From Big Medical Encyclopedia

BIRTH TRAUMA (trauma obstetricum; Greek trauma a wound, a mutilation) — the damages of fabrics and bodies of a fruit to childbirth caused by pathology of the pre-natal or intranatal period.

R.'s frequency of t., by data I. S. Der-gacheva (1964), makes from 2,1 to 7,6% of number of the children who were born live, and 40,5% of number mortinatus and the died newborns. By data And. II. Yelizarova (1977), the birth trauma is a proximate cause of death of 0,2% of the full-term children and 1,4% of the premature children who were born live. Among the reasons perinatal mortality (see) a birth trauma, according to E. I. Andreyeva (1973), makes apprx. 11%.

The factors contributing to R.'s emergence with t., are various patol. conditions of a fruit, a specific place among to-rykh holds hypoxia (see), promoting increase in permeability of vessels (see. Asphyxia of a fruit and newborn ). Adverse course of pregnancy, inf. diseases, cardiovascular and endokrnnny diseases of mother, toxicoses of pregnant women, Rh incompatibility, not wearing out and perenashivany pregnancies cause a state hron. hypoxias and decrease in adaptation abilities of a fruit. In such cases even normally proceeding childbirth can exert the damaging impact on a fruit. In R.'s pathogeny of t. the leading role belongs to two factors: to the mechanical influences arising during the passing of a fruit on patrimonial ways of N at obstetric interventions and the circulatory disturbances of the general and local character caused by a pre-natal hypoxia. The mechanical impacts on a fruit exceeding its stability arise at considerable discrepancy between the sizes of a fruit and a basin of mother (clinically or anatomically a narrow basin, etc.), anomalies of an iredlezhaniye (extensive presentation: perednetemenny, frontal, front), at long and rapid childbirth, and also disturbances of the technology of obstetric rodorazreshayushchy operations and grants (imposing of obstetric nippers, a vacuum extractor, version on a leg, rendering a grant at buttock presentation).

Distinguish R. of t. a nervous system (a craniocereberal birth trauma, a birth trauma of a backbone and spinal cord, a birth trauma of a peripheral nervous system), soft tissues, bones, internals, etc.

the Craniocereberal birth trauma

the Craniocereberal birth trauma — injury of a brain of the newborn to childbirth, a thicket against the background of a pre-natal hypoxia of a fruit. Owing to defeat of vessels of a brain and its covers there are subdural, primary subarachnoidal, intracerebral (intra-, periventrikulyarny and intra cerebellar) hemorrhages.

Subdural hemorrhage arises at gaps it is mashed a cerebellum, direct, cross, occipital and lower sagittal sine, a big brain vein (Galen's vein), superficial brain veins. The blood streaming under a firm meninx leads to a prelum and shift of a brain. Subdural hematomas (see. the Subshell hemorrhages ) can be one - or bilateral, to be combined with the parenchymatous hemorrhages resulting from a hypoxia.

At bystry increase of a hematoma a condition of newborns extremely heavy, symptoms of a prelum of a brain trunk, pallor of skin, a cold snap of extremities appear, tachypnea (see), bradycardia (see), arrhythmia (see. Arrhythmias of heart ), weak filling of pulse. The hypomyotonia, oppression of instinctive reflexes, periodic vomiting, sometimes is noted opisthotonos (see), spasms (see). Are characteristic the deviation of eyeglobes which is not disappearing during the movement of the head anisocoria (see), sluggish reaction of pupils to light (see. Pupillary reflexes ). Within minutes or hours in process of increase in a hematoma develops coma (see). Expansion of pupils is observed, symptoms of damage of lower parts of a brain trunk appear: arrhythmic breath, pendulum movements of eyes. The lethal outcome can come in the first days owing to a prelum of the vital centers of a brain trunk. At gradual increase in a hematoma nevrol. disturbances can appear by the end of the first days or even in several days. Excitement, vomiting, vomiting, arrhythmic breath, protrusion of a big (front) fontanel, a symptom Gref, sometimes focal convulsive attacks, a hyperthermia are observed.

