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Birth trauma. What is birth trauma?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Birth trauma is a collective concept that includes various damage to tissues and organs of a woman in labor or a newborn, caused by the action of birth forces. Among the birth injuries of the mother, there are hematomas, ruptures of the vulva, perineum and vagina, damage to the uterus, the formation of urogenital and enterogenital fistulas, and deformities of the pelvic bones. Many birth injuries can be life threatening. Diagnosis of birth injuries is based on external examination, gynecological examination, instrumental methods. Treatment of maternal birth injuries, as a rule, requires emergency surgical assistance and the involvement of narrow specialists (urologists, proctologists, traumatologists). nine0006

ICD-10

P10-P15 Birth trauma

• Common causes of maternal birth injuries
• Birth injuries of the vulva and vagina
  • Vulvar and vaginal hematomas
  • Tears of the vulva and vagina
• Birth injuries of the perineum
  • Perineal tear symptoms
  • Diagnosis and treatment of perineal tears
• Birth trauma of the uterus
  • Uterine ruptures
  • Classification of uterine ruptures
  • Symptoms of uterine rupture
  • Uterine rupture emergency
  • Cervical tears
  • Symptoms of cervical rupture
  • Diagnosis and treatment of cervical tears
• Other birth injuries
  • Uterine eversion
  • Sprains and ruptures of the pelvic joints
  • Urogenital and rectovaginal fistulas
nine0015 Prevention of birth injuries
• Prices for treatment

General

Childbirth is a difficult test for the newborn fetus and mother. Therefore, after the birth of a child, experts often state the presence of various birth injuries and postpartum disorders in a woman in labor and a newborn. In obstetrics and gynecology, maternal and child birth injuries are distinguished. Birth injuries of a newborn include damage to the peripheral and central nervous systems of various nature and severity, injuries to bones and soft tissues, and internal organs. As part of this review, the main birth injuries that occur in women will be considered. nine0006

Significant stretching of the mother's birth canal during childbirth often leads to their damage. These injuries - birth injuries, can be superficial, non-rough in nature (for example, abrasions, cracks) and heal on their own in the early postpartum period, and remain unrecognized. In some cases, birth injuries are so significant that they can lead to serious postpartum complications, disability and even death of a woman. Among birth injuries of the mother there are hematomas; ruptures of the vulva, perineum, vagina, body and cervix; inversion of the uterus; sprains and ruptures of the joints of the pelvis; urogenital and enterogenital fistulas. nine0006

Birth injury

Common causes of maternal birth injuries

The variety of variants of maternal birth injuries can be caused by various mechanical and histopathic causes. The mechanical factors in the occurrence of birth injuries include violent or discoordinated labor activity, the provision of operational aids during childbirth (the application of forceps, vacuum extraction of the fetus, manual separation of the placenta, fruit-destroying operations), excessive labor stimulation, irrational management of the straining period, inadequate protection of the perineum, etc. e. Post-term pregnancy, transverse position of the fetus, breech presentation of the fetus, premature birth, narrow pelvis, polyhydramnios, multiple pregnancy, placenta previa can contribute to birth injuries. nine0006

Histopathic causes of birth injuries are due to a burdened obstetric and gynecological history of the woman in labor. So, the causes of birth injuries of the uterus can be surgical interventions in the past (caesarean section, metroplasty, conservative myomectomy, complete or partial perforation of the uterus during abortion, etc.), which lead to the formation of a scar on the uterus and, as a result, inadequate contractility of the myometrium in childbirth.

The likelihood of birth canal injuries increases in the presence of anatomical defects of the genitals (intrauterine septum, uterine hypoplasia, bicornuate uterus), cervical rigidity in late primiparas, uterine hyperanteflexia. Also, birth injuries can be caused by cervicitis, adenomyosis, endometritis, colpitis, cystic drift and chorionepithelioma. In the etiopathogenesis of birth trauma, there are often several aggravating factors. nine0006

Birth injuries of the vulva and vagina

Hematomas of the vulva and vagina

Hematomas of the vulva and vagina are caused by stretching and rupture of blood vessels in the thickness of the soft tissues with intact integuments. In this case, the blood pouring out of the damaged vessel accumulates in the fiber and under the mucosa, forming a hematoma.

