Fatal Birth Trauma Due to an Undiagnosed Abdominal Teratoma

Abstract

The fetus is subjected to mechanical forces during labor and delivery, which may result in traumatic injuries. Such injuries include intracranial hemorrhage, spinal cord lesions, cephalhematoma, cranial or peripheral nerve palsies, intraabdominal organ rupture, or bony fractures. Risk for perinatal trauma and mortality is increased in primigravidas, multiple gestations, abnormal presentations, maternal-fetal disproportion, oligohydramnios, forceps or vacuum extractions, and internal version maneuvers. Very-low-birth-weight neonates (<1500 g) are at high risk due to ease of deformity of the cranium. Infants with certain congenital anomalies or pathologic processes that distort normal anatomy are also at increased risk, especially when a prenatal diagnosis is lacking. The authors present a case of a term gestation neonate who sustained a cervical spine dislocation fracture of C5-7, with subtotal transection of the spinal cord and resultant paralysis. The fetus was in vertex presentation, and a manual vaginal delivery was attempted. When the infant lodged in the birth canal following a difficult delivery of the head and arms, its enlarged abdomen was palpated, and the delivery was converted to an emergent cesarean section. The infant lived for 3 days and then expired due to neurologic complications of trauma sustained during the attempted vaginal delivery. Autopsy revealed a previously undiagnosed intraabdominal immature teratoma. The pathology of teratomas, the most common neonatal tumor and occasionally implicated in cases of birth trauma, will be addressed, followed by a review of the literature concerning birth trauma.

Birth Injury: Birth Asphyxia and Birth Trauma

“…Damage to the spinal cord and peripheral nerves is associated with macrosomia, cephalopelvic disproportion, difficult delivery, forceps, breech presentation, shoulder dystocia, and obstruction (Images 63 -66) (39).…”

A newborn with massive intra-abdominal haemorrhage

“…The exact mechanism of the haemorrhage is not known. It was possibly due to rapid haemodynamic changes or extrinsic sheering forces that occurred during delivery resulting in the rupture of blood vessels within the tumour 6. Bleeding occurred rapidly after birth because tamponade could not be achieved without tumour excision.…”