Birth trauma in newborns
Abstract: аНаЛиТиЧЕСкиЕ ОбЗОрЫ родовой травматизм новорожденныхРодовая травма -это повреждение плода (его мягких тканей, костно-суставной системы, внутренних органов, центральной и периферической нервной системы) действием неблагоприятных факторов во время родов. В ряде случаев травма, проявляющаяся после рождения, может формироваться антенатально.Родовые травмы новорожденных при влагалищных родах встречаются в 3,6% случаев, при операции кесарева сечения -в 1,2%. В последнее время отмечается увеличение родового травмати… Show more
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Study of the somatic, neurological and osteopathic status of full-term newborns born by cesarean section in a planned and emergency manner
Introduction. Currently, the frequency of cesarean section (CS) in the world is at least 25 %, in Russia — at least 30 %. It is known that newborns after CS are a special risk group for the development of somatic dysfunctions (SD), which should be considered comprehensively, taking into account their somatic and neurological status.The aim is to study the effect of emergency CS on the somatic, neurological and osteopathic status of newborns and on the course of the early neonatal period.Materials and methods. 60 patients of the Department of Neonatal Physiology, aged 3–5 days of life, without structural pathology or malformations, born by cesarean section, were examined. Children are divided into 2 groups of 30 people. Group 1 — children born by emergency caesarean section (ECS). Group 2 — children born by planned (elective) caesarean section (PCS). A complex of examination methods was used in both groups. The anamnestic method included an assessment of the main risk factors during pregnancy and features of the early neonatal period. The clinical method included assessment of the somatic status of newborns; neurological assessment. Assessment of osteopathic status according to clinical guidelines. Assessment of functional disorders — using neuro-sonography, ultrasound of the hip joints, ultrasound of the abdominal organs. Statistical data processing was carried out using Microsoft Excel and the Medstatistic statistical software package. To study the relationships between the characteristics, a comparison of the populations was carried out based on qualitative characteristics. Fisher′s exact test was used for statistical processing of data. The analysis used a significance level of p<0,05, which reflects the strength of the dependence of the characteristics being compared. Pearson′s coefficient was used as a criterion for the strength of connection.Results. When analyzing risk factors in both groups, a predominance of women over 30 years of age with a complicated pregnancy was noted among mothers. Extragenital pathology (most often pathology of the endocrine system) was detected in 70 % of mothers. In the ECS group, early and more intense jaundice was observed significantly more often (p<0,05) (12 out of 30 children versus 4 out of 30 children in the PCS group); muscular dystonia with a tendency to increase muscle tone in the upper extremities and decrease in the lower extremities (in 22 out of 30 children in this group versus 12 out of 30 children in the PCS group); SD of the head region (13 cases in this group versus 4 cases in the second group). In the PCS group, autonomic disorders were observed significantly more often (p<0,05) (12 out of 30 children versus 2 out of 30 children in the ECS group); SD of the pelvic region (visceral component, 9 cases versus 2 in the ECS group). In children of the ECS group, a statistically significant (p<0,05) relationship was revealed between breech presentation and SD of the pelvic region (somatic component) — contingency coefficient 0,44; structural features of the chest (asymmetry, protruding xiphoid process) and SD of the thoracic region (visceral component) — 0,43; characteristics of the neurological status (hyperexcitability syndrome) and SD of the head region — 0,45. In children of the PCS group, a statistically significant (p<0,05) relationship was revealed between morpho-functional immaturity and SD of the thoracic region (visceral component) — contingency coefficient 0.39; features of the skeletal system of the skull (Gothic palate, combination of Gothic palate and suture entry) and SD of the dura mater — 0,5; structural features of the chest (asymmetry, protruding xiphoid process) and SD of the thoracic region (somatic component) — 0,6; characteristics of the hip joints (asymmetry of the gluteal folds, difficulty in abduction, hypermobility) and SD of the pelvic region (somatic component) — 0,45; postural disorders (flexion, extension, latero-flexion to the right, latero-flexion to the left) and SD of the pelvic region (somatic component) — 0,49; increased muscle tone of the arms and SD of the thoracic region (visceral component) — 0,41.Conclusion. A comparative assessment of the osteopathic status of children born by cesarean section in a planned manner and for emergency indications was carried out, and an analysis of the possible connection of the identified somatic dysfunctions with risk factors for pregnancy and features of the early neonatal period was carried out. Based on the identified relationships between the somatic, neurological and osteopathic statuses of newborns in the first day of life, in the future it is possible to develop optimal timing for consultation with an osteopath for the purpose of earlier diagnosis and correction of somatic dysfunctions.
