P133 Adrenal haemorrhage following birth trauma

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This case based presentation focuses on a term infant with multiple traumatic birth injuries, including intra-abdominal injury, following a vaginal delivery with shoulder dystocia.

Due to a four-minute delay in which anterior shoulder was stuck, and following less traumatic methods of delivery, the right clavicle was broken to deliver the shoulder; after delivery he was noted to also have a deformed right upper arm and was suspected to have a humeral fracture. He was admitted to the NICU for pain relief and orthopaedic input following x-ray confirmation of the injuries.

During examination the following day the baby was noted to have a large mass in the left hypochondria. He was also noted to be significantly jaundiced, but otherwise the rest of the examination was normal and his vital signs were within normal limits. An abdominal ultrasound was performed which revealed a large left adrenal haematoma, which was compressing the kidney inferiorly. His blood tests revealed an unconjugated hyperbilirubinaemia and mild anaemia that support the diagnosis of haemorrhage; endocrine function remained normal. He was placed on continuous monitoring, but despite the adrenal haemorrhage he remained haemodynamically stable throughout admission with a normal urine output; he was discharged following treatment for his multiple fractures.

This case highlights rare, but important, intra-abdominal injuries following traumatic births that can cause serious morbidity and even death in newborns. We discuss such birth injuries in this presentation, with a focus on this case and problems arising from adrenal haemorrhage.

We suggest that ultrasound abdomen should be considered in situations where significant force has been used to extract the foetus so that appropriate precautions are taken in intra-abdominal haemorrhage and laceration of internal organs.

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