ff as a result of compression of the skull against the bony parts of the canal. There may be some internal bleeding, more likely to be found in premature infants, possibly associated with hypoxia (low oxygen). Sudden relief of pressure on the head, as in a precipitate delivery, may result in intracranial bleeding – a quick delivery may seem to be desirable but in fact is dangerous. There are three layers of membranes between the brain and the skull, bleeding may be found between these layers, or within the brain’s cavity (ventricle) or less often, within the substance of the brain.
Some hemorrhage into the eye, sub-conjunctival, or retinal may occur with difficult or precipitate deliveries
Passive Trauma to the Brachial Plexus in the Birth Canal
The brachial plexus is a mesh of interconnecting nerve roots, located at the base of the neck, and liable to be stretched if the arm is pulled down or the head is pulled sideways. This may occur with damage to the plexus during a difficult delivery, as for instance shoulder dystocia, but since it is also found when there has been a Caesarean section, it is not reasonable to assume automatically it was the result of force.
The phrenic nerve to one side of the diaphragm may be paralyzed, but usually recovers spontaneously.
If force is applied with forceps or by vacuum extractor, it is inevitable that some mark will be left. In general these marks subside in a few days, and are a small price to pay for the easing of a difficult labor.
Occasionally there will be more significant injury such as a fracture of the skull, or an injury to the facial nerve; injury to this nerve is not necessarily iatrogenic, and may have occurred due to other unrecognized factors during birth.
There is a potential for spinal vertebral or cord injury by extreme manipulation, traction with a breech delivery or rotation with a difficult vertex delivery; the spinal cord has very limited opportunity for self-repair.
Fractures of long bones, humerus and femur, may occur as a result of forced manipulation during a difficult delivery, usually a malpresentation. Although they add to the distress of the occasion, they can be expected to heal rapidly without any lasting ill-effect.
Intra-abdominal injuries to liver and spleen may occur with forceful handling of the neonate, more likely to occur if there has been difficulty instituting breathing, and in the premature frail neonate.