At a rupture of superficial brain veins the wedge, manifestations depend on the size of a hematoma. The small hematoma causes easy excitement, a sleep disorder, vomiting. Focal symptoms — spasms, a hemiparesis appear in more hard cases on 2 — the 3rd day (see. Hemiplegia ), deviation of eyeglobes aside, opposite to a hemiparesis. Sometimes note defeat of the III couple cherepnomozgovy (cranial, T.) nerves, shown mydriasis (see). Symptoms of defeat of a brain trunk testify to the infratentorialny hematoma which resulted from a gap is mashed a cerebellum more often. The symptoms characteristic of defeat of cerebral hemispheres indicate a konveksitalny subdural hematoma. Wedge, the diagnosis is confirmed by a puncture of a subdural space, kraniografiya (see), ekhoentsefalografiya (see), a computer tomography of a brain (see. Tomography computer ).

Differential diagnosis of a subdural hematoma is carried out with pre-natal damage of a brain, abscess, a tumor of a brain (see. Brain ), meningitis (see).

At gaps it is mashed a cerebellum, the sine of a firm meninx, a sickle of a brain causing heavy damages of a brain trunk, the forecast for life usually adverse. However early removal of a hematoma can save the newborn. At superficial subdural hemorrhage the forecast is favorable if the subdural puncture is timely made, the hematoma is removed and it is reduced intracranial pressure (see). At inefficiency of a subdural puncture neurosurgical intervention is necessary (see. Craniotrypesis ). Further subdural hemorrhage can become the reason hydrocephaly (see), focal nevrol. symptoms, delay of psychomotor development.

Primary subarachnoidal hemorrhage unlike secondary, connected with intra-and periventri-kulyarny hemorrhages, a rupture of aneurism, results from damage of large and small vessels soft meninx (see). More often happens at premature children. In development of primary subarachnoidal krovopz-lnyaniye the hypoxia of tissue of brain is of great importance. Hemorrhage is located between the acting sites of a brain, is more often in the field of temporal shares and in a back cranial pole. Tissue of a brain is edematous, vessels are overflowed with blood. Heavy primary subarachnoidal hemorrhage sometimes is followed by the coagulopathy aggravating weight of a condition of the child.

Nevrol. disturbances vary depending on the size of hemorrhage and existence of other hemorrhages. Small subarachnoidal hemorrhage is characterized minimum nevrol. symptomatology: vomiting, an easy tremor at a postural change of a body, increase in tendon jerks. Sometimes nevrol. symptoms appear on 2 — the 3rd day after applying of the child to a breast. More massive hemorrhage is often combined with asphyxia (see Asphyxia of a fruit and the newborn) or is its reason, is followed by excitement, vomiting, vomiting, a tremor, frustration of a dream, spasms. Spasms are more often observed at the full-term children, usually for the 2nd day of life. Increase in a muscle tone, a hyperesthesia, a stiff neck, Moro and Babinsko-go's spontaneous reflexes are noted. Pathology of cranial nerves is shown squint (see), nystagmus (see), symptom Gref. On 3 — the 4th day after the birth can be observed a syndrome of the Harlequin — passing (of 30 sec. up to 20 min.) periodically repeating decolourization of skin of a half of a body of the newborn from pink to tsianotpchny, the most expressed at position of the child on one side. At decolourization of skin the health of the child is not broken.

The diagnosis establish on the basis a wedge, manifestations, availability of blood and the increased protein content, and then and a cytosis in cerebrospinal liquid (see), results of a computer tomography of a brain of ultrasonic investigation.

Treatment in the acute period is directed to correction of cardiovascular, respiratory, metabolic frustration and a stop of bleeding. The spinal puncture for the purpose of cerebral decompression and removal of blood is shown. At detection of inflammatory changes carry out antibacterial therapy. At inefficiency of conservative therapy and progressing of hydrocephaly an operative measure is shown (see Hydrocephaly).

The forecast depends on weight of a hypoxia and injury of a brain. At the subarachnoidal hemorrhage which is followed by a slight hypoxia, the forecast favorable. At a long hypoxia of a brain newborns often perish. At the survived children hydrocephaly, spasms, motive disturbances are observed.

