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Zervikale Dislokation der Halswirbelkörper nach Vakuumextraktion und Schulterdystokie

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Zusammenfassung

Fälle von traumatischen Halswirbelsäulen- und Halsmarkschädigungen nach operativer Entbindung sind heutzutage aufgrund differenzierter diagnostischer Möglichkeiten sehr selten. Berichtet wird über ein 2,5 Tage alt gewordenes Neugeborenes, dessen Körpergewicht sonographisch auf 3000 g geschätzt worden war. Bei der vaginalen Entbindung zum Termin (40. SSW) trat ein Geburtsstillstand auf, so dass eine Vakuumextraktion durchgeführt wurde. Nach der Entwicklung wirkte das 5400 g schwere und beatmungspflichtige Kind schlapp; es fiel eine zunehmende Schwellung des Halses auf. Radiologisch konnte eine komplette zervikale Dislokation zwischen C5 und C6 nachgewiesen werden. Das Kind starb nach klinischen Angaben infolge zerebraler Ischämie und spinalen Schocks. Die Obduktion ergab eine komplette horizontale Durchtrennung der Halswirbelsäule einschließlich des Bandapparates und des Halsmarks; die Halsmuskulatur war dickschichtig eingeblutet. Todesursächlich war die geburtstraumatische Halsmarkverletzung. Im Vorfeld hätte eine korrekte (sonographische) Ermittlung des Geburtsgewichtes zu einer primären Sectio caesarea geführt und den stattgehabten Geburtsverlauf verhindert.

Summary

Cases of traumatic damage to the cervical spine and spinal cord are nowadays rare due to extensive diagnostical possibilities. The authors report on a case of a newborn which lived for 2.5 days and whose weight was estimated at 3,000 g by sonography. Under vaginal delivery at term (40th week of pregnancy) the birth stagnated so that a vacuum extraction was carried out. After delivery the newborn weighed 5,400 g, was dependent on artificial respiration, seemed to be limp, and increasing tumefaction of the neck was noticed. By x-ray a complete dislocation of the cervical vertebral spine between C5 and C6 was detected. According to the clinicians report the infant died as a consequence of cerebral ischemia and spinal shock. The autopsy revealed a complete horizontal separation of the cervical spine including ligaments and spinal cord, and voluminous haemorraging was found in the neck muscles. The cause of death was the traumatic spinal cord injury. If a correct determination of the birth weight in the beginning would have been made, a cesarean section would have been carried out and the sequence of events would have been prevented.

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  1. Institut für Rechtsmedizin, Rheinische Friedrich-Wilhelms-Universität Bonn

    F. Driever, R. Dettmeyer & B. Madea

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  1. F. Driever
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  2. R. Dettmeyer
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  3. B. Madea
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Driever, F., Dettmeyer, R. & Madea, B. Zervikale Dislokation der Halswirbelkörper nach Vakuumextraktion und Schulterdystokie. Rechtsmedizin 13, 26–32 (2003). https://doi.org/10.1007/s00194-002-0179-x

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  • DOI: https://doi.org/10.1007/s00194-002-0179-x

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