Mechanical birth-related trauma to the neonate: An imaging perspective
Insights Imaging
Mechanical birth-related trauma to the neonate: An imaging perspective
Apeksha Chaturvedi 0 1
Abhishek Chaturvedi 0 1
A. Luana Stanescu 0 1
Johan G. Blickman 0 1
Steven P. Meyers 0 1
0 Department of Radiology, Seattle Children's Hospital , Seattle, WA , USA
1 Department of Imaging Sciences, University of Rochester Medical Center , 601, Elmwood Avenue, Box 648, Rochester, NY 14642 , USA
2 Apeksha Chaturvedi
Mechanical birth-related injuries to the neonate are declining in incidence with advances in prenatal diagnosis and care. These injuries, however, continue to represent an important source of morbidity and mortality in the affected patient population. In the United States, these injuries are estimated to occur among 2.6% of births. Although more usual in context of existing feto-maternal risk factors, their occurrence can be unpredictable. While often superficial and temporary, functional and cosmetic sequelae, disability or even death can result as a consequence of birth-related injuries. The Agency for Healthcare research and quality (AHRQ) in the USA has developed, through expert consensus, patient safety indicators which include seven types of birth-related injuries including subdural and intracerebral hemorrhage, epicranial subaponeurotic hemorrhage, skeletal injuries, injuries to spine and spinal cord, peripheral and cranial nerve injuries and other types of specified and non-specified birth trauma. Understandably, birth-related injuries are a source of great concern for the parents and clinician. Many of these injuries have imaging manifestations. This article seeks to familiarize the reader with the clinical spectrum, significance and multimodality imaging appearances of neonatal multiorgan birth-related trauma and its sequelae, where applicable. Teaching points Mechanical trauma related to birth usually occurs with preexisting feto-maternal risk factors. Several organ systems can be affected; neurologic, musculoskeletal or visceral injuries can occur. Injuries can be mild and transient or disabling, even lifethreatening. Imaging plays an important role in injury identification and triage of affected neonates.
Neonate; Mechanical trauma; Macrosomia; Instrumental delivery; Cephalopelvic disproportion
Introduction
The process of birth, whether spontaneous or assisted, is
inherently traumatic for the newborn. Birth-related
injuries encompass both mechanical and hypoxic-ischemic
events. This review focuses mostly on mechanical
trauma sustained by the neonate owing to the forces of
labor and delivery. For conciseness of this review,
birth-related hypoxic-ischemic injuries to the neonate
will not be separately addressed.
Trauma related to birth may affect several organ systems of
the neonate (ESM_1). The exact incidence of mechanical
trauma of birth may be somewhat underestimated. Incidence is
0.82%, prevalence has been estimated at 9.5 per 1000 live
births [1]. Less than 2% of neonatal deaths result from birth
trauma [2].
Fig. 1 Illustration demonstrating
the layers of scalp, skull,
meninges and brain on a coronal
section (a)
Birth-related trauma can occur without identifiable risk
factors; however, it is more common in context of predisposing
feto-maternal risk factors. Risk factors can be fetal
(macrosomia-birth weight > 4500 g, malpresentation or
shoulder dystocia (defined as passage of more than 60 s between the
delivery of the head and body [3], resulting in requirement of
additional obstetric maneuvers for delivery of fetal shoulders
[4])); maternal (diabetes, primiparity, small pelvis); or
obstetric (epidural analgesia, induced or instrumental
delivery).
Over the following paragraphs, we discuss the
clinical context and imaging findings of birth -related
Fig. 2 Illustration depicting
hemorrhages by location within
the different layers of the
meninges (left of image) and
scalp (right of image)
Fig. 3 Caput succedaneum and
subgaleal hemorrhage Grayscale
ultrasound images (a-c) of the
scalp in a newborn male
demonstrate a fluid collection that
crosses midline, is deep to the
subcutaneous fat/galeal
aponeurosis and superficial to the
periosteum/calvarium (noted as
thick echogenic interface)
consistent with a subgaleal
hemorrhage. Axial CT (d) image
in a 1-day-old male with history
of traumatic delivery demonstrate
scalp soft tissue overlying
bilateral parietal regions and
crossing the sagittal suture
(arrows). Follow-up coronal MR
image (e) demonstrates a deep
subaponeurotic scalp fluid
collection crossing the sagittal
suture and extending anteriorly
into the right temporal region,
consistent with subgaleal
hematoma (arrows). A more
superficial overlying fluid
collection with a similar
distribution also noted
(arrowheads). This collection is
within the subcutaneous fibrofatty
tissues superficial to galea
aponeurosis and is consistent with
caput succedaneum
injuries categorized by different portions of the
neonate’s anatomy.
Injuries to the head and face
Extracranial
Scal (...truncated)