Birth injury

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Birth injury refers to damage or injury to the child before, during, or just after the birthing process. "Birth trauma" refers specifically to mechanical damage sustained during delivery (such as nerve damage and broken bones). [1]

Contents

The term "birth injury" may be used in two different ways:

  1. the ICD-10 uses "birth injury" and "birth trauma" interchangeably to refer to mechanical injuries sustained during delivery;
  2. the legal community uses "birth injury" to refer to any damage or injury sustained during pregnancy, during delivery, or just after delivery, including injuries caused by trauma.

Birth injuries must be distinguished from birth defects. "Birth defect" refers to damage that occurs while the fetus is in the womb, which may be caused by genetic mutations, infections, or exposure to toxins. There are more than 4,000 types of birth defects. [2]

Causes

Difficult labor (dystocia)

Difficult labor, also known as dystocia or obstructed labor, occurs when the child cannot easily pass through the birth canal. This can result in fetal distress or physical trauma to the child, especially broken clavicles and damage to the brachial plexus nerves. It can also deprive the child of oxygen as the umbilical cord is pinched, potentially causing brain damage or death. [3]

Difficult labor may occur because the baby is abnormally large (macrosomia), because the mother's pelvis or birth canal is small or deformed, or because the baby is in an abnormal presentation for the birth (such as breech or transverse presentation). [4]

External causes

Fetal malformations and birth injuries may occur as a result of exposure to environmental toxins such as mercury or lead. [5] Many medications can also affect the development of the fetus, as can alcohol, tobacco, and illicit drugs. [6]

Genetic mutations

Genetic mutations can cause a wide variety of fetal malformations, ranging from relatively mild cleft lips to severe and even fatal deformities.[ medical citation needed ]

Infection

Maternal infection may be transmitted to the fetus; this is called a vertically transmitted infection. The fetus has a weak immune system, so infections that are relatively minor in adults can be serious in a developing fetus.[ medical citation needed ] In addition, some studies suggest that maternal infections increase the risk of neurodevelopmental disorders, including schizophrenia, in the child. [7]

Intrauterine hypoxia

Intrauterine hypoxia, or oxygen deprivation in the womb, can cause serious brain damage in the fetus. It most commonly occurs because of damage to or malformation of the umbilical cord or placenta. Intrauterine hypoxia can cause brain damage, including cerebral palsy and other neurological and psychiatric disorders. [8]

Maternal health issues

Certain maternal health issues can cause birth injuries. Gestational diabetes can cause premature birth, macrosomia, or stillbirth. [9]

Pregnancy complications

Complications such as placenta previa, placental abruption, placenta accreta, retained placenta, placental insufficiency, placental infarcts, anemia, and preeclampsia can limit the supply of oxygen and nutrients to the fetus, increasing the risk of birth defects. Severe cases may be fatal to the fetus. [10]

Common types of birth injury

Brachial plexus injury

The brachial plexus is the plexus of nerves that lies between the neck and axilla and controls the motion of the arm and hand. The brachial plexus may be stretched and damaged during a difficult delivery. In minor cases, the nerves heal and full use of the hand and arm is recovered. In more severe cases, the child may sustain permanent nerve damage and may not have full use of the shoulder, arm, or hand. Brachial plexus injuries occur in 1–3 children per 1,000 live births. [11]

See Erb's palsy and Klumpke's palsy.

Brain damage

Brain damage may be caused by a number of factors, including fetal malformation due to genetic mutation or exposure to toxins, intrauterine hypoxia, or physical trauma during delivery. [12]

Cerebral palsy is one example of brain damage incurred before or during delivery; about 10,000 children are diagnosed with cerebral palsy every year. [13]

Bruising

A difficult delivery may lead to bruising, especially on the head and face, from pressure against the mother's pelvis or pressure caused by forceps or a vacuum device (see ventouse) used in delivery. [14]

Bone fractures

Bone fractures can occur during a difficult delivery. Fracture of the clavicle is the most common birth injury. [15]

Meconium aspiration syndrome

Meconium is a sticky substance that usually makes up the child's first bowel movement. If the fetus is stressed before or during delivery, the meconium may be released and may mix with the amniotic fluid. If it gets into the child's airways or lungs, it can cause meconium aspiration syndrome. Serious cases may result in pneumonia or a collapsed lung. [16]

Birth injuries may be unavoidable or they may be attributable to medical malpractice. When a legal claim results, birth injury cases are a subset of medical malpractice cases. Legal claims from birth injury cases typically seek compensation for the medical costs associated with the injury, including ongoing therapeutic and medical support for the child.

