1- Serviço de Neurocirurgia, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, E.P.E.;
2 - Serviço de Neurorradiologia/Radiologia, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, E.P.E.
- 23rd Congress of the European Society for Pediatric Neurosurgery, 1 a 5 Maio 2012, Amsterdão (poster).
Objective: delivery is the most critical moment for a baby after 40 weeks in a safety environment. Obstetric manouvers during expulsive period, either in eutocic or dystocic deliveries, may cause head and brain trauma to the newborn. The authors studied the incidence, type, severity, management and consequences of this special type of brain trauma.
Methods: we review casuistics of Hospital Dona Estefânia in a period of time between 2005 and 2009 including related factors from the mother, newborn, delivery conditions, cranial and brain injuries described, neurosurgical atitude and prognosis of these patients. The authors review literature in Pubmed/MEDLINE database (key words: "delivery", "brain trauma" and "head trauma").
Results: In this period of time there were 10394 deliveries in our hospital (5683 eutocic and 4711 distocic) revealing a 0,004% incidence of brain trauma. The most frequent lesions observed were cranial vault fractures (42%), subdural hematomas (14%), epidural hematomas (8,6%), subaracnoid hemorrage (5,7%) and hemorragic contusions (2,9%). The "instrumented" deliveries were responsible for the majority of trauma lesions. A conservative management was the usual atitude by neurosurgeons, been surgically treated only two patients (5,7%).
Conclusions: Delivery is a difficult period for the newborn and may be associated to brain trauma. In the majority of cases the conservative management is the best choice with few cases demanding a surgical treatment. This is an issue less studied in terms of neurotraumatology and may be underreported in many institutions. Fortunately it has good prognosis with a benign course and only few surgical cases.
Key-words: delivery, brain trauma.