PRASAVA KALINA ABHIGHATA ( प्रसवकालिन अभिघात – Birth Injuries)

SHWASAVRODHA (श्वसवरोध - Asphyxia Neonatorum)

Definition

A condition of impaired gas exchange, that leads if persistent, to fetal hypoxia and hypercarbia.

ASPHYXIA NEONATRUM

Etiology

  • Drop in maternal blood pressure
  • Some other substantial interference with blood flow to the infant's brain during delivery.

Clinical features

  • when the infant is deprived of oxygen ⇾ Rapid breathing increases.
  • If the asphyxia continues, the respiratory movements cease, the heart rate begins to fall, Neuromuscular tone gradually decrease, And the infant enters a period of apnea. In the most instances, tactile stimulation and exposure to oxygen during period will induce respiration.
  • If the asphyxia continues, enters into a period of secondary apnea
  • Apnea - cessation of breathing.

Management : Neonatal Resuscitation.

ULVAKA (उल्वक)

ULVAKA

Definition :

The child cannot vomit the phlegm of the throat, the Rasa Dhatu getting aggravated in the hridaya and obstruct the channels.

Symptoms

  • Clenching of the fists
  • Unconsciousness
  • Convulsions
  • Dyspnea
  • Cough
  • Vomiting
  • Fever

The disease is described as सहज व्याधि.

Management

  • स्रोतोविशोधन
  • अज मूत्र पान
  • Bathing and Abhyanga should avoid to the child.

UPASHIRSHAKA (उपशिर्षक )

कपाले पवने दुष्टे गर्भस्थसयापि जायते | सवर्णो निरुज: शोफस्तं विध्यादुपशिर्षकं || (अ.हृ.उ. 23/21)

At the age of fetal period, vitiation of vata develops swelling of the skin of the scalp without pain known as Upashirshaka.

Management

In primary stage of upashirshaka, treatment prescribed as Vatavyadhi chikitsa and in later stage with purulent condition, the treatment prescribed as Vidradhi should be done.

Caput Succidenum Cephalohematoma
1. Formation of the swelling of soft tissues of the scalp over the presenting part. 1. It is sub periosteal collection of blood secondary to injury during delivery.
2. The swelling is present at the birth and its size and severity is related to the duration of labor. 2. Developed due to rupture of superficial veins between the skull and periosteum.
3. The swelling is pitting and not limited by sutures. 3. The swelling appears after 2-3 days after birth
4. Dissolves / Disappears spontaneously within 24 hours after birth. 4. It is fluctuant swelling and does not cross the suture line.
5. Depending upon its size, it resolves spontaneously after a few days or weeks.

FACIAL PARALYSIS

Facial paralysis
  • It may occur with or without forceps application.
  • Facial asymmetry, inability to close the eye and absent rooting reflex on the affected size suggest the diagnosis. The recovery is excellent and complete.
  • Most peripheral nerve injuries in the newborn carry a good prognosis because of greater regenerative power and short length of nerves.

ERB'S PARALYSIS

Erb's Palsy
  • Injury to upper cervical roots (C5, C6)
  • The arm hangs limply, adducted and internally rotated with elbow extended and pronated. Arm recoil is lost.

Management

  • The arm should be kept in the position of abduction and external rotation at the shoulder and flexion of elbow.
  • Massage and passive movements of the muscles would recovery that is generally complete but may take few weeks or months.

KLUMPKE'S PALSY

KLUMPKE'S PALSY
  • Injury to lower cervical roots (C7, C8 and T1).
  • Manifest as wrist drop and flaccid paralysis of hand with absent grasp response.

Management

  • Cotton ball should be placed in the baby's hand to avoid contractures.
  • Massage and passive movements of the muscles would recovery that is generally complete but may take few weeks or months.

BHAGNA (FRACTURES)

Bhagna
  • Skull - The liner skull fractures may be associated in one fourth of infants with cephalohematoma and are of no therapeutic significance.

The depressed fractures may occur due to compression as a result of forceps or against the maternal symphysis pubis and sacral promontory. These also disappear spontaneously.

  • Clavicle : Most common fracture and often follows breech extraction or shoulder impaction. Immobilization of arm can be achieved.
  • Femur : Fracture of femur is rare and caused by forcible manipulation of legs during breech extraction. Spontaneous healing may occur.
  • Humerus : The forcible manipulations and pulling at baby's arm during delivery may result in fracture of humerus, The diagnosis is suspected by pain and limitation of affected limb.

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