How does a hematoma occur after childbirth? Hemorrhage due to intracerebral hematoma, complications. Observation and care

Appearance Path little man the world is thorny. Nature has thought out the process of childbirth to the smallest detail, but sometimes it goes wrong. The newborn's head is designed in such a way as to minimize the risk of injury when passing through the birth canal. However, sometimes a baby is born with a hematoma or small tumor at birth. The protective natural function did not work a little. How dangerous is this? For the expectant mother It is important to know about birth injuries and their consequences.

What does a hematoma look like and how does it differ from a birth tumor?

A hematoma in a newborn appears as a result of a rupture blood vessels. This happens because of the efforts that the child makes when he is born. A hematoma is a kind of bruise. It happens different sizes and appears immediately after birth or a few days later. Doctors reassure that this is an ordinary case that does not require urgent medical attention.

Every day, the hematoma on the newborn’s head increases due to the fluid accumulating in it and stops growing on the 5-7th day of the baby’s life. It can appear anywhere, but is most often localized in the head area. It’s not difficult to recognize: the injury doesn’t look like a bruise at all.

The hematoma of newborns is a ball. If you press on it, it will roll from place to place. For mothers, this picture is shocking, especially when the ball reaches considerable size. The most common locations of neoplasms are the crown, back of the head, front and side of the head.

It happens that not a hematoma, but a tumor is found on the head of a newborn. Such a statement from a doctor can easily drive a mommy crazy: a tumor is associated with malignant neoplasms. However, with newborn babies it is a completely different matter.

A tumor is swelling that results from stagnation of lymph and blood during the passage of a newborn through the birth canal. The tumor appears on the forehead, face or butt (depending on how the baby was born - head first or feet first).

The hematoma and tumor on the child’s head look similar - like bumps. However, their nature is completely different:

1. the hematoma is located on one cranial bone, and the tumor can be located on several simultaneously;
2. when pressed, the hematoma neoplasm will “float” in different directions like a wave, and the tumor will roll from one side to the other;
3. the tumor goes away faster because it does not have elements of hemorrhage.

In any case, there is no need to sound the alarm and give in to panic. If you see a suspicious lump, show your baby to a specialist and listen to his recommendations.

Causes

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The birth process is a test for both the woman and the child. While passing through the birth canal, the baby must withstand many difficulties, from pressure drops that cause weak baby blood vessels to burst, to the inability to be born easily due to certain features head structure.

Promotes the appearance of hematomas whole line factors:

• large fruit;
• any type of presentation, except for the head (this puts additional stress on the baby’s body, since it will be quite difficult for the head to come out after the leg or buttock);
• a woman in labor is an unlucky owner of narrow hip bones;
• oligohydramnios, due to which the baby’s head follows dry paths, which increases blood pressure;
• assistance in obstetrics in the form of forceps or a vacuum (today these methods are not welcome, but there are situations in which they cannot be avoided);
• weak labor and assistance in turning the baby;
• birth of a baby prematurely;
• birth by caesarean section;
• rapid birth, during which the child may fall out and, as a result of the blow, receive a hematoma of the head;
• short umbilical cord.

The condition of the expectant mother’s body also plays an important role. It has been proven that hematoma formations occur in babies whose mothers abuse bad habits, had a difficult pregnancy, carried the fetus to term.

Types of hematomas in newborns on the head

As doctors say, hematoma and hematoma are different. One may be absolutely harmless, while the other will spoil a lot of nerves for new parents.

The following types of birth hematoma injuries are distinguished:

1. Subdural hematoma, in which blood gets trapped under the hard bones of the skull. Occurs in weakened and premature babies. Can be treated quickly.
2. Cephalohematoma (more details in the article:). A peculiar bruise located on the occipital, parietal, frontal or temporal part of the head. It occurs due to the accumulation of blood fluid between the bones of the skull and the periosteum. A week or maximum two after birth, the cephalohematoma resolves on its own without medical intervention.
3. Intracerebral hematoma is an injury affecting the brain. The phenomenon is rare, but occurs in children who have experienced oxygen starvation or had birth defects as weak blood vessels, too soft tissues of the skull, lack of vitamins and minerals. This is one of the complications of difficult childbirth.
4. Epidural. This birth injury is characterized by rupture of blood vessels at the place where the bones of the skull meet. One of the most terrible hematomas, leading to irreversible postpartum consequences: convulsions, changes in the fundus, pathological dilation of the pupils.