In order to prevail in a birth injury malpractice case, the plaintiff must show (1) that the medical care provider owed a duty to the child, (2) that the medical care provider breached that duty by failing to meet the accepted standard of care, (3) that the child sustained an injury that was caused by the medical care provider's breach of duty to the child, and (4) the child sustained damages as a result of the injury. All four elements must be present in order for the plaintiff to win. [17]

Related Research Articles

<span class="mw-page-title-main">Brachial plexus</span> Network of nerves

The brachial plexus is a network of nerves formed by the anterior rami of the lower four cervical nerves and first thoracic nerve. This plexus extends from the spinal cord, through the cervicoaxillary canal in the neck, over the first rib, and into the armpit, it supplies afferent and efferent nerve fibers to the chest, shoulder, arm, forearm, and hand.

<span class="mw-page-title-main">Birth defect</span> Condition present at birth regardless of cause

A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can range from mild to severe. Birth defects are divided into two main types: structural disorders in which problems are seen with the shape of a body part and functional disorders in which problems exist with how a body part works. Functional disorders include metabolic and degenerative disorders. Some birth defects include both structural and functional disorders.

<span class="mw-page-title-main">Twin-to-twin transfusion syndrome</span> Medical condition

Twin-to-twin transfusion syndrome (TTTS), also known as feto-fetal transfusion syndrome (FFTS), twin oligohydramnios-polyhydramnios sequence (TOPS) and stuck twin syndrome, is a complication of monochorionic multiple pregnancies in which there is disproportionate blood supply between the fetuses. This leads to unequal levels of amniotic fluid between each fetus and usually leads to death of the undersupplied twin and, without treatment, usually death or a range of birth defects or disabilities for a surviving twin, such as underdeveloped, damaged or missing limbs, digits or organs, especially cerebral palsy.

Perinatal asphyxia is the medical condition resulting from deprivation of oxygen to a newborn infant that lasts long enough during the birth process to cause physical harm, usually to the brain. It remains a serious condition which causes significant mortality and morbidity. It is also the inability to establish and sustain adequate or spontaneous respiration upon delivery of the newborn, an emergency condition that requires adequate and quick resuscitation measures. Perinatal asphyxia is also an oxygen deficit from the 28th week of gestation to the first seven days following delivery. It is also an insult to the fetus or newborn due to lack of oxygen or lack of perfusion to various organs and may be associated with a lack of ventilation. In accordance with WHO, perinatal asphyxia is characterised by: profound metabolic acidosis, with a pH less than 7.20 on umbilical cord arterial blood sample, persistence of an Apgar score of 3 at the 5th minute, clinical neurologic sequelae in the immediate neonatal period, or evidence of multiorgan system dysfunction in the immediate neonatal period. Hypoxic damage can occur to most of the infant's organs, but brain damage is of most concern and perhaps the least likely to quickly or completely heal. In more pronounced cases, an infant will survive, but with damage to the brain manifested as either mental, such as developmental delay or intellectual disability, or physical, such as spasticity.

<span class="mw-page-title-main">Erb's palsy</span> Paralysis of the arm usually caused during birth

Erb's palsy is a paralysis of the arm caused by injury to the upper group of the arm's main nerves, specifically the severing of the upper trunk C5–C6 nerves. These form part of the brachial plexus, comprising the ventral rami of spinal nerves C5–C8 and thoracic nerve T1. These injuries arise most commonly, but not exclusively, from shoulder dystocia during a difficult birth. Depending on the nature of the damage, the paralysis can either resolve on its own over a period of months, necessitate rehabilitative therapy, or require surgery.

<span class="mw-page-title-main">Cerebral hypoxia</span> Oxygen shortage of the brain

Cerebral hypoxia is a form of hypoxia, specifically involving the brain; when the brain is completely deprived of oxygen, it is called cerebral anoxia. There are four categories of cerebral hypoxia; they are, in order of increasing severity: diffuse cerebral hypoxia (DCH), focal cerebral ischemia, cerebral infarction, and global cerebral ischemia. Prolonged hypoxia induces neuronal cell death via apoptosis, resulting in a hypoxic brain injury.

