Being born is quite a traumatic experience. It becomes even more traumatic if there are complications, such as shoulder dystocia, failure to progress or an instrumental delivery. There are some key injuries that can occur at birth.
Caput succedaneum (caput) involves fluid (oedema) collecting on the scalp, outside the periosteum. Caput is caused by pressure to a specific area of the scalp during a traumatic, prolonged or instrumental delivery. The periosteum is a layer of dense connective tissue that lines the outside of the skull and does not cross the sutures (the gaps in the baby’s skull). The fluid is outside the periosteum, which means it is able to cross the suture lines. There is usually no, or only mild, discolouration of the skin. It does not require any treatment and will resolve within a few days.
A cephalohaematoma is a collection of blood between the skull and the periosteum. It is caused by damage to blood vessels during a traumatic, prolonged or instrumental delivery. It can be described as a traumatic subperiosteal haematoma.
The blood is below the periosteum, therefore the lump does not cross the suture lines of the skull. This is an important way of distinguishing caput succedaneum from cephalohaematoma. Additionally, the blood can cause discolouration of the skin in the affected area.
Usually a cephalohaematoma does not required any intervention and resolves without treatment within a few months. There is a risk of anaemia and jaundice due to the blood that collects within the haematoma and breaks down, releasing bilirubin. For this reason the baby should be monitored for anaemia, jaundice and resolution of the haematoma.
Delivery can cause damage to the facial nerve. Facial nerve injury is typically associated with a forceps delivery. This can result in facial palsy (weakness of the facial nerve on one side). Function normally returns spontaneously within a few months. If function does not return they may required neurosurgical input.
An Erbs palsy is the result of injury to the C5/C6 nerves in the brachial plexus during birth. It is associated with shoulder dystocia, traumatic or instrumental delivery and large birth weight.
Damaged to the C5/C6 nerves leads to weakness of shoulder abduction and external rotation, arm flexion and finger extension. This leads to the affected arm having a “waiters tip” appearance:
- Internally rotated shoulder
- Extended elbow
- Flexed wrist facing backwards (pronated)
- Lack of movement in the affected arm
Function normally returns spontaneously within a few months. If function does not return then they may required neurosurgical input.
The clavicle may be fractured during birth. A fractured clavicle can be associated with shoulder dystocia, traumatic or instrumental delivery and large birth weight.
A fractured clavicle can be picked up shortly after birth or during the newborn examination with:
- Noticeable lack of movement or asymmetry of movement in the affected arm
- Asymmetry of the shoulders, with the affected shoulder lower than the normal shoulder
- Pain and distress on movement of the arm
A fractured clavicle can be confirmed with ultrasound or x-ray. Management is conservative, occasionally with immobilisation of the affected arm. It usually heals well. The main complication of a fractured clavicle is injury to the brachial plexus, with a subsequent nerve palsy.
Last updated January 2020