A natural question for any mother would be about what reasons could lead to the formation of a hematoma in a child. Each case is individual, but there are a number general premises the appearance of neoplasms on the head of a newborn.

Features of treatment

The most common birth injury is cephalohematoma. According to doctors, it does not require treatment, does not pose any danger to the life and health of the baby, and will resolve on its own within two weeks. If this does not happen and the bruise only increases in size, you should immediately consult a doctor.

The main tests to clarify the diagnosis and prescribe treatment are:

• ultrasonography;
• X-ray examination.

A hematoma resulting from a blow is examined especially carefully. The phenomenon is rare, but it happens. The baby will probably be prescribed a computer examination of the injured tissues of the head.

Draining the fluid using a special needle is the main treatment for this problem. The process is absolutely painless, although it causes a lot of anxiety among parents. The procedure involves two needles, one of which directly pumps out the accumulated blood, while the other maintains the necessary pressure to avoid a sharp drop. You will be able to notice improvements almost immediately: the child will become much livelier, more active, and more cheerful. But do not forget about careful monitoring of the baby.

Depending on the condition of the hematoma itself, treatment may be prescribed. medications. You can’t do without them if the injury is quite large sizes. After pumping out the fluid, concomitant medications that increase blood clotting are occasionally necessary. They must contain calcium and vitamin K.

It’s good if after the operation the baby is on breastfeeding. This will help him recover faster and gain strength. It is not worth rocking such children to sleep. Going to bed should be calm, without unnecessary movements.

Is a hematoma in a newborn dangerous, what are the consequences?

Theoretically, a hematoma is not a dangerous phenomenon. At the same time, it’s also not worth letting everything take its course. The child must be monitored for some time after surgery. Parents should be alert to changes in the size or color of the injury. Also, under no circumstances should the area through which the fluid was pumped be allowed to fester.

Accumulation must be closely monitored bloody discharge. It is better to surgically remove the hematoma again than to wait for it to harden until the removal process becomes impossible.

Deformation of the skull, mental, mental and physical retardation physical development, cerebral palsy (in in rare cases) - all this possible consequences hematoma, undetected and not removed in time. The resulting injury puts pressure on all parts of the brain, which significantly slows down the development process, and sometimes even leads to the extinction of vital reflexes.

It’s worse when the “bruise” is not visible externally, since the injury was deep inside. Then such an acquired neoplasm can become a serious threat to the life and health of the little person.

Contact your doctor immediately if you experience the following symptoms:

• the child is nervous, capricious, overly excitable or lethargic, inactive;
• the baby has eaten and spits up like a fountain;
• shows no interest in breastfeeding or food;
• lethargy, drowsiness, apathy are observed;
• Tears appear in the eyes in bright light;
• the baby throws his head back or tries to keep it in one position.

The birth of a child is not as simple as it might seem at first glance. Sometimes during natural childbirth, various injuries occur to the baby, despite the fact that nature provides for minimizing the risk of injury. Thus, a hematoma in newborns often occurs during the birth process. Doctors consider this injury normal occurrence, so they try to calm down mothers who are very worried about what happened.

Hematoma on the head of a newborn

In order for the baby to go through birth canal, he needs to squeeze between the muscle ring and the bones of the mother’s pelvis. As the baby moves forward, it makes corkscrew, pendulum and other movements. Meanwhile, all children have strong, but at the same time elastic skull bones, which are connected to each other by natural shock absorbers - sutures and fontanelles.

The fontanelle is the space that remains free in the middle of the skull and is necessary for the birth of a child. A newborn has two fontanels: large and small. The large one is located on the crown of the baby’s head and is a soft place covered by a thin membrane. The small fontanel is located in the occipital part of the head. Thanks to this structure, the bones are able to move apart and come closer together.

