These may result from difficult delivery including instrumental delivery and may cause:

1. Extensive caput succedaneum
2. Cephalhaematoma
3. Subgaleal haemorrhage
4. Nerve palsies
5. Fractures

1. EXTENSIVE CAPUT SUCCEDANEUM

It is a diffuse swelling of the presenting part of the scalp that may extend beyond suture lines.

TREATMENT

Leave alone and reassure parents. It resolves spontaneously over 3-4 days.

2. CEPHALHAEMATOMA

It is a haemorrhage involving the skull bones. It is confined by suture lines. Usually unilateral but occasionally bilaterally.

TREATMENT

No specific treatment is required

Leave alone. Do not perform incision and drainage. It resolves with time.

Prevention: Phytomenadione (Vitamin K), IM, 1 mg at birth.

3. SUBGALEAL HAEMORRHAGE

This is a swelling resulting from bleeding under the scalp. It may be extensive enough to distort shape of head and also cause severe pallor. Jaundice follows later.

INVESTIGATION

• Full blood count - looking for degree of anaemia.

TREATMENT

Therapeutic objective

• To arrest further bleeding and treat complications.

Non-Pharmacological Treatment

• Give phototherapy if jaundice is severe
• Transfuse with blood if Hb <12 g/l

Pharmacological Treatment

(Evidence rating: C)

• Give Phytomenadione, IM, 1 mg and refer to hospital in severe cases.

4. NERVE INJURIES

Excessive traction may result in injuries to the brachial plexus of nerves.

Types

Erbs Palsy: - Whole upper limb does not move. There’s movement only in the fingers.

Klumpke’s Palsy: - Fingers of the arm affected do not move but there is spontaneous movement in arm and fore arm.

TREATMENT

Therapeutic objective

• To re-establish near normal movement in affected area if possible.

Patient needs early and regular physiotherapy thus requires referral to hospital.