With birth injuries of soft tissues in the vulva and vagina, a blue-purple tumor appears, the size of which can reach the head of a newborn. Hematomas cause a feeling of discomfort (bursting, pressure), soreness. Large progressive hematomas extend to the pelvic tissue and may be accompanied by the development of hemorrhagic shock. Small hemorrhages usually resolve on their own; with large hematomas, their suppuration is possible. Recognition of birth injuries of soft tissues occurs during external examination and gynecological examination. nine0006

Surgical tactics are indicated for large (more than 4-5 cm in diameter) and progressive hematomas. At the same time, the tissues above the hematoma are opened, the accumulated blood is removed, the bleeding vessel is isolated and tied up, the wound is sewn up tightly. With an infected hematoma, the wound is not sutured. With a progressive hematoma, abdominotomy is sometimes required.

Tears of the vulva and vagina

Birth injuries of the vulva and vagina are most common in primiparas. Mild cracks and tears are usually asymptomatic and do not require intervention. Tears in the clitoris, urethra, vagina are accompanied by the formation of hematomas, massive bleeding, hemorrhagic shock. nine0006

Birth injuries of the vagina can be spontaneous and violent. In the latter case, the causes of birth injuries are various obstetric operations. Vaginal tears can occur in its upper, middle, or lower sections; be superficial or deep, reaching the tissue of the small pelvis and abdominal cavity.

Birth injuries of the tissues of the vulva are detected during examination. To exclude internal tears, it is necessary to examine the walls of the vagina with the help of mirrors. nine0006

Treatment of birth injuries of the vulva and vagina is exclusively surgical. After catheterization of the bladder with a metal catheter, the tears are sutured with catgut sutures. In the postoperative period, antimicrobial therapy and vaginal baths with antiseptics are prescribed. Unrecognized vaginal tears may heal uncomplicated or become infected. Deep tears can subsequently lead to secondary vaginal atresia, necessitating vaginoplasty. nine0006

Birth injuries of the perineum

Birth injuries of the perineum include violent or spontaneous ruptures of the skin, fiber and muscle-fascial tissues of the pelvic floor. Birth injuries of the perineum occur in 7-15% of women in labor, and much more often in primiparas. Perineal ruptures are often combined with birth injuries of the vagina.

Protrusion and cyanosis of the tissues of the pelvic floor, swelling and luster of tissues, cracks testify to the threat of birth injury of the perineum. If there is a threat of birth injury of the perineum, they resort to a median dissection of tissues - perineotomy or a lateral incision - episiotomy, followed by suturing. nine0006

Perineal tear symptoms

Depending on the depth of the birth injury, 3 degrees of perineal ruptures are distinguished.

With a rupture of the perineum of the 1st degree, the integrity of the skin and subcutaneous tissue in the region of the posterior commissure is violated. II degree of perineal rupture is characterized by additional injuries of the pelvic floor muscles (including the muscles that lift the anus), the back or side walls of the vagina. With a birth injury of the perineum of the III degree, the rupture of the external sphincter, and sometimes the walls of the rectum, joins the above injuries. nine0006

Birth injuries of the perineum are manifested by a violation of the integrity of tissues and bleeding.

Diagnosis and treatment of perineal tears

Birth injuries of the perineum are recognized after the birth of the placenta. To do this, the obstetrician-gynecologist spreads the genital gap, examines the walls of the vagina and the cervix. More often damage to the perineum during childbirth occurs not along the midline, but extramedially, but there is also a central gap between the posterior commissure and the muscle that lifts the anus. nine0006

Restoration of the integrity of the tissues of the perineum is performed by suturing under local infiltration or general anesthesia. Separate catgut sutures are placed on the damaged walls of the vagina and rectum, pelvic floor muscles, subcutaneous tissue and perineal skin. In the postpartum period, sutures are processed, a thorough toilet of the wound after each defecation and urination, and constipation is prevented.