Intracerebral bleeding. Intraventricular and periventrikulyarny hemorrhages arise at premature children more often. Their development is promoted by immaturity of vascular textures of ventricles of a brain. Disturbance of self-control of a brain blood-groove (see. Cerebral circulation ), the most expressed in the conditions of a hypoxia, easily leads to increase in the ABP and a rupture of vessels. At premature children of hemorrhage occur in the field of a kernel having a tail, at full-term more often — in the field of a vascular texture of a side ventricle. At periventrikulyarny hemorrhage in 75% of observations penetration of the streamed blood into ventricles of a brain is noted. Blood, passing through Marangdi's openings (a median aperture of the fourth ventricle) and Lushki (a lateral aperture of the fourth ventricle), accumulates in a back cranial pole. As a result of it in several weeks obliterating fibrous develops arachnoiditis (see), to-ry further causes disturbance of outflow of cerebrospinal liquid.

Nevrol. the symptomatology depends on extensiveness of hemorrhage and speed of its distribution on ventricles of a brain. At a fulminant current the wedge, symptoms develop within several minutes or hours. The newborn is in coma, arrhythmic breath, bradycardia, decrease in the ABP, paresis of a look, sluggish reaction of pupils to light, tension of a big fontanel, a hypomyotonia, tonic spasms, sharp oppression of instinctive reflexes (children do not suck and do not swallow), metabolic are noted acidosis (see), disturbance of water and electrolytic balance (see. Water salt metabolism ), hypo - or a hyperglycemia (see. Hypoglycemia , Hyperglycemia ). Cases with slower development a wedge, pictures can be observed. At intraventricular hemorrhage at 50% of newborns the symptomatology is almost absent. Make a spinal puncture for specification of the diagnosis (cerebrospinal liquid in the first days bloody, then xanthochromatic, with the increased protein content and the lowered content of glucose), ultrasonic investigation and a computer tomography of a brain.

Intraventricular hemorrhages arise and develop in the first two days of life of the newborn therefore holding preventive actions is reasonable (maintenance of a metabolic homeostasis, normalization of the ABP, ensuring continuous ventilation, restriction of excessive manipulations with the child).

Urgent actions in the acute period are directed to the prevention of a gppovolemiya (intravenous administration of liquids), cerebral decompression (use of a glitserol, magnesia, Mannitolum) and correction of metabolic disturbances with the help oxygen therapy (see), administrations of sodium bicarbonate, glucose, electrolytes. These events should be held carefully because of possible paradoxical reaction. Further make repeated spinal punctures for the purpose of removal of elements of blood, cerebral decompression and control of composition of cerebrospinal liquid, and also administer the drugs preventing development of hydrocephaly (Diacarbum, lasixum, glitserol). If expansion of ventricles of a brain stops, treatment is continued within 3 — 4 months and more. At purpose of dehydrating agents it is necessary to watch osmolarity of blood, content in it of sodium, glucose, nitrogen, urea. At inefficiency conservative terapshg and development of hydrocephaly resort to neurosurgical intervention.

The forecast depends on weight and prevalence of hemorrhage.

At massive hemorrhage newborns often perish. In other cases the forecast is more favorable, however developing of hydrocephaly and a delay of psychomotor development are possible further. Defeat of periventrikulyarny white matter leads to spastic paralyzes (see. Paralyses, paresis ).

Intra cerebellar hemorrhage meets at premature children more often. Softness of bones of a skull, plentiful vascularization of a cerebellum and disturbance of vascular auto-regulation, and also the hypoxia promoting cardiovascular frustration, build-up of pressure in vessels of a brain contributes to its emergence. At a pathoanatomical research the rupture of vessels of a cerebellum, big vein of a brain or an occipital sine comes to light.

In a wedge, a picture symptoms of defeat of a brain trunk prevail: the pendulum movements of eyes, assignment pkh in one party, defeat of caudal group of cranial nerves (the IX—XII couple). The apnoea and bradycardia result from involvement in patol. process of a myelencephalon.

The diagnosis is established on the basis by a wedge, pictures, detection of blood in the cerebrospinal liquid and a computer tomography confirming availability of blood in a back cranial pole. At a hematoma in a cerebellum (see) a lumbar puncture it is necessary to make with care since at the same time perhaps vklineny almonds of a cerebellum in a big occipital opening (see. Dislocation of a brain ).

Treatment consists in evacuation of a hematoma from a back cranial pole. Efficiency of treatment depends on weight nevrol. frustration and extent of dysfunction of other bodies and systems.

The forecast is adverse, a lethality in the acute period high. At had intra cerebellar hemorrhage further the disturbances caused by destruction of a cerebellum are found.

