the skin of the forehead, impaired sucking.
There may also be partial damage to one of the branches of the nerve, which is manifested by
dysfunction of certain muscle groups (forehead, eye, mouth).
Differential diagnosis includes Mobius syndrome (congenital agenesis of the nuclei of the VII pair),
intracranial hemorrhage, congenital muscle hypoplasia (depressor anguli oris), congenital facial muscle
defect or lack of nerve branches.
In most cases, spontaneous recovery of function nerve for 2-3 weeks. It is important to protect the
cornea, which does not close, by putting ointment in it (at least 4 times a day), covering or moisturizing it.
Spinal cord injury
Clinical signs are nonspecific. Pathognomonic symptoms are absent, which complicates the
diagnosis of spinal cord injury. In the presence of severe injuries, there is a picture of spinal shock. Children
are lethargic, adynamic, pronounced general hypotension, extensor position of the limbs. Observe urinary
retention, bloating, paradoxical type of breathing. In the clinic of the acute period it is often not possible to
determine a clear level of damage associated with immaturity of the nervous system, as well as stretching
of the spinal cord and its roots along its entire length and the presence of numerous diapedetic
hemorrhages. The degree of manifestation of clinical symptoms varies and depends on the level and
severity of the lesion.
Spinal cord injury at the level of C1-C4 is manifested by severe paralysis of the respiratory muscles,
flaccid paralysis of the neck muscles with limited head rotation, anesthesia of the skin in the back of the
head, central tetraplegia, intestinal paresis, impaired sensitivity in the affected area. The forecast is
unfavorable. The leading symptoms are movement disorders. In children with spinal cord injuries at the
cervical level, the Moreau and Babkin reflexes are almost not caused, their asymmetry is noted. There are
no grasping and Robinson reflexes. Reduced motor activity, show muscular hypotension.
Genital paresis of the diaphragm develops when the diaphragmatic nerve is damaged in childbirth
(segments C3-C5). It is often combined with defeat of a brachial plexus of the top type.
Involvement in the pathological process of C5-C6 segments of the spinal cord may indicate a
symptom of "doll's hands", short neck, paralysis Erb. Characterized by a weakened cry. Possible bulbar
disorders: in particular, swallowing, there is a humming tinge of crying
Defeat of segments C5-T1 (cervical thickening) leads to combined tetraplegia or tetraparesis,
analgesia, pelvic dysfunction, intestinal paresis
The lesion at the level of the sympathetic center (C8-T2) is accompanied by Horner-Bernard
syndrome - narrowing of the pupil, orbit, sagging of the eyeball; asymmetry of cerebral circulation, which is
confirmed by Doppler. Respiratory disorders may be due to dysfunction of the diaphragm.
Diagnosis
Ophthalmoscopy of the fundus in the case of injuries of the cervical region reveals varicose veins,
narrowing of the arteries, blurred boundaries of the optic disc. On the direct roentgenogram detection of
vertical damages of bodies of vertebrae, roots of brackets, shift of spinous sprouts is possible. The lateral
radiograph reveals compressions of vertebral bodies, their subluxations, dislocations and displacements.
The most informative method of diagnosis is computed tomography.
Electromyography is used. Lumbar puncture and ultrasound are also used for diagnosis and
differential diagnosis. Neurovascular disorders and microcirculation disorders are detected by thermal
imaging.
Example of diagnosis: Childbirth injury: proximal type of paresis of the right hand; acute period.
Treatment
It is important to ensure the immobilization of the spine using the cervical roller, to create peace, to
prevent bending of the head. The method of treatment depends on the type of spinal cord injury, brachial
plexus, peripheral nerves, location and severity of the lesion. Neuroorthopedic therapy in all cases is the
first stage of treatment. Based on the data of radiography and computed tomography, perform manual
correction, then immobilization. The general principles of drug therapy are the same as in cases of
intracranial trauma, although the effectiveness of such therapy is questionable.
