Congenital anomalies and birth injuries among live births: United States, 1973--74.
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A rare case of birth injury having intrauterine complete perineal tear is presented. Defunctioning sigmoid colostomy was undertaken because of bad perineal condition. The baby died of Pseudomonas septicemia on the 15th day before definitive surgical procedure could be undertaken.
A rare case of cervical syringomyelia related to breech delivery is reported. The initial diagnosis was bilateral brachial plexus palsy due to birth injury, which was revealed by magnetic resonance imaging (MRI) to be traumatic syringomyelia. The usefulness of MRI in the early diagnosis of cervical cord birth injury, especially in differentiating between brachial plexus palsy due to birth injury and spinal cord trauma due to birth injury in infancy, is emphasized.
A birth injury in the vicinity of a joint might lead to a fracture through the epiphyseal cartilage. The criteria for diagnosing such a fracture at radiography are considered and the continued remodelling of the bone demonstrated. The history of 2 cases with late diagnosis and serious long-term sequelae are described, in order to emphasize the necessity of early radiography.
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In this paper, census data were used to assess the effectiveness in birth delivery of obstetricians and general practitioners.though the data reported require some qualification and additional research, preliminary results indicate that general practitioners report approximately three times more birth injuries and/or malformations (than do obstetricians) at birth. Both groups (obstetricians and general practitioners) report approximately the same number of complications in pregnancy and delivery. It was tentatively concluded that the similarity in diagnosed complications was probably due to diagnostic error. This error, in combination with sample differences and differing delivery techniques, resulted in the consequent differences in rates of birth injury and malformation.
The possible role of cerebral birth injury in the aetiology of epilepsy was evaluated by comparing the birth histories of 101 epileptic patients with focal seizures and 208 with non-focal seizures. The former were smaller at birth and their mothers were older and had higher blood pressures than the mothers of the latter. Although the two groups did not differ significantly with regard to the frequency of breech birth, assisted vaginal breech deliveries were significantly more numerous in the focal group. The injured half of the brain was as often pressed against the sacrum as against the symphysis during birth.
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Twenty-four cases of birth injury to the brachial plexus were seen in 21 infants over 15 years. Obstetric complications were common, and in 11 cases traction was needed to deliver the shoulders. Three out of every four arms fully recovered after exercises. Splints were not needed. Reconstructive procedures were performed on three permanently paralysed arms when the children were aged about 4. There was no way of predicting which patients would recover. The muscles supplied by the suprascapular nerve were paralysed in all patients, and this paralysis persisted in those whose arms failed to recover fully.
11 cases of children with birth injury to the spinal cord born between 1960 and 1970 are presented in review and compared to about 200 previously published cases. 8 children presented at delivery with one or both feet and 2 with breech. 9 of these infants were born by difficult extraction and needed resuscitation due to primary asphyxia. One child had an easy vertex delivery without evident risk. Diagnosis was established within the first days of life, based on flaccid motor and sensory paralysis below a defined level, mostly in the cervical or upper thoracic spine, with bladder and bowel paralysis, and confirmed by autopsy or by follow-up study. One child with disruption of the spinal cord above C4 survived only a few hours despite artificial ventilation. 4 children died within the first three years of life, 3 of them due to acute pneumonia. 5 of 6 surviving children were followed regularly and are now 10 to 18 years old. They are ambulant with crutches and are well integrated in their families. 4 children attend normal school, and one girl gets special training for mentally retarded children.
The authors report of their experience in the rehabilitation of active functions in the upper extremities of 22 children with sequelae of birth injuries of the shoulder plexi of the Erb type. In order to accelerate the reconstruction of the function of the transplanted trapezius muscle a method of adaptive bioregulations is suggested which permitted to quantify the doses of developed muscular tension and control the movements. The obtained results give ground to positively evaluate this method, based on the principle of external reverse connection in the rehabilitative period following an operation of myolavsanoplastics in children with spquelae of birth injuries of the shoulder joint of the Erb's type.
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The acute syndroms of the brainstem of cerebral injuried newborns by the birth trauma (casuistry). The neurologic clinical symptomatology of the acute syndroms of the brainstem are described in brief. Three cases of damaged newborn with this syndroms are particular published. Especially performed are: the possibility of repair, the changing of the symptoms, the danger of manual transformation of abnormous cephalic positions and the need of topological diagnosis in follow-up of special care.
We recommend to define the "birth trauma" as all influences, which injure the fetus under birth in any pattern. These birth traumatical agents we divide in the group of predominant mechanical agents and in the group of predominant metabolic components (hypoxia). This definition is explained and justified in a matter-of-fact way. We discuss the advantages of its application in practice.
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