The birth trauma of a backbone and spinal cord

the Birth trauma of a backbone and spinal cord arises at buttock presentation more often when the angle of extension of a head exceeds 90 ° that can be caused by the congenital anomaly of cervical department of a backbone expressed by a hypomyotonia. At head presentation of R. of t. a spinal cord occurs during the imposing of band obstetric nippers. Injury of a spinal cord to childbirth results from intensive longitudinal traction (at buttock presentation) or torsions (at head).

In the acute period hypostasis of a meninx and substance of a spinal cord, epidural and intramedullary hemorrhages are observed, to-rye can be combined with stretching and a rupture of a spinal cord, a separation of ventral and back roots of spinal nerves. Injuries of a backbone find much less often. Later fibrous tyazh between a firm cover of a spinal cord and a spinal cord, the centers of a necrosis in tissue of a spinal cord with the subsequent formation of cystous cavities are formed. At buttock presentation the lower cervical and upper chest segments of a spinal cord are more often damaged, at head — upper cervical segments; changes can be observed also throughout a spinal cord. By determination of level of sensitivity to a prick it is possible to establish the upper bound of injury of a spinal cord. The injury in the field of upper cervical segments can be combined with intracranial damages (a gap it is mashed a cerebellum, injury of a cerebellum).

Nevrol. the symptomatology depends on localization and severity of an injury. In hard cases symptoms of spinal shock are observed (see. Diaschisis ): the expressed slackness, an adynamia, weak shout, impression of a thorax, paradoxical breath, retraction of intercostal spaces, abdominal distention. The sharp hypomyotonia, lack of tendon and instinctive reflexes is noted. The spontaneous movements are poorly expressed or are absent, however the reflex of an otdergivaniye in response to a prick can be strengthened. Dysfunction of upper extremities is observed: in one cases — asymmetry of a muscle tone, spontaneous movements, in others — preservation of function of biceps of a shoulder at paralysis tricipital that is shown by characteristic bending of hands against the background of hypotonia of muscles. Sometimes paresis of brushes (a pose of «gun») at rather safe movements in proximal departments of hands comes to light. In the first days of life dysfunction of a bladder is noted. At a simultaneous injury of a spinal cord and a brachial plexus Dyushenn's paralyzes — Erba are observed (see. Dyusheina — Erba paralysis ), Dezherin-Klyumpka (see. Dezherin-Klyumpka paralysis ), paresis of a diaphragm, Bernard's syndrome — Horner (see. Bernard — Horner a syndrome ). At a combination of an injury of upper cervical segments of a spinal cord to damage of a brain trunk there is no spontaneous breath therefore apply artificial ventilation of the lungs (see. Artificial respiration ).

At slight injuries of a spinal cord nevrol. the symptomatology is expressed unsharply. The passing hypomyotonia, the weakened shout, easy disturbances of breath is noted. Further nek-ry children have a hypomyotonia and areflexia (see) remain a long time, at others — in several months in the affected extremities muscular accrues tone (see), raise tendon jerks (see), appear clonuses (see) and patol. reflexes (see. Reflexes pathological ).

The diagnosis is established on the basis of characteristic by a wedge, pictures and data miyelografiya (see), with the help a cut in the first days of life it is possible to reveal the block of a subarachnoid space which resulted from hemorrhage, and further — a local atrophy of a spinal cord. At rentgenol. a research in a side projection the shift of one of vertebrae from the centerline sometimes is defined.

Differential diagnosis should be carried out with a disease of Verdniga — Goffmanna (see. Amyotrophy ), inborn myopathies (see) and anomalies of development of a spinal cord (see).

Treatment consists in an immobilization backbone (see) with full restriction of mobility of its cervical department, purpose of styptic means. At development resistant focal nevrol. disturbances long holding rehabilitation actions is necessary. The forecast depends on weight of injury of a spinal cord.

The birth trauma of a peripheral nervous system

the Birth trauma of a peripheral nervous system includes obstetric paresis of hands, paresis of a diaphragm, mimic muscles.