Birth injuries of the uterus

Uterine ruptures

Uterine rupture is one of the most severe birth injuries and occurs in 0.015% -0.1% of the total number of births. When the uterus ruptures, the integrity of the walls of its body is violated. The lethality of women with birth trauma of the uterus from shock, anemia and septic complications reaches 3-4%. Many women who have had uterine rupture develop hypoxic encephalopathy later on. Fetal death in uterine rupture is close to 100%. nine0006

Classification of uterine ruptures

There are uterine ruptures that occurred during pregnancy and during childbirth. According to the pathogenetic signs of birth trauma, spontaneous (mechanical, histopathic and mechanical-histopathic) and violent (traumatic, mixed) uterine ruptures are distinguished. According to the birth trauma clinic, uterine ruptures can be threatening, begun, completed.

According to the degree of damage to the walls of the uterus, a birth injury can take the form of a crack, incomplete rupture and complete rupture penetrating into the abdominal cavity. By localization, there is a rupture of the bottom of the uterus, its body, the lower segment, as well as a complete separation of the uterus from the vaginal vaults (colpoporexis) in the transverse position of the fetus. nine0006

Symptoms of uterine rupture

The clinic of birth trauma of the uterus depends on the causes, stage, degree, localization of the rupture. The severity of manifestations and consequences are largely due to the accompanying background - in the presence of somatic diseases of the woman in labor, gestosis, physical and mental exhaustion, infection, etc., irreversible changes quickly develop in the body.

For threatening rupture of the uterus, excessive labor activity with painful strong contractions, deformity of the uterus in the form of an hourglass, development of edema of the cervix, vagina and vulva, difficulty urinating, anxiety of the woman in labor are typical. With the onset of uterine rupture, the listed symptoms are supplemented by convulsive contractions, the appearance of sanious or bloody discharge from the vagina, and hematuria. nine0006

With the completed rupture of the uterus, after a sharp pain and burning sensation in the abdomen, labor activity stops, the woman in labor calms down, becomes depressed, apathetic. Due to the development of hemorrhagic and painful shock, pallor of the skin, hypotension, tachycardia rapidly increase, cold sweat, nausea and vomiting appear. After rupture of the uterus, parts of the fetus are partially or completely palpated in the abdominal cavity, there is no fetal heartbeat. External bleeding with this birth injury can be significant or scanty, depending on the size and location of uterine rupture. nine0006

Uterine rupture emergency

If there is a threat of uterine rupture, it is necessary to immediately stop labor and complete labor by surgery - caesarean section or fruit-destroying surgery. With the onset or completed uterine rupture, cerebrosection is performed, the fetus and placenta are removed, amniotic fluid and blood are removed, and hemostasis is performed. The volume of intervention for these birth injuries ranges from supravaginal amputation to hysterectomy. Uterine suturing is possible in young patients with recent and small ruptures of a linear nature, the absence of infection. nine0006

At the same time, it is necessary to carry out adequate replenishment of blood loss, anti-shock infusion-transfusion therapy, and correction of hemocoagulation. If birth injuries of the uterus were not recognized, bleeding or peritonitis may develop, as well as the death of the puerperal. With infectious complications, laparotomy, removal of the uterus with appendages (panhysterectomy), drainage of the abdominal cavity, and massive antibiotic therapy are undertaken.

Cervical tears

This type of birth injury occurs according to various authors in 3-60% of women in labor. Cervical ruptures (violent or spontaneous) are divided into 3 degrees according to the depth of damage: I - a defect of no more than 2 cm; II - defect more than 2 cm, but not reaching the vaginal vaults; III - a defect that reaches the vaults and passes to them. Cervical ruptures are usually localized in the lateral sections, more often on the left.

Symptoms of cervical tears

Birth injuries of the cervix are manifested by postpartum bleeding from the vagina after the birth of the placenta and contraction of the uterus. Blood flowing from the genital tract has a scarlet color, is released in a continuous stream or in the form of a large number of clots in the absence of external damage to the birth canal. Sometimes there is little or no bleeding. If the branches of the uterine arteries are damaged, there is a massive outpouring of blood or the formation of hematomas in the paracervical tissue, a clinic of hemorrhagic shock. nine0006

If cervical ruptures remain unrecognized, in the future this can lead to the development of postpartum ulcers, parametritis, pelvioperitonitis, spontaneous abortions, and cervical dysplasia.