During the process of birth, the head changes its shape somewhat: the bones of the skull overlap each other, which allows it to squeeze through the most narrow places. Subsequently, the bones of the skull quickly straighten out with the baby’s first cry, as well as during attachment to the breast. If the child is healthy, he usually passes through the birth canal without any consequences. But if the baby has intrauterine complications or the mother has health problems, then the baby is not always able to be born without damage. Sometimes it is impossible to avoid the formation of a hematoma on the head of a newborn.

Quite often, birth trauma to the skull occurs against the background of intrauterine fetal hypoxia. In conditions of a lack of oxygen in a baby, metabolism in all tissues may change, which can reduce the elasticity of his blood vessels. During birth, “weak” blood vessels and capillaries cannot withstand the difference between the pressure inside the uterus and in the external environment, which can lead to hemorrhage into the brain tissue. As a result, a hematoma forms in the newborn.

Often, such birth trauma occurs in premature infants, whose body is not yet fully mature, including the blood vessels. Also, sometimes post-term babies are born with damage, as their bones begin to harden and their fontanel begins to close. Therefore, their skull is less elastic and mobile. Bruising and tissue swelling can form not only on the child’s head, but also on the body or face.

As a rule, hematoma in newborns goes away quite quickly, without any special consequences for the baby’s health. On the second or third day, the skin at the injury site evens out, the bruises turn pale, and then disappear after a couple of weeks. Although, there are still exceptions. In some children, the birth tumor may grow and bleed, which is quite dangerous due to various complications. In this case, it is no longer possible to do without treatment. The child is given hemostatic agents and even antibiotics in case of hematoma suppuration.

Cephalohematoma in newborns

Depending on where exactly the hemorrhage occurred, there are several types of hematomas. However, the most common type is cephalohematoma. It is a hemorrhage under the periosteum of the skull bones. When you press on this place, waves seem to diverge under your fingers. In this case, the surface of the skin over the hematoma in a newborn is not changed, the color remains the same, although pinpoint traces of blood may be observed.

The mechanism of injury is that the skin shifts along with the periosteum and when the baby’s head moves through the birth canal, blood vessels rupture due to compression of the skull bones. Causes of cephalohematoma in newborns:

• Overloads to which the baby is exposed at birth;
• Discrepancy between the size of the fetus and the birth canal;
• Prematurity;
• Complications after vacuum extraction.

It is quite difficult to detect a cephalohematoma immediately after birth, since it is covered by the birth tumor and becomes noticeable only after its resorption. As a result of damage to blood vessels, a certain amount of blood accumulates. Moreover, the blood in the hematoma does not collect all at once on the first day, but gradually. The fact is that newborn children usually have a temporary deficiency of blood clotting factors. Therefore, the tumor that appears immediately after birth continues to increase in size over the next 2-3 days, and the volume of cephalohematoma in newborns ranges from 10 to 150 ml of blood.

settle down this type hematomas may various parts head, and the blood inside remains liquid for a long time due to its low coagulability. If there is little blood in the cephalohematoma, after about a week it will begin to resolve on its own, without any intervention or treatment. With significant hemorrhage, this process may take several months. Therefore, puncture is used to treat hematoma in newborns.

To do this, use two special needles to suction the blood. One needle is for removing blood, and the other is so that negative pressure does not arise in the vacated cavity and does not provoke a new hemorrhage. Usually this manipulation scares baby’s mothers, but there is nothing complicated about it. You need to be wary of the consequences of a hematoma in a newborn; if it is not treated in time, it can fester or ossify and leave an ugly bump on the child’s head.

Complications of cephalohematoma:

• Anemia – develops as a result of significant blood loss;
• Jaundice – formed when hemorrhage resolves;
• Tumor suppuration;
• Ossification of hematoma.

You should urgently consult a doctor if you have a hematoma in a newborn if:

• The child has difficulty feeding;
• The baby is restless or overly excitable;
• The baby has asymmetry of the head and problems with muscle tone;
• The child has a strong tilt of the head back.

