Birth-Related Complications
Key Points
- Birth trauma includes physical injuries to the newborn caused during labor and delivery; severity ranges from mild/self-limited to life-threatening.
- Common injuries include caput succedaneum, cephalohematoma, subgaleal hemorrhage, clavicle fracture, and brachial plexus-related palsies.
- Key risk factors include macrosomia, difficult shoulder delivery, operative vaginal birth, prolonged labor, and cephalopelvic disproportion.
- Early bedside recognition and serial reassessment are essential to prevent missed deterioration.
Pathophysiology
Mechanical compression, traction, and shear forces during difficult birth can damage scalp tissues, bones, blood vessels, or peripheral nerves. Injury pattern depends on fetal position, birth assistance methods, and maternal-fetal anatomy.
Many injuries are self-limited as edema and bruising resolve. Others, especially hemorrhagic scalp injuries or neurologic deficits, may progress and require urgent imaging, hemodynamic support, or specialist management.
Classification
- Head soft-tissue injuries: caput-succedaneum, cephalohematoma, subgaleal-hemorrhage.
- Skeletal injuries: Clavicle fracture and selected skull fractures.
- Peripheral nerve injuries: brachial-plexus-injury, Erb-Duchenne pattern, Klumpke pattern, facial nerve palsy.
- Severe intracranial injury context: Subdural bleeding or skull trauma with neurologic risk.
Nursing Assessment
NCLEX Focus
Questions often test how to distinguish injuries that cross suture lines (caput/subgaleal) from those that do not (cephalohematoma), and when escalation is urgent.
- Assess scalp/cranial findings serially, including location, fluctuation, crossing of suture lines, and head-circumference trends.
- Assess perfusion and blood-loss signs (pallor, tachycardia, altered activity/alertness).
- Assess extremity movement symmetry, reflexes (including Moro/grasp), and signs of clavicular tenderness or crepitus.
- Assess facial symmetry at rest and during crying for facial nerve dysfunction.
- Review delivery history for risk cues: macrosomia, operative assistance, shoulder dystocia, prolonged second stage, breech.
Nursing Interventions
- Escalate immediately when findings suggest expanding hemorrhage or neurologic compromise.
- Support gentle handling and positioning of affected limbs or fracture areas while healing progresses.
- Coordinate diagnostic workup (for example, ultrasound/CT/MRI or x-ray) per provider plan.
- Monitor bilirubin trends when bruising/hematoma burden raises jaundice risk.
- Provide family-centered education on expected healing timeline, warning signs, and follow-up milestones.
Subgaleal Hemorrhage Risk
Subgaleal bleeding can expand significantly and cause hypovolemia; delayed recognition increases mortality risk.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| blood-products | Packed red blood cell transfusion context | May be required in significant hemorrhagic birth injury with hemodynamic compromise. |
| phototherapy | Hyperbilirubinemia treatment context | Required when hematoma-related bilirubin burden causes clinically significant jaundice. |
| analgesics | Newborn pain-control context | Supports comfort while avoiding unnecessary handling stress in fracture/soft-tissue injury. |
Clinical Judgment Application
Clinical Scenario
A vacuum-assisted birth newborn develops a boggy scalp mass that crosses sutures, increasing head circumference, pallor, and tachycardia over several hours.
Recognize Cues: Progressive scalp swelling with systemic blood-loss indicators. Analyze Cues: Pattern is concerning for subgaleal hemorrhage rather than isolated caput. Prioritize Hypotheses: Immediate priority is hemodynamic stabilization and urgent diagnostic confirmation. Generate Solutions: Activate escalation, prepare monitoring/transfusion pathway, and intensify neurologic/perfusion reassessment. Take Action: Implement emergent care plan and coordinate neonatal specialist involvement. Evaluate Outcomes: Hemodynamic status stabilizes and expansion of hemorrhage is controlled.
Related Concepts
- care-of-common-problems-in-the-newborn - Hematoma and trauma can trigger secondary jaundice and feeding complications.
- physical-assessment-of-the-newborn - Systematic exam identifies subtle early trauma findings.
- newborn-resuscitation - Severe birth trauma may require advanced stabilization.
- postpartum-hemorrhage - Difficult births can involve concurrent maternal and neonatal complications.
- apgar-scoring - Early low scores can reflect significant birth-related compromise.
Self-Check
- How can bedside findings differentiate caput succedaneum, cephalohematoma, and subgaleal hemorrhage?
- Which delivery risk factors most strongly increase risk for brachial plexus injury?
- Why are serial head-circumference and perfusion checks critical after suspected scalp hemorrhage?