Diagnosis and treatment of cervical tears

To recognize birth injuries of the cervix, all puerperas need to be examined with the help of mirrors immediately after the completion of childbirth, and also 6-48 hours after the reduction of edema and tissue stretching.

Detected ruptures of the cervix are subject to suturing immediately or delayed, no later than 2 days after birth. The sutures are applied to the ruptures of the neck through all layers of tissues, starting from the upper corner of the defect in the direction of the external pharynx. Due to unfavorable conditions (the presence of lochia, edema, crushing of tissues), birth injuries of the cervix often heal by secondary intention. nine0006

Other birth injuries

Uterine eversion

The development of acute uterine inversion is due to improper management of the afterbirth period, weakness of the uterine ligaments, and atony of the uterus. Distinguish between partial and complete eversion of the uterus. This birth injury proceeds with the phenomena of pain shock.

Treatment of uterine inversion consists in anti-shock measures and reduction of the uterus to its anatomical site under general anesthesia.

Sprains and ruptures of the pelvic joints

These birth injuries develop with excessive softening of the joints of the pelvis (symphysiopathy, symphysitis), childbirth with a premature or large fetus, obstetric benefits. In this case, the pubic bones are stretched and separated at a distance of more than 0.5 cm from each other. Rupture of the pubic joint is often accompanied by displacement of bones, damage to the bladder, urethra, and clitoris. Stretching of the sacroiliac joints leads to hemorrhages and subsequent inflammation of the joints.

The clinic of birth injuries of the pelvic joints is manifested by pain in the womb, coccyx, sacrum, aggravated by abduction of the legs, walking; gait disturbance, skin hyperemia and swelling of surrounding tissues.

Birth injuries of the pelvic region are detected during the consultation of a traumatologist during examination, palpation, radiography of the pubic, sacroiliac joint, and pelvis. Treatment of sprains of the pelvic joints requires rest, tight bandaging, wearing special corsets. A rupture of the pubic symphysis or a significant divergence of the pelvic bones requires surgical intervention. nine0006

Urogenital and rectovaginal fistulas

Birth injuries with the formation of fistulas are caused by prolonged (more than 2 hours) standing of the child's head in one plane, as a result of which a violation of blood circulation in tissues develops with their subsequent necrosis. Sometimes urogenital and rectal-vaginal fistulas are formed as a result of intraoperative damage to the walls of the bladder or rectum.

Fistulas are manifested by the release of urine or gases and feces through the vagina outside the acts of urination and defecation. Such disorders are always accompanied by the development of a local inflammatory reaction in the vagina (colpitis). nine0006

Diagnosis of urogenital fistulas is made during a gynecological examination, cystoscopy; rectal-vaginal fistulas are recognized by digital rectal examination, irrigoscopy, fistulography, and rectoscopy. When detecting urogenital and rectovaginal fistulas, their surgical closure (fistuloplasty) is usually required.

Birth injury prevention

Prevention of birth injuries of the uterus requires the study of the gynecological history of the pregnant woman in the early stages, ultrasound monitoring of the state of scars on the uterus during pregnancy, hospitalization of pregnant women with the threat of traumatism during childbirth. nine0006

Prevention of birth injuries requires the rejection of forced delivery, the use of obstetric benefits strictly according to indications.

You can share your medical history, what helped you in the treatment of birth trauma.

Sources

1. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor. nine0006

   Birth injury - causes of disease, methods, prevention

   Birth injury

   Sign up Clinic "OSTEOMED" provides treatment of birth injuries, rehabilitation after birth injuries in newborns, infants (infants), babies. Birth trauma is treated with effective osteopathic methods. Traditional and modern methods of reflexology (reflexotherapy) are actively used in the treatment. We carry out the restoration of the child's nervous system (NS), recovery after birth injuries. In pediatric practice, an osteopathic approach is mainly used, which is absolutely gentle and safe for babies. The osteopath applies gentle hand pressure on the baby's head and body to ease the effects of birth stress, and correct tension in the skull bones and restore their proper movement. Children and babies feel great after treatment and sleep better. nine0006

   Birth injury is damage to the tissues or organs of the fetus during childbirth (birth act) due to the local action of mechanical forces on the fetus. Unfortunately, birth injuries in newborns are quite common.