In such cases, it is important for the newborn to receive timely medical care. The consequences of birth trauma can be various, including speech and language delays. mental development. Therefore, you should not postpone visiting a doctor if any disturbing symptoms are observed in your baby.

Childbirth is a difficult experience for both the woman and the child. In most cases, this process occurs without complications, when both mother and newborn remain healthy. However, it happens that after childbirth the baby develops so-called birth injuries. The most common of these is a hematoma, which forms on the head or other places as a result of disturbances during contractions, pushing and birth.

What is it and for what reasons does it occur?

A hematoma on the head of a newborn or other part of the body is a type of birth injury in which soft and hard tissues. The hematoma itself is a tumor - the result of rupture of blood vessels due to injury to internal organs.

There are different degrees of severity and intensity of injuries received during childbirth. Many of them resolve on their own 2-4 weeks after birth without medical intervention, while others require specialist supervision.

The main causes of hematomas on the baby’s head after childbirth:

1. Compression of the head or other part of the body at birth. The baby's cranial bones are still flexible (to facilitate passage through the narrow birth canal). Since the head comes out first at the birth of a child, it is compressed, especially when narrow pelvis or too large a head circumference.
2. Different pressures in the womb and outside the mother's body. Consequence sharp changes pressure upon birth can cause rupture of blood vessels and hemorrhage. This is observed during caesarean section or hardware extraction of the fetus.

Possible causes of hematoma in a newborn:

What does it look like and where is it located?

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Hematoma can be found in 1-2% of newborns. The most common place for its formation is the head. Locations on the head:

• crown;
• back of the head;
• front end;
• side area.

In appearance, the hematoma resembles a lump, and it is easy to confuse it with a birth tumor. However, they have different etiologies and require separate treatment approaches.

The tumor is a swelling of muscle tissue and is located on several bones of the skull. The hematoma is located only on the bone that received the blow or pressure. You can distinguish a tumor from a hematoma by their movement when pressed. If the lump moves in both directions, it is a tumor; if it changes shape and moves in waves, it is a hematoma. In any case, only a specialist should make a diagnosis.

If the hematoma is small in size and there are no other pathological processes, puncture is optional. It is enough to take a course of medications for 3-5 days. The drugs prescribed include: calcium gluconate, which is administered intravenously, vitamin K in liquid form. This treatment is carried out in the maternity hospital.

Consequences of hematoma

It is important to admit further development process. In 80% of cases, hematomas disappear completely without provoking negative consequences and complications, but the risk of their occurrence still exists.

Without timely treatment or with improper therapy, the following complications are possible:

1. Unaesthetic appearance. The hematoma ossifies, leaving a lump on the head, the shape of the head changes (we recommend reading:).
2. Delayed physical and mental development.
3. Anemia or anemia. The production of hemoglobin decreases and the process of transporting oxygen to organs and tissues is disrupted.
4. Jaundice is the result of bilirubin accumulating in surrounding tissues and entering the bloodstream. Characteristic symptoms jaundice - the acquisition of a yellow tint by the skin and eye sclera.

Injuries during childbirth are not such a rare occurrence. Sometimes injuries are not limited to just external tears. During natural birth the woman is at risk of getting bruises varying degrees severity and poorly diagnosed internal ruptures.

Hematomas of the vagina and vulva

Localization below and above the main pelvic floor muscle (mm. Levator ani) and its fascia. More often, a hematoma occurs below the fascia and spreads to the vulva and buttocks, less often - above the fascia and spreads along the paravaginal tissue, retroperitoneally, up to the perinephric region.

Cause of vaginal hematomas during childbirth

The main cause of hematomas is change vascular wall. Occurs when varicose veins veins of the external genitalia and pelvis, hypovitaminosis C, hypertension, chronic glomerulonephritis, gestosis in pregnant women. Against this background, a hematoma is formed not only as a result of complicated childbirth (long or rapid, with a narrow pelvis, overlapping obstetric forceps, extraction by the pelvic end), but also during spontaneous uncomplicated childbirth.