Prenatal development involves the development of the embryo and of the fetus during a viviparous animal's gestation. Prenatal development starts with fertilization, in the germinal stage of embryonic development, and continues in fetal development until birth.

<span class="mw-page-title-main">Brachial plexus injury</span> Medical condition

A brachial plexus injury (BPI), also known as brachial plexus lesion, is an injury to the brachial plexus, the network of nerves that conducts signals from the spinal cord to the shoulder, arm and hand. These nerves originate in the fifth, sixth, seventh and eighth cervical (C5–C8), and first thoracic (T1) spinal nerves, and innervate the muscles and skin of the chest, shoulder, arm and hand.

Neurodevelopmental disorders are a group of conditions that begin to emerge during childhood. According to the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5) published in 2013, these conditions generally appear in early childhood, usually before children start school, and can persist into adulthood. The key characteristic of all these disorders is that they negatively impact a person's functioning in one or more domains of life depending on the disorder and deficits it has caused. All of these disorders and their levels of impairment exist on a spectrum, and affected individuals can experience varying degrees of symptoms and deficits, despite having the same diagnosis.

<span class="mw-page-title-main">Intrauterine hypoxia</span> Medical condition when the fetus is deprived of sufficient oxygen

Intrauterine hypoxia occurs when the fetus is deprived of an adequate supply of oxygen. It may be due to a variety of reasons such as prolapse or occlusion of the umbilical cord, placental infarction, maternal diabetes and maternal smoking. Intrauterine growth restriction may cause or be the result of hypoxia. Intrauterine hypoxia can cause cellular damage that occurs within the central nervous system. This results in an increased mortality rate, including an increased risk of sudden infant death syndrome (SIDS). Oxygen deprivation in the fetus and neonate have been implicated as either a primary or as a contributing risk factor in numerous neurological and neuropsychiatric disorders such as epilepsy, attention deficit hyperactivity disorder, eating disorders and cerebral palsy.

Postterm pregnancy is when a woman has not yet delivered her baby after 42 weeks of gestation, two weeks beyond the typical 40-week duration of pregnancy. Postmature births carry risks for both the mother and the baby, including fetal malnutrition, meconium aspiration syndrome, and stillbirths. After the 42nd week of gestation, the placenta, which supplies the baby with nutrients and oxygen from the mother, starts aging and will eventually fail. Postterm pregnancy is a reason to induce labor.

Spastic quadriplegia, also known as spastic tetraplegia, is a subset of spastic cerebral palsy that affects all four limbs.

An asynclitic birth or asynclitism are terms used in obstetrics to refer to childbirth in which there is malposition of the head of the fetus in the uterus, relative to the birth canal. Asynclitic presentation is different from a shoulder presentation, in which the shoulder is presenting first. Many babies enter the pelvis in an asynclitic presentation, and most asynclitism corrects spontaneously as part of the normal birthing process.

An obstetric labor complication is a difficulty or abnormality that arises during the process of labor or delivery.

<span class="mw-page-title-main">Birth trauma (physical)</span> Medical condition

Birth trauma refers to damage of the tissues and organs of a newly delivered child, often as a result of physical pressure or trauma during childbirth. It encompasses the long term consequences, often of cognitive nature, of damage to the brain or cranium. Medical study of birth trauma dates to the 16th century, and the morphological consequences of mishandled delivery are described in Renaissance-era medical literature. Birth injury occupies a unique area of concern and study in the medical canon. In ICD-10 "birth trauma" occupied 49 individual codes (P10–Р15).

<span class="mw-page-title-main">Circumvallate placenta</span> Medical condition

Circumvallate placenta is a rare condition affecting about 1-2% of pregnancies, in which the amnion and chorion fetal membranes essentially "double back" on the fetal side around the edges of the placenta. After delivery, a circumvallate placenta has a thick ring of membranes on its fetal surface. Circumvallate placenta is a placental morphological abnormality associated with increased fetal morbidity and mortality due to the restricted availability of nutrients and oxygen to the developing fetus.

Uterine Tachysystole is a condition of excessively frequent uterine contractions during pregnancy. It is most often seen in induced or augmented labor, though it can also occur during spontaneous labor, and this may result in fetal hypoxia and acidosis. This may have serious effects on both the mother and the fetus including hemorrhaging and death. There are still major gaps in understanding treatment as well as clinical outcomes of this condition. Uterine tachysystole is defined as more than 5 contractions in 10 minutes, averaged over a 30-minute period.