   90% of children have a birth injury, most often it is the cervical spine. If the diagnosis of "birth trauma" is not made, it is advisable for you to contact an osteopath if the following situations occurred during childbirth:

   • long dry period
   • Opening the fetal bladder by a doctor in the maternity hospital
   • Stimulation of labor
   • Obstetric manipulations: imposition of forceps, fruit squeezing
   • The birth of a child in the pelvic presentation
   • Caesarean section
   • Epidural (spinal) anesthesia in women in women and after 35 years
   • the birth of a large fetus, more than 4 kg
   • if your child was born in a state of hypoxia: blue, did not cry immediately, there was an entanglement of the umbilical cord, low Apgar scores
   • if your child had a cephalohematoma (swelling on the baby's head) - this indicates a serious injury to the bones of the skull
   • your child has been diagnosed with PEP (perinatal encephalopathy), IUGR (intrauterine growth retardation)

   Predisposing factors for birth trauma

   The main predisposing factors leading to birth trauma are as follows:

   1. Pathology of the prenatal period.

   2. Pathology of the antenatal period. nine0006

   3. Wrong course of pregnancy.

   4. Toxicosis, preeclampsia.

   5. Placenta previa.

   6. Infection of the birth canal (vagina, uterus, etc.).

   7. Genital diseases of the mother (woman), diseases of the genital organs: salpingitis, inflammation of the appendages, salpingoophoritis, endometritis, vaginitis, vulvovaginitis, sexually transmitted diseases (venous diseases, venous diseases), infections, inflammatory diseases of the genital organs. nine0006

   8. Extragenital diseases (diseases) of the mother. Diseases of the cardiovascular system, Rh incompatibility (Rh conflict) have a particularly strong influence.

   9. Preterm pregnancy (fetal miscarriage).

   10. Prolongation of pregnancy (post-term fetus).

   11. Intrauterine fetal hypoxia (VGP, VUG, VUGP), chronic intrauterine hypoxia (lack of oxygen).

   12. Cesarean section (birth trauma during caesarean section).

   13. The use of a vacuum extractor in childbirth (vacuum extraction, vacuum extractors, a comprehensive vacuum system for obstetrics, a vacuum extractor). Vacuum fruit extraction.

   14. Rapid delivery, stimulation in childbirth.

   15. Stress, neurosis, neurasthenia.

   16. Increased risk if previous pregnancies ended badly (miscarriage, stillbirth, stillbirth, congenital malformations - congenital malformations). nine0006

   Mechanism of development, pathogenesis of birth trauma

   What is the mechanism of development of birth trauma, its pathogenesis? All of the above factors cause fetal hypoxia and reduce the resistance of its organs and tissues, especially the brain. All this leads to traumatic effects during childbirth.

   Classification of lesions of the nervous system in children

   Neonatologist, neurologist, neuropathologist, microneuropathologist distinguish 2 main types of birth injuries (classification by localization): nine0006

   1. Birth trauma of the central nervous system (CNS).

   2. Birth trauma of the peripheral nervous system (PNS).

   There are also the following pathologies: obstetric paralysis (obstetric paralysis), intracranial birth injury (for example, traumatic brain birth injury of the head, brain, cerebellum), birth injury of the spinal cord (for example, birth injury of the cervical spine, neck), birth injuries of peripheral nerves , birth injury of soft tissues (for example, birth tumor), birth injury of bones, skeletal system (for example, fracture of the collarbone), birth injury of internal organs. Separately, obstetric trauma due to obstetric manipulations is singled out, especially in case of an abnormal course of childbirth. nine0006