Study of the somatic, neurological and osteopathic status of full-term newborns born by cesarean section in a planned and emergency manner
Introduction. Currently, the frequency of cesarean section (CS) in the world is at least 25 %, in Russia — at least 30 %. It is known that newborns after CS are a special risk group for the development of somatic dysfunctions (SD), which should be considered comprehensively, taking into account their somatic and neurological status.The aim is to study the effect of emergency CS on the somatic, neurological and osteopathic status of newborns and on the course of the early neonatal period.Materials and methods. 60 patients of the Department of Neonatal Physiology, aged 3–5 days of life, without structural pathology or malformations, born by cesarean section, were examined. Children are divided into 2 groups of 30 people. Group 1 — children born by emergency caesarean section (ECS). Group 2 — children born by planned (elective) caesarean section (PCS). A complex of examination methods was used in both groups. The anamnestic method included an assessment of the main risk factors during pregnancy and features of the early neonatal period. The clinical method included assessment of the somatic status of newborns; neurological assessment. Assessment of osteopathic status according to clinical guidelines. Assessment of functional disorders — using neuro-sonography, ultrasound of the hip joints, ultrasound of the abdominal organs. Statistical data processing was carried out using Microsoft Excel and the Medstatistic statistical software package. To study the relationships between the characteristics, a comparison of the populations was carried out based on qualitative characteristics. Fisher′s exact test was used for statistical processing of data. The analysis used a significance level of p<0,05, which reflects the strength of the dependence of the characteristics being compared. Pearson′s coefficient was used as a criterion for the strength of connection.Results. When analyzing risk factors in both groups, a predominance of women over 30 years of age with a complicated pregnancy was noted among mothers. Extragenital pathology (most often pathology of the endocrine system) was detected in 70 % of mothers. In the ECS group, early and more intense jaundice was observed significantly more often (p<0,05) (12 out of 30 children versus 4 out of 30 children in the PCS group); muscular dystonia with a tendency to increase muscle tone in the upper extremities and decrease in the lower extremities (in 22 out of 30 children in this group versus 12 out of 30 children in the PCS group); SD of the head region (13 cases in this group versus 4 cases in the second group). In the PCS group, autonomic disorders were observed significantly more often (p<0,05) (12 out of 30 children versus 2 out of 30 children in the ECS group); SD of the pelvic region (visceral component, 9 cases versus 2 in the ECS group). In children of the ECS group, a statistically significant (p<0,05) relationship was revealed between breech presentation and SD of the pelvic region (somatic component) — contingency coefficient 0,44; structural features of the chest (asymmetry, protruding xiphoid process) and SD of the thoracic region (visceral component) — 0,43; characteristics of the neurological status (hyperexcitability syndrome) and SD of the head region — 0,45. In children of the PCS group, a statistically significant (p<0,05) relationship was revealed between morpho-functional immaturity and SD of the thoracic region (visceral component) — contingency coefficient 0.39; features of the skeletal system of the skull (Gothic palate, combination of Gothic palate and suture entry) and SD of the dura mater — 0,5; structural features of the chest (asymmetry, protruding xiphoid process) and SD of the thoracic region (somatic component) — 0,6; characteristics of the hip joints (asymmetry of the gluteal folds, difficulty in abduction, hypermobility) and SD of the pelvic region (somatic component) — 0,45; postural disorders (flexion, extension, latero-flexion to the right, latero-flexion to the left) and SD of the pelvic region (somatic component) — 0,49; increased muscle tone of the arms and SD of the thoracic region (visceral component) — 0,41.Conclusion. A comparative assessment of the osteopathic status of children born by cesarean section in a planned manner and for emergency indications was carried out, and an analysis of the possible connection of the identified somatic dysfunctions with risk factors for pregnancy and features of the early neonatal period was carried out. Based on the identified relationships between the somatic, neurological and osteopathic statuses of newborns in the first day of life, in the future it is possible to develop optimal timing for consultation with an osteopath for the purpose of earlier diagnosis and correction of somatic dysfunctions.
Contemporary issues of the birth trauma
Background. Birth trauma is a group of diseases caused by mechanical factors during childbirth. Birth trauma is an interdisciplinary problem, affecting various fields of medicine, such as obstetrics, pediatrics, child neurology and other sciences. Birth trauma occupies an important place in the structure of perinatal morbidity and mortality. Birth injuries of newborns during vaginal birth occur in 3.6% of cases, during cesarean section — in 1.2%. However, at present, despite a comprehensive study of the problem, the incidence of birth trauma in newborns remains high. Along with obstetric birth trauma, spontaneous birth trauma also occurs — not associated with any obstetric care.Purpose of review. To summarize and analyze the available data on the causes of birth trauma in newborns depending on the type of birth injury.Materials and methods. The review includes published data over the past 10 years regarding the study of the causes of the main types of birth injuries in newborns. The literature search was conducted in Web of Science, Google Scholar, PubMed, and ELibrary databases.Results. The problem of fetal-pelvic disproportion in the genesis of the development of risk factors for maternal-fetal trauma remains relevant. Fetal macrosomia is one of the most significant factors in birth trauma. The most common skull injury in newborns is cephalohematoma. According to the mechanism of occurrence, birth trauma is divided into spontaneous — occurring during physiological childbirth — and obstetric — associated with any obstetric benefits. The degree of configuration of the fetal head plays a significant role in the pathogenesis of birth trauma. Birth trauma is considered as a systemic reaction on the part of the newborn’s body, which leads to a breakdown of compensatory and adaptive mechanisms and the development of critical damage to the central nervous system and is differentiated from birth damage, which includes only local changes.Conclusion. To search for preventive measures aimed at preventing birth injuries in newborns, it is necessary to systematize the groups of causes that influence the increased risk of birth injury. Timely assessment of the pathological configuration of the fetal head is extremely important when deciding on the advisability of using obstetric aids during vaginal operative delivery, since it is an early predictor of the formation of fetal-pelvic disproportion — a significant factor in birth trauma in the newborn. In recent years, taking into account the active study of molecular genetic mechanisms in the genesis of the formation of various pathological conditions, the search for various genetic and epigenetic factors that influence the risk of developing birth traumatic injuries in a newborn against the background of individual susceptibility to the effects of any physical factors during childbirth.
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