<span class="mw-page-title-main">High-risk pregnancy</span> Medical condition

A high-risk pregnancy is a pregnancy where the mother or the fetus has an increased risk of adverse outcomes compared to uncomplicated pregnancies. No concrete guidelines currently exist for distinguishing “high-risk” pregnancies from “low-risk” pregnancies; however, there are certain studied conditions that have been shown to put the mother or fetus at a higher risk of poor outcomes. These conditions can be classified into three main categories: health problems in the mother that occur before she becomes pregnant, health problems in the mother that occur during pregnancy, and certain health conditions with the fetus.

<span class="mw-page-title-main">Operative vaginal delivery</span>

Operative vaginal delivery, also known as assisted or instrumental vaginal delivery, is a vaginal delivery that is assisted by the use of forceps or a vacuum extractor.

References

  1. ↑ Laroia, Nirupama (2 February 2015). "Birth Trauma". MedScape. WebMD LLC. Retrieved 13 December 2017.
  2. ↑ "Birth Defects". Kids Health. Nemours. Retrieved 13 December 2017.
  3. ↑ James, Andrew (28 October 2009). "Brain and Behaviour Problems". AboutKidsHealth. Retrieved 13 December 2017.
  4. ↑ Kancherla, Ramprasad; Sankinean, Sukesh Rao; Naranje, Sameer; Rijal, Laxman; Kumar, Ramakant; Ansari, Tahir; Trikha, Vivek (26 June 2012). "Birth-related femoral fracture in newborns: risk factors and management". Journal of Children's Orthopaedics. 6 (3): 177–180. doi:10.1007/s11832-012-0412-4. PMC   3400005 . PMID   23814617.
  5. ↑ Roberts, James (31 December 2009). "Toxic Effects of Lead and Mercury". MedScape. Retrieved 13 December 2017.
  6. ↑ "NICHD Research Seeks Clues into the Causes of Alcohol- and Drug-Related Birth Defects". NIH. National Institutes of Health. 27 June 2012. Retrieved 13 December 2017.
  7. ↑ Urakubo, Ari; Jarskog, L. Fredrik; Lieberman, Jeffrey A.; Gilmore, John H. (15 January 2001). "Prenatal exposure to maternal infection alters cytokine expression in the placenta, amniotic fluid, and fetal brain". Schizophrenia Research. 47 (1): 27–36. doi:10.1016/s0920-9964(00)00032-3. PMID   11163542. S2CID   29110700 . Retrieved 13 December 2017.
  8. ↑ Gunn, AJ; Bennet, L (2009). "Fetal hypoxia insults and patterns of brain injury: insights from animal models". Clin Perinatol. 36 (3): 579–93. doi:10.1016/j.clp.2009.06.007. PMC   2767254 . PMID   19732615.
  9. ↑ "Meconium aspiration". March of Dimes. 21 September 2010. Retrieved 13 December 2017.
  10. ↑ "Pregnancy Complications". Center for Disease Control. 17 June 2016. Retrieved 13 December 2017.
  11. ↑ "Brachial Plexus Birth Palsy". Boston Children's Hospital. Archived from the original on 14 December 2017. Retrieved 13 December 2017.
  12. ↑ Hagberg, Henrik; Edwards, A. Davis; Groenendaal, Floris (August 2016). "Perinatal brain damage: The term infant". Neurobiology of Disease. 92 (Pt A): 102–112. doi:10.1016/j.nbd.2015.09.011. PMC   4915441 . PMID   26409031.
  13. ↑ "Data & Statistics for Cerebral Palsy". Centers for Disease Control and Prevention. 2 May 2016. Retrieved 13 December 2017.
  14. ↑ "Recovering from an assisted birth Approved". BabyCentre. July 2015. Retrieved 13 December 2017.
  15. ↑ "Newborn Clavicle Fractures". Nationwide Children's. Nationwide Children's Hospital. Retrieved 13 December 2017.
  16. ↑ "Meconium aspiration". 21 September 2010.
  17. ↑ Bal, B. Sonny (26 November 2008). "An Introduction to Medical Malpractice in the United States". Clinical Orthopaedics & Related Research. 467 (2): 339–347. doi:10.1007/s11999-008-0636-2. PMC   2628513 . PMID   19034593.
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