   Consequences of birth injuries

   The consequences of birth trauma are varied. Hemorrhages in the brain, paralysis (paralysis), paresis (paresis), retarded growth and development of arms or legs, impaired muscle tone, convulsions, hypertension syndrome, intracranial hypertension, hydrocephalus, convulsive and non-convulsive seizures, damage to cranial nerves, liquorodynamic disorders, decerebrate rigidity, cerebral palsy (ICP), perinatal encephalopathy (PEP), psychomotor retardation, speech retardation, minimal brain dysfunction, pneumonia, urosepsis and the worst consequences. nine0006

   Birth injury prevention

   How to avoid birth trauma in newborns? To avoid birth injuries, you must follow a number of recommendations:

   1. Plan conception and pregnancy in advance.
   2. Treat chronic conditions before pregnancy.
   3. Eliminate alcohol (alcoholic beverages), smoking (quit smoking) 3 months before conception and during pregnancy.
   4. Carry out activities aimed at the prevention and treatment of intrauterine fetal hypoxia. nine0016
   5. Give birth in a good health facility.
   6. Prior to delivery (1 month in advance) communicate with such specialists as an obstetrician, gynecologist, midwife, neonatologist, neurologist, microneurologist, neuropathologist, resuscitator who will take part in childbirth.
   7. Eat well and take vitamins during pregnancy.
   8. During pregnancy, attend childbirth preparation courses.
   9. During pregnancy, rest more and work less, walk in the fresh air.
   10. During pregnancy, regularly visit a medical institution such as a antenatal clinic, conduct the necessary tests, examinations, and studies.
   11. During pregnancy, avoid contact with infectious patients (especially those with diseases such as influenza, adenovirus infection, parainfluenza, MS infection (respiratory syncytial infection), rotavirus infection (rotavirus infection), SARS, herpes (herpetic infection), rubella, measles, mumps (mumps, mumps), chicken pox (chickenpox), chlamydia, Ebola, plague, HIV infection, tuberculosis, diphtheria, tetanus, echinococcosis, toxoplasmosis, teratogenic infections). nine0016
   12. Carry out activities aimed at preventing Rh conflict (take into account the Rh blood of the father and mother Rh, use a condom during oral sex).
   13. During pregnancy, try to avoid exposure to pathological factors such as ionizing radiation, radio waves (microwave ovens, microwave ovens, microwave ovens, x-rays, radiography, MRI - magnetic resonance imaging, NMRI (nuclear magnetic resonance imaging), CT (computed tomography), cellular phone, smartphone, tablet, computer). nine0016
   14. Exclude the intake of the following: medicines, medicines, medicines, medicines, dietary supplements, dietary supplements not prescribed by a doctor. Do not engage in self-medication, uncontrolled intake of drugs.

   Signs of birth trauma

   Many parents, fathers and mothers ask us: “What are the first signs that a child has a birth injury?”, “How to determine a birth injury in a child, a newborn?” “Does the baby have a birth injury?” "What are the signs of birth trauma, the consequences of birth trauma?". You should consult a doctor if you notice any of the following signs: nine0006
   

   Online entry

   Online record

   Date of visit

   20.12.2022

   Doctors

   Our specialists

   Smirnov Andrey Valerievich

   Clinic Osteomeda, neurologist-pool, candidate of medical sciences, member of ENRO, ENRO, ENRO, ENRO, ENRO, ENRO, ENRO, ENRO, ENRO, ENR doctor of osteopathy in Europe (registration number 248041051021), lecturer at the School of Osteopathy on the Neva at the Department of Neurology, St. Petersburg Institute of Higher Education

   Kristina Aleksandrovna Zoller

   Neurologist-osteopath, candidate of medical sciences, member of ENRO and ROSA, doctor of osteopathy in Europe (registration number 204115070812), director of the "School of Osteopathy on the Neva", head of the course of osteopathy at the Department of Neurology, SPbIUVE

   Kaprielov Karen Aleksandrovich

   Osteopath, member of ENRO, doctor of osteopathy of Europe (registration number 244046031012), manual therapist

   Cherny Roman Anatolyevich

   Osteopath, member of ENRO, doctor of osteopathy of Europe (registration number 22212) School of Osteopathy on the Neva" at the Department of Neurology, St.

   ---

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