Özgün Araştırma

Yenidoğanın Fiziksel Doğum Travmaları

  • Ali Bülbül
  • Füsun Okan
  • Asiye Nuhoğlu

Med Bull Haseki 2006;44(3):0-0

ÖzetAmaç: Fiziksel dogum travmasi gelisen bebeklerin klinik özellikleri ve dogum travmasi gelismesinde risk faktörlerinin belirlenmesi amaçlanmistir.Gereç ve Yöntem: 2001-2004 yillari arasinda hastanemizde dogan 9987 bebegin dosyalari dogum travmalari açisindan retrospektif olarak incelenerek, fiziksel dogum travmasi olan bebekler çalismaya alindi. Dogum travmalari; 1- yumusak doku hasarlari (sefal hematom, ekimoz, kaput suksadeneum, cilt kesisi), 2- sinir dokusu hasarlari (brakiyal pleksus, fasiyalsinir hasarlari), 3- kemik doku hasarlari (klavikula, femur, humerus ve kafatasi kiriklari) olarak siniflandirildi. Perinatal asfiksi, mekonyum aspirasyonu ve yenidogan konvülsiyonu gibi intrauterin faktörlerden etkilenebilen dogum hasarlari çalismaya alinmadi.Bulgular: Çalismada 76 (%0.7) bebekte dogum travmasi saptandi. Cinsiyet dagilimlari 31 olgu (%40.8) kiz, 45 olgu (%59.2) erkek, ortalama gebelik haftasi 39.2±3.1 hafta, ortalama dogum tartisi 3310±746 g idi. Dogum; %79 normal spontan yolla dogum (NSD), %21 sezaryen ile gerçeklesmisti. Bes olguda vakum kullanilmisti. Travma bulunan olgularin 64'ü (%84.2) term, 12'si (%15.8) preterm idi. Yumusak doku hasari %70.7, sinir dokusu hasari %17.1 ve kemik dokusu hasari %12.2 oranindaydi. Risk faktörleri degerlendirildiginde bebeklerin 26'sinda iri bebek olma, 12'sinde prematürite, 8'inde prezentasyon anomalisi, 6'sinda uzamis dogum eylemi saptandi. Otuz üç bebekte risk faktörü saptanmadi.Sonuç: Dogum travmalari, neonatal morbidite ve mortalitenin önemli bir sebebidir. Dogum travmalari her ne kadar siklikla travmatik dogum eylemi ile ilgili ise de, risk faktörü olmayan bazi normal spontan dogumlarda da olusabilmektedir. Gebelik ve dogum eyleminin yakin takibi, travmatik dogum için risk faktörlerinin önceden tespit edilerek bebek için uygun dogum seklinin belirlenmesi travmatik dogum sikligini azaltacaktir. Anahtar kelimeler: Yenidogan, dogum travmasi, risk faktörleriSummaryObjective: The aim of this study was to evaluate the clinical characteristics of newborns with birth injuries and identify the risk factors for birth associated trauma. Material and Method: The medical records of 9987 live-born infants in our hospital between 2001 and 2004 were reviewed retrospectively regarding birth related traumas. Birth-related injuries was defined as, 1- soft tissue lesions (cephalohematoma, caput succedaneum, skin laceration), 2- nervous tissue damages (brachial plexus and facial nerve injuries) and 3- skeletal fractures (clavicular, femoral, humerus and others). All live-born infants with birth injuries were included to the study however, infants with perinatal asphyxia, meconium aspiration and neonatal seizures, which may be influenced by intrauterine factors, were excluded.Results: Birth related trauma was detected in 76 (0.7%) of all live births. Of 76 babies studied, 64 (84.2%) were term, and 12 (15.8%) were preterm infants. The gender, mean gestational age and mean birth weight of the infants were 40.8% female, 59.2% male; 39.2 ±3.1 weeks and 3310±746 g, respectively. Among the babies 79% were born with spontaneous vaginal delivery (5 with vacum assisted delivery) and 21% were born with cesarean section. The most common type of birth injury was soft tissue lesions (70.7%), whereas other lesions were nervous tissue damages (17.1%) and, skeletal fractures (12.2%). Risk factors for birth injury were found to be; large birth weight (26 babies), prematurity (12 babies), presentation anomalies (8 babies), and prolonged labour (6 babies). Of the infants, 33 (43%) had not any risk factors. Conclusion: Birth injuries are a significant cause of neonatal morbidity and mortality. Although they are frequently associated with traumatic delivery, birth injuries occur in some normal spontaneous deliveries in the absence of any risk factors. We suggest that infants who have a risk of traumatic delivery must be carefully monitored and closely followed up to choose the proper birth type by detecting the birth related risk factors to decrease the incidense of the birth related injuries.Key words: Newborn, birth trauma, risk factors