Obstetric paresis of hands — dysfunctions of muscles of upper extremities owing to damage to childbirth of peripheral motor-neuron of a front horn of a spinal cord. Frequency makes them 2 — 3 on 1000 newborns. Depending on localization distinguish upper type of Dyushenn — Erba (see. Children's paralyzes , Dyushenna — Erba paralysis ), the lower type Dezherin-Klyumpka (see. Children's paralyzes , Dezherin-Klyumpka paralysis) and total type of obstetric paresis. The last develops as a result of an injury of a top and bottom brachial plexus of trunks or roots of spinal nerves of Cv — Thi and is the heaviest. At this type of obstetric paresis there is an injury of all muscles of a hand and total absence in the acute period of active movements is noted, the muscular atrophy, especially in distal departments of an extremity, painful and a thermoesthesia in the field of the bottom of a shoulder early develops, forearms and brushes it is lowered, tendon jerks are not caused.

Treatment should be begun as soon as possible, it shall be complex and continuous. Apply orthopedic laying, LFK, massage, medicamentous therapy.

The forecast in mild cases favorable, recovery of function begins from the first days of life and in 3 — 5 months the volume of active movements becomes full (sometimes muscular weakness remains it is long). In hard cases recovery, as a rule, happens incomplete because of a degeneration of nerve fibrils, muscular atrophies and the developed contractures.

Paresis of a diaphragm (Kofferat's syndrome) — restriction of function of a diaphragm as a result of injury of a phrenic nerve (is more often than left) or roots of spinal nerves of C3 — C4. It is shown by repeated attacks of cyanosis, the speeded-up, irregular breath, protrusion of a thorax and neck on the party of defeat, paradoxical breath. At auscultation on the party of paresis the weakened breath, sometimes single rattles in upper parts of lungs is listened. Paresis of a diaphragm is often found only at rentgenol. a research of a thorax on high standing of a diaphragm, its paradoxic movement (raising of the paralyzed half of a diaphragm at a breath and lowering at an exhalation) and to an atelectasis in the basis of a lung on the party of defeat. Paresis of a diaphragm is often combined with obstetric paresis of a hand of upper type (see Dyushenn — Erba paralysis).

Treatment is same, as at other types of flaccid paralyzes (see. Children's paralyzes).

Paresis of mimic muscles as the result of defeat of a facial nerve arises owing to long standing of a head in patrimonial ways, pressing it to pelvic bones of mother, a prelum obstetric nippers, hemorrhages in a trunk of a nerve or in a myelencephalon, and also a fracture of a temporal bone in the field of a mastoid.

Peripheral paresis of traumatic character tend to bystry recovery, sometimes and without specific treatment. At the expressed changes apply physical therapy and pharmaceuticals (see. Children's paralyzes ).

The children who transferred R. of t. a nervous system, need treatment in conditions nevrol. a hospital for newborns and babies and in the subsequent dispensary observation of the neuropathologist.

Neurologic disturbances and mental disorders in the remote period of a birth trauma of a nervous system

concern To them the following nevrol. disturbances: hydrocephaly (see), spasms (see), children's paralyzes (see), a delay of age psychomotor development, the isolated defeats of cranial nerves, small brain and cerebellar disturbances (see. Cerebellum ).

The delay of psychomotor development at early age is shown by delay of formation of motive and mental functions. It can be total when delay of development of those and other functions happens rather evenly, or partial, at a cut motive development lags behind from mental, or on the contrary. It is possible to observe also a disproportion of development within one functional system. E.g., within motive function formation of static functions is late, and autokinesias develop timely. Damages of cherepnomozgovy nerves are shown dispersing squint (see), ptosis (see) at defeat of a third cranial nerve (see), the meeting squint at damage of the taking-away nerve (see), the central and peripheral defeat facial nerve (see), bulbar paralysis at defeat of a glossopharyngeal nerve (see), a vagus nerve (see), hypoglossal nerve (see). Often defeats of cranial nerves are combined with motive and mental disturbances, but can be and isolated.

Small brain disturbances are shown by asymmetry of a muscle tone, cutaneous and tendon jerks, autokinesias, motor awkwardness of hands, disturbance of gait. These changes can be combined with insufficiency of the highest cortical functions (the speech, attention, memory, etc.).

