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| CASE IMAGE |
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| Year : 2022 | Volume
: 2
| Issue : 4 | Page : 253-254 |
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Neonatal Genital Trauma Following Breech Delivery
Tonyot Gailson, Sadbhavna Pandit
Department of Pediatrics, Government Multispecialty Hospital-16, Chandigarh, India
| Date of Submission | 12-Sep-2022 |
| Date of Decision | 28-Oct-2022 |
| Date of Acceptance | 28-Oct-2022 |
| Date of Web Publication | 29-Nov-2022 |
Correspondence Address:
Dr. Tonyot Gailson
Department of Pediatrics, Government Multispecialty Hospital-16, Chandigarh - 160 016
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ipcares.ipcares_216_22
How to cite this article:
Gailson T, Pandit S. Neonatal Genital Trauma Following Breech Delivery. Indian Pediatr Case Rep 2022;2:253-4 |
A baby girl of 39+5 weeks gestation was born to an unsupervised second gravida mother by breech vaginal delivery after 8 h of labor. The Apgar score was normal (7 and 9 at 1 and 5 min, respectively) and birth weight 2.8 kg. At birth, the baby had transient tachypnea which settled within 6 h. Genital swelling and discoloration were also noted which was not associated with excessive irritability and/or crying when she passed urine. Breastfeeding was established successfully. The vitals were stable. Local examination revealed tender swelling of the labia which was bilaterally symmetrical, smooth, and violet red in color [Figure 1]a. The surrounding structures were normal. The rest of the general physical and systemic examination was unremarkable. We kept a diagnosis of postdelivery genital trauma and monitored the baby for complications. | Figure 1: (a) Diffuse hematoma of labia majora at birth. (b) Complete resolution of hematoma without sequelae at 3-month of age
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At 30 h of life, the baby developed neonatal jaundice. Although investigations revealed Rh-incompatibility, the jaundice was not considered pathological since the need for phototherapy resolved within 24 h. The swelling and ecchymosis diminished spontaneously by 7 days of life without any complications, and she was discharged on the 8th day, after which she remained asymptomatic. [Figure 1]b was the status at 3 months.
The initial differential diagnoses of bilateral labial swelling with or without discoloration are genital trauma, ambiguous genitalia, congenital genital hemangioma, inguinal hernia, and infections. Detailed history and careful examination is crucial to determine the underlying cause as it prevents unnecessary investigations. Genital trauma is a known complication of breech delivery. It can range from mild labial swelling in females to testicular torsion in males. Leakage from capillaries and venules during labor lead to diffuse ecchymosis which result in swollen and tender genitalia.[1] Most cases are asymptomatic with uneventful resolution within a week, but some babies may experience mild perineal discomfort and pain on micturition. Some neonate may develop neonatal jaundice due to the breakdown of red blood cells on resorption of the hematomas.[1] Ambiguous genitalia can result from virilization of the genetic female (labial hypertrophy and clitoromegaly) or under-virilization of the genetic male (bifid scrotum, micropenis, and perineal hypospadiasis).[2] In this case, only the labia majora appeared transiently hypertrophic at birth due to the swelling, and the clitoris and labia minora were normal. Congenital hemangiomas present at birth and starts involuting within weeks with complete resolution by 6-14 months. Inguinal hernia in baby girls may present as an intermittent labial bulge during crying, coughing and straining, when there is increased abdominal pressure.[3] Perianal streptococcal infection, candidal diaper dermatitis, and Bartholin gland abscess may have a similar appearance but usually can be differentiated clinically.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient's parent(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patient's parents understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Blanchard A. Neonatal genital trauma associated with breech presentation. CMAJ 2002;166:1306-7.  |
| 2. | Chi C, Lee HC, Neely EK. Ambiguous genitalia in the newborn (Review). Neoreviews 2008;9:e78-84. |
| 3. | Kapur P, Caty MG, Glick PL. Pediatric hernias and hydroceles. Pediatr Clin North Am 1998;45:773-89. |
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