Hematomas are more often formed on the left, which is associated with asymmetry of development venous system and more frequent formation of 1 position with the longitudinal position of the fetus.

Symptoms and diagnosis of hematomas of the external and internal genital organs

The size of hematomas can vary, and the severity depends on this clinical manifestations. Symptoms of a hematoma of significant size: pain and a feeling of pressure at the site of localization (tenesmus due to compression of the rectum), as well as anemia with an extensive hematoma. When examining postpartum women, a tumor-like formation of a blue-purple color is discovered, protruding outward towards the vulva or into the lumen of the vaginal opening, deforming it. On palpation, the hematoma fluctuates. Diagnosis of vaginal hematoma is more difficult. It is necessary to use vaginal examination, speculum examination and rectal examination to determine the size and topography of the hematoma. If the hematoma spreads to the parametrial tissue vaginally, a vaginal examination reveals the uterus pushed to the side and between it and the pelvic wall an immobile and painful tumor-like formation. In this situation, it is difficult to differentiate a hematoma from an incomplete uterine rupture in the lower segment.

Treatment of hematomas

Treatment of hematoma is conservative or surgical; it depends on its location, size and clinical course. Small, non-progressive hematomas of the vagina and vulva, which gradually resolve, are treated conservatively. Urgent surgery required when the hematoma rapidly increases in size with signs of anemia; with a hematoma that produces profuse external bleeding; with a large hematoma that occurred before the onset of labor and in the first period. The latter will create an obstacle to the birth of a child and contribute to additional trauma and crushing of tissues.

The operation is performed under general anesthesia and consists of the following stages: cutting tissue above the tumor; removing blood clots; ligation of bleeding vessels or stitching with 8-shaped catgut sutures; closing and draining the hematoma cavity. A hematoma of the broad uterine ligament requires transection, opening the peritoneum between round ligament uterus and infundibulopelvic ligament, removal of blood tumors, ligation of damaged vessels. The operation is limited to this unless the uterus ruptures.

Prevention of vaginal hematomas consists of the treatment of diseases that affect the condition of the vascular wall, as well as the qualified management of labor and delivery operations.

Obstetric fistulas

This concept includes genitourinary and enterogenital fistulas, that is, unhealed cavities due to injuries and ruptures of deep-lying organs. They arise as a result of severe birth trauma and lead to permanent loss of ability to work, disorders of a woman’s sexual, menstrual and generative functions. Fistulas contribute to the development of ascending infection of the genital organs and urinary system.

Based on the nature of their occurrence, fistulas are divided into spontaneous and violent. According to localization, vesicovaginal, cervicovaginal, urethrovaginal, ureterovaginal, and enterovaginal fistulas are distinguished.

How do obstetric fistulas occur?

Spontaneous fistulas are more common, and according to localization - vesicovaginal. The formation of fistulas is associated with necrosis of the wall area Bladder or rectum if blood circulation in them is impaired as a result of prolonged (more than 3-4 hours) compression of tissues by the fetal head. This is observed with a functionally narrow pelvis or with severe weakness labor activity. Fistulas of a violent nature are rarely formed and occur during delivery operations (fertility operations, obstetric forceps, C-section). Rectovaginal fistulas can form as a result of unsuccessful suturing of a 3rd degree perineal tear.

Symptoms and diagnosis of fistulas

With genitourinary fistulas, urine leaks from the vagina of varying intensity, and with entero-genital fistulas, gas and feces are released. Diagnostic value there is a time for these symptoms to appear: injury to adjacent organs is indicated by the appearance of these symptoms in the first hours after operative delivery. When a fistula forms as a result of tissue necrosis, these symptoms appear 6-9 days after birth. The final diagnosis is made by examining the vagina in speculums, as well as with the help of urological and X-ray methods diagnostics

Treatment of obstetric fistulas

Treatment of fistulas is only surgical. If adjacent organs are injured by instruments and there is no tissue necrosis, the operation is performed immediately after childbirth; in case of fistula formation as a result of tissue necrosis - 3-4 months after birth. Small fistulas sometimes close as a result of conservative local treatment.