Mental disorders at a craniocereberal birth trauma

Mental disorders at a craniocereberal birth trauma are expressed in various manifestations of a psychoorganic syndrome (see). At children's age they correspond to syndromes of early cerebral insufficiency or organic defect. Expressiveness of a psychoorganic syndrome as well as nevrol. symptoms, at R. of t. depends on weight and localization of injury of a brain (hl. obr. hemorrhages). Reliable data about the frequency of the mental disorders caused by craniocereberal R. in t., no.

Mental disorders in the remote period of craniocereberal R. of t. are shown by the states which are characterized by intellectual insufficiency (an oligophrenia, secondary delays of mental development, etc.), states with dominance of behavior disorders (psychopatholike syndromes), the states which are followed by convulsive manifestations (epileptiform syndromes, symptomatic epilepsy) and also asthenic states and psychotic frustration.

The oligophrenia connected with R. in t., meets rather seldom. Its distinctiveness is the combination of a mental underdevelopment to signs of a psychoorganic syndrome (asthenic, psychopatholike, epileptiform frustration) and rezidualnoorganichesky nevrol. symptoms. The structure of weak-mindedness is represented more difficult, than at a simple (uncomplicated) oligophrenia (see). In hard cases the wedge, a picture in many respects corresponds to organic dementia (see. Weak-mindedness ).

The secondary delays of mental development arising on the residual and organic soil differ in easier intellectual insufficiency and the reversible nature of disturbances in comparison with an oligophrenia. Clinically they are expressed in delays of rate of mental development, in particular in the form of organic mental (or psychophysical) infantility (see).

Psychopatholike syndromes in the remote period of R. of t. are characterized by dominance of emotional and strong-willed frustration and special psychomotor excitement. The hypererethism, motive disinhibition, instability, strengthening of rough inclinations which are combined with variously expressed asthenic frustration, and sometimes and decrease in intelligence are most often observed. Also aggression and brutality are characteristic. In the conditions of neglect and an adverse microsocial environment on this soil easily arise various patol. reactions and pathological development of the personality ( see).

Epileptiform manifestations in the remote period of R. of t. are various and expressed in various degree depending on localization and weight of injury of a brain. The mental disturbances accompanying them are also heterogeneous: along with organic decrease in level of the personality (see. A psychoorganic syndrome) epileptic changes of the personality, especially in cases zlokachestvenno of the proceeding symptomatic epilepsy are possible (see).

Asthenic states are observed almost at all forms of the remote effects of craniocereberal R. of t. Usually they are shown in the form of a long asthenic syndrome (see). The important place in a clinical picture belongs to other neurosis-like frustration, distinctiveness to-rykh consists in their lability and reversibility. However under the influence of adverse external and internal factors (an infection, an injury, a psychogenia, age crises, etc.) there can easily be a decompensation of a state.

Psychotic frustration in the remote period of R. of t. are observed seldom and have a difficult pathogeny. A certain value has, apparently, and hereditary predisposition. The wedge, a picture in many respects corresponds to a pathopsyhosis (see), in particular to periodic and incidental psychoses on integrally defective soil. Long forms quite often proceed with various shizofrenopodobny pictures.

Treatment of mental disorders, as a rule, symptomatic. Are of great importance the dehydrational, fortifying and stimulating therapy. If necessary use anticonvulsant and psychotropic drugs, including nootropic means. Medical and pedagogical actions and special methods of training are of great importance for a social readaptation.

The forecast of the mental disorders caused by R. in t., the wedge, pictures depends on weight of initial injury of a brain and features. In mild cases it is rather favorable.

Prevention nevrol. and mental disorders the t comes down to R.'s prevention.

The birth trauma of soft tissues

the Patrimonial tumor belongs to damages of soft tissues of the prelying part of a fruit and is characterized by hypostasis and frequent a hematoma. The hematoma formed under a periosteum of one of bones of a skull on its surface is called cephalhematoma (see). A patrimonial tumor (see. Caput succedaneum ) is located on a head of a fruit in parietal and occipital areas more often. Unlike a cephalhematoma hypostasis at a patrimonial tumor can extend out of limits of one cranial bone. At presentation of other parts of a fruit the patrimonial tumor arises respectively on a face, buttocks, a crotch, a shin. A wedge, manifestations depend on its sizes and localization, and also on a combination to other types of R. of t.

At buttock presentation the patrimonial tumor arises in the field of generative organs (big and small vulvar lips — at girls, a scrotum and testicles — at boys). Hemorrhage in a scrotum and testicles can be followed by painful shock.