Lesions of the brachial plexus
Frequency - 0.1-0.2%. Caused by excessive traction of the head, neck or arms during childbirth. Risk
factors include macrosomia, shoulder dystocia, abnormal presentation, and instrumental delivery.
Neurological symptoms depend on the level of damage.
In the upper proximal type of Duchenne-Erb paresis (C5-C7; 90% of all cases), the lesions are
recognized soon after the birth of the child, primarily by the position of the limb. The function of the
proximal arm is impaired. The shoulder is turned inwards, the elbow is unbent, the pronation of the
forearm is revealed, the hand is sometimes bent. Damaged muscles that divert the shoulder, turn it out and
raise above the horizontal level of the flexors and insteps of the forearm. Muscle tone in the paresisaffected hand is reduced. The Moreau reflex cannot be induced or it is realized with a smaller amplitude.
Absent or sharply reduced reflex from the biceps brachii. The grasping reflex is intact. In the case of a
severe lesion, subluxation or dislocation of the humeral head may occur due to a sharp decrease in the
tone of the muscles that fix the shoulder joint. In 5% of cases, paresis of the diaphragm may be detected.
In the case of the least common (<1% of cases) lower distal paresis Degerin-Klumpke (C7-T1)
observed paralysis (paresis) of the muscles of the hand with weakness of the flexors and fingers. There is no
grasping reflex, it is not possible to cause a palmar-oral reflex. You can also detect a loss of sensitivity of the
ulnar part of the forearm and hand. The presence of a Horner-Bernard symptom on the appropriate side is
often noted.
In the case of a total lesion (C5-T1; up to 10% of all cases), the hand hangs in the pronation position
and can be easily wrapped around the neck - a symptom of a "scarf". Tendon reflexes are not caused. There
are no grasping and palmar-oral reflexes. The hand does not participate in the Moreau reflex. Severe
periodic disorders - cyanosis, cold, symptom of "ischemic glove", symptom of "skin membrane" in the
proximal shoulder, symptom of "axillary islet" - in the inguinal fossa on the side of paralysis show many
folds, frequent bumps. If the sympathetic fibers (T1) are damaged, Horner-Bernard syndrome may occur.
The differential diagnosis includes intracranial lesions, which are also manifested by other
symptoms; fractures of the clavicle, humerus and cervical spine.
To rule out bone fractures, an X-ray of the neck, shoulder and arm should be performed.
Treatment includes temporary (for 7 days) immobilization of the arm (as in the case of a fracture).
humerus), as well as physiotherapy and physical therapy (passive movements), which begin after 7-10 days.
In most infants, full recovery occurs before the age of 3 months.
Children who have suffered a spinal cord injury, intracranial hemorrhage, in the future may have
significant neurological disorders, delayed psychomotor development, paresis, paralysis, convulsions and
more.
Bone fractures
Clavicle fractures
The most common birth injury, which can occur in approximately 3% of newborns. In 40% of cases,
the diagnosis is not made during the stay in the obstetric institution.
The most important risk factors are shoulder dystocia, sciatica, macrosomia. type of "green
branch". Bone callus is formed in 7-10 days. A complete fracture is characterized by crepitation, palpation
of the bone defect, spasm of the neck muscles, and pseudoparesis of the arm on the affected side
(movements cause pain).
The differential diagnosis includes a humeral fracture and paresis of the humeral plexus.
The diagnosis is confirmed by X-ray examination. If the fracture is accompanied by pain, temporary
immobilization of the arm is indicated (as in the case of a fracture of the humerus).
Fracture of the humerus
Usually occurs in cases of difficult removal of the handle during childbirth in the buttocks or
difficulty in removal of the shoulders during childbirth in the main presentation. Direct pressure on the
humerus can also cause a fracture.
Green branch fractures may not appear until a callus forms. Typical initial signs of a fracture are the
absence or restriction of spontaneous movements of the limb, with the subsequent occurrence of local
edema and pain during passive movements. A complete fracture with displacement of the fragments looks
like a deformity of the limb. The diagnosis is confirmed by X-ray examination.
The differential diagnosis includes a fracture of the clavicle and paresis of the humeral plexus.