Prevention of fistulas

Identification of a risk group for clinical discrepancy between the fetal head and the mother’s pelvis, early hospitalization of these pregnant women in the antenatal department to resolve the issue of a planned caesarean section.

Rational management of childbirth, timely diagnosis and treatment of clinical discrepancy between the fetal head and the mother’s pelvis, treatment of weakness of labor, not allowing the fetal head to stand in one plane for more than 2-3 hours, monitoring the function of the bladder and intestines, competent performance of delivery operations.

It seems that nature has provided everything to ensure the safety of the birth process, but, unfortunately, injuries received during childbirth, both for mother and baby, are also not uncommon in our time. Most common unpleasant consequence This is a hematoma on the head of a newborn after childbirth. Fortunately, over time it easily goes away on its own. However, a hematoma requires close monitoring and vigilance on the part of parents. If there are signs of hematoma development, it is necessary to urgently seek advice from a specialist.

Cephalohematoma, what is it?

Cephalohematoma in newborns is a hemorrhage that is formed due to compression of its head during the passage of the birth canal. In places that were strongly pressed against the birth canal, a bruise forms. Vessels and capillaries rupture, blood flows into the space between the periosteum (tissue that lines the bones of the head) and the cranial bones. The surface of the skin remains unchanged, even the color remains, but they talk about cephalohematoma dotted spots blood (hemorrhage) on the surface of the head.

Classifications of blood effusions on the head

Depending on the location where the hemorrhage occurred, hematomas are divided into 4 types:

Important statistics! About 2% of babies are born with cephalohematoma.

Causes of hematoma during childbirth in newborns

1. The baby's body is too large for the birth canal, which causes compression of the baby's head;
2. The cause of hemorrhage can be a sharp difference in pressure between external environment and the womb. Often this injury occurs when labor is resolved by vacuum extraction or cesarean section. Vacuum extraction is an operation during which the baby is pulled out of the birth canal using a vacuum between its head and a special cup of the device. This method is used when it is too late to use a caesarean section.
3. More often, hematoma appears in premature babies, because... their body is not yet ready to cope with the stresses that arise during labor, including pressure differences.
4. Swelling can also appear in post-term babies, due to the fact that their bones lose their elasticity and the fontanel tightens.
5. Hypoxia (oxygen deficiency) of the fetus, which significantly reduces the elasticity of blood vessels. At birth, the newborn's blood vessels cannot withstand the pressure difference between the uterine and external environments.
6. A small amount of amniotic fluid can lead to the appearance of a tubercle on the child’s head, because in such cases the child leaves the uterus through a “dry” canal and, as a result, is injured.
7. Giving birth to a baby feet first also provokes hematoma. The body is thinner in size than the baby’s head, so it does not open the birth canal well. It becomes more difficult for the head to follow this path.

First aid and treatment

If, apart from swelling, the child has no other symptoms, then special drugs or surgical intervention will not be required and all that remains is to wait for the blood to resolve on its own. During the healing period, it is necessary to ensure maximum rest and avoid rocking the child. Additionally, doctors may prescribe vitamin K, which improves blood clotting and reduces blood flow.

Important! After successful resorption of the hematoma, it no longer makes itself felt. However, cephalohematoma takes quite a long time to resolve.

If there is no change in the first month, or you see a deterioration in the baby's condition, such as lethargy, rapid pulse, lack of response to external stimuli, vomiting, convulsions, restless sleep, tearing only on one side of the eye, then you need to urgently consult a doctor.

Important tip! When diagnosing a hematoma in a newborn, even with the most favorable prognosis, a consultation with a neurologist is necessary 12-14 days after discharge from the hospital.

To prevent infection, doctors make an incision (puncture) in the area of ​​the tumor and the blood flows out. After the puncture, a tight bandage is placed on the child’s head. Before this, an X-ray diagnosis is made, and after the operation, the baby is observed by a neurologist to avoid complications.