At front presentation the patrimonial tumor is located in a forehead, eye-sockets, zygomas, a mouth, sometimes is followed by a considerable chemosis and a mucous membrane of lips, petekhialny and larger hemorrhages, is often combined with a craniocereberal birth trauma. Hypostasis of a mucous membrane of lips complicates the act of suction, the child is raised via the probe. At treatment of a patrimonial tumor apply locally cold, inside styptic means (Calcium chloratum, Rutinum, Vikasolum).

Usually patrimonial tumor resolves on 2 — the 3rd days of life of the child.

Quite often at childbirth hemorrhages in a sclera are observed, to-rye occur at large newborns at the complicated passing of a shoulder girdle in patrimonial ways of mother, and also at rapid childbirth and hard encirclement of an umbilical cord around a neck. Hemorrhages in a sclera of one or both eyes have the form of a half moon. At such disturbances apply oxygen therapy (see), styptic means, washing of a conjunctiva of 2% solution boric to - you. Hemorrhages resolve within 12 — 14 days.

Retinal apoplexies of eyes are combined with craniocereberal R. in t. At a research eyeground (see) in this case on a papilledema, a phlebectasia and existence of the centers of hemorrhages it is possible to establish intracranial hypertensia. Newborns with a retinal apoplexy need dehydrational therapy.

Injuries of skin and hypodermic cellulose result from a prelum and cups of a vacuum extractor are localized in places of pressing of fabrics to the cape of a sacrum of a bone basin of mother, and also in the field of imposing of electrodes of the monitor, obstetric and craniodermal nippers, that is especially adverse. Sites of the injured skin process 0,5% spirit solution of iodine and apply a dry aseptic bandage. During the bulging with hemorrhagic contents salve dressings with 1% of Shintoism-mitsinovoy an emulsion, antibacterial therapy are shown.

The aseptic necrosis of hypodermic cellulose in the form of the merging knotty consolidations and a bright dermahemia over them is noted in infrascapular area and area of a shoulder girdle. It the prelum of tissues of the child is the reason, to-rogo accumulation of acid products of exchange and loss fat to - t (stearin and palmitic) with formation of paraffinomas results. It is more often observed at large fruits, and also at the fruits which transferred diabetic fetopathy (see). Forecast favorable. Infection, as a rule, does not happen. Perhaps full rassasyvaniye of sites of consolidation in 2 — 3 weeks or partial treatment by their salts of calcium. Rassasyvaniya of consolidations salve dressings and heat baths promote. At suspicion on infection carry out antibacterial therapy.

Injuries of muscles of a fruit can arise at a rough obstetric grant. Damage grudino - a clavicular and mastoidal muscle happens at extraction of a fruit for the pelvic end, imposing of obstetric nippers and difficulty in removal of a head at buttock presentation. The hematoma accompanying a rupture of fibers grudino - a clavicular and mastoidal muscle, is found on a slivoobrazny thickening of this muscle in average or its lower third. The newborn at the same time inclines the head in the sick party, the wryneck in connection with shortening of N a thickening of the affected muscle, UVCh disappearing after use, special laying of the head and massage of muscles of cervicobrachial area is noted. The wryneck which is not cured at chest age demands further ortopedo-surgical treatment (see. Wryneck ). River of t. face muscles can result from a prelum its hinges of forceps, it is characterized by formation of a hematoma and a swelling in a cheek of the child, sometimes complicates suction.

The birth trauma of bones

the Fracture of a clavicle — one of the most frequent birth trauma (1 — 2%), a cut is the reason a wedge, discrepancy between the sizes of a basin of mother and a shoulder girdle of a large fruit. The fracture of a clavicle is observed at rapid childbirth when the shoulder girdle does not manage to make turn in a direct size and is born through narrower amount of escaping of a basin. Quite often the wrong rendering a manual grant in labor, with premature removal of a back plechik of a fruit and excessively strong pressing of a front plechik of a fruit to a pubic symphysis of mother is the reason of a fracture of clavicle. The fracture of the right clavicle as childbirth usually happens in the first position of a fruit is more often observed. The fracture of a clavicle is found right after the birth on crepitation and restriction of active movements of a hand. The subperiostal fracture of a clavicle and a change without shift can be found only on 5 — the 7th day of life of the child, after formation of a cartilaginous callosity. At a fracture of a clavicle apply a retentive bandage a shoulder girdle and a hand of the child, under a shoulder enclose the roller and take away a hand from a thorax, and bend a forearm in an elbow joint and lead to a trunk. The fracture of a clavicle grows together on 7 — the 8th day, the active movements in a hand are recovered. With a pressure of the displaced fragments upon area of a brachial plexus or formation of a hematoma emergence traumatic is possible plexitis (see).