Treatment. Immobilization for 2 weeks.
The prognosis is favorable.
Femoral fracture
Femoral fractures are usually the result of delivery in the buttocks. There is an increased risk for
infants with congenital muscular hypotension.
Objective examination reveals a deformity of the thigh. In some cases, the fracture may go
unnoticed for several days until swelling, restricted movement, or palpable pain. The diagnosis is confirmed
by X-ray examination.
Treatment. Immobilization for 2 weeks with a splint. The prognosis is favorable.
Soft tissue damage
Subcutaneous necrosis of adipose tissue
Objectively manifested by areas of soft tissue compaction on the limbs, face, torso or buttocks,
which appear during the first 2 weeks of life. Areas of damage have clear boundaries and irregular shape.
The skin over them may be unchanged, dark red or crimson-cyanotic. No treatment is required. Necrosis
completely "resorbs" spontaneously within a few weeks or months.
Childbirth trauma to internal organs
Rupture of the liver is caused by pressure on it during birth during pelvic presentation or its large
size, sometimes against the background of hemorrhagic disorders. Rupture of the liver leads to the
formation of subcapsular hematoma. The child has clinical manifestations of acute blood loss (severe
condition, lethargy, pale skin, tachycardia, low blood pressure) and its consequences (posthemorrhagic
anemia, jaundice). Sometimes the hematoma can be palpated. Small hematomas may be asymptomatic
and may be detected by liver ultrasound. Rupture of the hematoma capsule can lead to shock and death.
Treatment is aimed at stopping bleeding, replenishing the volume of circulating blood, maintaining vital
functions. A surgeon's consultation is required.
Rupture of the spleen is often combined with rupture of the liver. Manifested by symptoms of
internal bleeding. A dense formation is palpated in the area of the left hypochondrium. Treatment is aimed
at stopping bleeding, replenishing the volume of circulating blood, maintaining vital functions. A surgeon's
consultation is required.
Hemorrhage in the adrenal glands occurs at birth in pelvic presentation; may also be of nontraumatic origin, due to hypoxia or infection. The clinical picture is characterized by a sharp drop in blood
pressure, pale skin, severe muscular hypotension up to atony, intestinal paresis. The diagnosis is confirmed
by ultrasound of the adrenal glands. Treatment is aimed at maintaining blood pressure, stopping bleeding,
replenishing the volume of circulating blood.
Questions for self-control
1. Causes leading to the development of birth injuries.
2. Classification of birth injuries.
3. Classification of intracranial hemorrhage (ICC).
4. Manifestations of the syndrome of general depression.
5. Hypertensive-hydrocephalic syndrome.
6. Convulsive syndrome.
7. Clinical manifestations of Cheka.
8. Treatment of birth defects of the brain.
9. Features of birth injuries of the brain in premature infants.
10. Causes of birth injuries of the spinal cord.
11. Upper brachial plexus. The level of damage. Clinical picture, diagnosis, treatment.
12. Lower paralysis of the humeral plexus. The level of damage. Clinical picture, diagnosis, treatment.
13. Total paralysis of the upper extremity. The level of damage. Clinical picture, diagnosis, treatment.
14. Cephalohematoma. Clinical picture, diagnosis, treatment tactics.
15. Clinical picture, diagnosis and treatment tactics for clavicle fracture.
16. Criteria for diagnosis of "crooked neck".
17. Principles of prevention of birth injuries.
Self-monitoring task
The child's condition after birth is rated on the Apgar scale at 7/8 points. During childbirth, there
was a short-term difficulty in removing the shoulders. After birth, the child was found to have a forced
position of the right handle with impaired function of the proximal arm. On examination, the shoulder is
turned inward, the elbow is unbent, the forearm is pronated, the hand is bent in the form of a "doll's
hand". Muscle tone is reduced. Moreau's reflex is weakened, almost not caused. The reflex from a biceps
muscle of a shoulder is sharply reduced.
Task:
1. Make a clinical diagnosis.
2. What should be the tactics of a pediatrician in this case?