Views and Reviews Parturitional Injury of the Head and Neck Thierry A.G.M. Huisman, MD, Timothy Phelps, MS, FAMI, Thangamadhan Bosemani, MD, Aylin Tekes, MD, Andrea Poretti, MD From the Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD (TAGMH, TB, AT, AP); Department of Art as Applied to Medicine, The Johns Hopkins University, Baltimore, MD (TP) Keywords: Neonatal, trauma, head, neck. Acceptance: Received December 13, 2013, and in revised form March 23, 2014. Accepted for publication March 30, 2014. Correspondence: Address correspon- dence to Thierry A.G.M. Huisman, MD, Director of Pediatric Radiology and Pediatric Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Char- lotte R. Bloomberg Children’s Center, Sheikh Zayed Tower, Room 4174, 1800 Orleans Street, Baltimore, MD 21287- 0842, USA. E-mail: thuisma1@jhmi.edu J Neuroimaging 2014;00:1-16. DOI: 10.1111/jon.12144 ABSTRACT Parturitional injuries refer to injuries sustained during and secondary to fetal delivery. The skull, brain, and head and neck regions are frequently involved. Accurate differen- tiation and classification of the various injuries is essential for treatment, prognosis, and parental counseling. In this review, we discuss the various “bumps and lumps” that maybe encountered along the neonatal skull as well as the most frequent calvarial and intracranial parturitional injuries. In addition, a short discussion of the most common head and neck, facial, and spinal lesions is included. Various mimickers and risk factors are also presented. Introduction Parturitional injury relates to any condition that affects the fe- tus adversely during labor and delivery. 1 In the past decades, the improving pre-, peri-, and postnatal care has dramatically decreased the incidence of parturitional injuries. Currently, birth trauma is reported to occur in less than 3% of all live births in the United States. In addition, parturitional injury ac- counts for less than 2% of all neonatal deaths in the United States. Many maternal and fetal risk factors have been identified. 1 Maternal risk factors include diabetes, obesity, a small pelvis, large weight gain, induction of labor, epidural analgesia, prim- iparity, and history of a macrosomic infant. Fetal risk factors include macrosomia (birth weight >3,500 g), delayed and pro- longed delivery, abnormal fetal presentation (eg, breech presen- tation), instrumented delivery, perinatal depression, and shoul- der dystocia. 1 Depending on the severity of parturitional injury, the impact on the short- and long-term quality of life of the neonate may be significant. In addition, even when the parturi- tional injuries are mild or benign, this may result in significant anxiety for the family. Accurate diagnosis of parturitional injury is mandatory to guide treatment, prevent secondary complications, and to coun- sel the parents. Parturitional injury is typically classified in 2 ma- jor categories; birth injury and birth trauma. 2 Birth injuries re- sult from various combinations of hypoxia/hypoperfusion and infection, while birth trauma results from the direct impact of mechanical forces exerted to the fetus during labor and deliv- ery. In this manuscript, we will focus on the imaging findings related to birth trauma involving the neonatal brain and skull. In addition, a short discussion will be included of injuries to the neonatal spinal cord and the head and neck region. Parturitional Skull and Brain Injuries In the immediate postnatal time period, a wide spectrum of extracranial, cranial (skull), and intracranial lesions may be encountered. 3-7 Depending on the severity and type of the in- jury, location of the lesion, exerted mass effect on adjacent brain structures, development of primary (eg, anemia and hy- povolemic shock in subgaleal hematomas), and/or secondary (eg, hyperbilirubinemia in subgaleal hematomas and secondary ischemic lesions in skull fractures with midline shift) complica- tions and presence of complicating factors outside of the central nervous system (eg, systemic hypoxia, hypoperfusion, or sep- sis), various degrees of reversible or irreversible brain injury may result. It is therefore essential to diagnose parturitional injury quickly as well as with high sensitivity, specificity, and Copyright ◦ C 2014 by the American Society of Neuroimaging 1