The fracture of a humeral bone meets in one case on 2 thousand childbirth. Arises at difficulty of extraction of the handle of a fruit during rendering an obstetric grant at pelvic presentation. Occurs in an average third of a shoulder more often, is followed by the insignificant shift of fragments. It is distinguished on crepitation of fragments and formation of a tumor on site of a hematoma. Treatment consists in fixing of a hand along a body or imposing of the plaster tire from the back of a shoulder. The union occurs in 2 — 3 weeks. The change is possible also in the field of an epiphysis of a shoulder that it can be followed by its separation from a diaphysis of a bone, a rupture of sheaves and formation of an intra joint hematoma. The hand hangs on the party of damage, the rotirovana inside is brought to a body. In this case on the injured extremity impose the tire and the hand is given the provision of assignment and rotation of a knaruzha. Treatment comes in 3 weeks.

Fractures of bones of a forearm and edges meet very seldom and not R. are caused by t., and resuscitation actions.

Fractures of bones of a hip and shin at newborns are observed in one case on 4 thousand childbirth and are possible at extraction of a fruit for a leg in labor or extraction of a fruit legs at Cesarean section. The fracture of a femur is noted more often in an average third, is determined by the shortening of a hip connected with strong retraction of muscles and formation of a swelling, and also by painful reaction of the child. The diagnosis is confirmed at rentgenol. research. Treatment is carried out by skeletal traction. Treatment is done on the 4th week of life. The fracture of bones of a shin is determined by crepitation of fragments, by puffinesses of an extremity, painful reaction of the child. Is confirmed radiological. The immobilization of an extremity by means of the tire is necessary. The bone callosity is formed on the 3rd week of life of the child.

In case of long childbirth at buttock presentation and as a result of a mechanical prelum of the pelvic end of a fruit the injury of a pubic symphysis is possible. At treatment apply anesthetizing (Droperidolums) and styptic means, locally cold, applications from 0,25% solution of novocaine or lead lotions. To the child create the guarding mode and stack on spin with divorced hips. Forecast in most cases favorable.

The birth trauma of internals

the Birth trauma of internals makes about 30% of total number of R. of t., the newborns who were a cause of death. The liver, adrenal glands and kidneys are more often injured. The injury of abdominal organs and retroperitoneal space got at the time of delivery can be a cause of death of the child during the first hours or days of life. Occurs more often at large and premature fruits, at the rapid or long childbirth which is followed by a hypoxia. The injury of a liver is promoted its increase (at a hemolitic disease, vascular tumors) and the wrong arrangement. Even at a small injury of a liver gradually increasing hematoma conducts to extensive amotio of the capsule, and then its gap with the subsequent bleeding in an abdominal cavity. Weight of a picture depends On a damage rate and the size of a hematoma. Pallor of skin, slackness, swelling, asymmetry, tension and morbidity of a stomach, a cholemesis, sometimes raying of a hematoma through a front abdominal wall, decrease in a hemoglobin content in blood is noted. Make a puncture of an abdominal cavity for confirmation of the diagnosis (see. Laparocentesis ). Treatment consists in urgent laparotomies (see), hemihepatectomies (see), hemotransfusion.

At injury of a kidney the general condition of the child soon after the birth progressively worsens, appears blood in urine, vomiting, vomiting, a swelling in lumbar area. The diagnosis is confirmed at urological inspection. Styptic and antibacterial therapy is shown.

Hemorrhages in adrenal glands are characterized by sharply expressed general weakness, development collapse (see) and anemias (see). Treatment is carried out by a hydrocortisone and styptic means.

The forecast at R. of t. internals serious, lethality high.

See also Newborn , Perinatal pathology .

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I. P. Yelizarova; L. O. Badalyan, L. T. Zhurba (not BP.), M. Sh. Vrono (psikhiat.).