40. Assessment of the baby
developmental dysplasia of the hips
CHAPTER CONTENTS
Developmental dysplasia287
When to assess for developmental dysplasia of the hips288
Appearance of the legs and thigh skin folds288
Role and responsibilities of the midwife291
Summary291
Self-assessment exercises291
References291
LEARNING OUTCOMES
Having read this chapter the reader should be able to:
• describe how the hips are examined to detect developmental dysplasia
• discuss the role and responsibilities of the midwife in relation to this screening test.
Developmental dysplasia of the hips (congenital dislocation of the hips) encompasses a continuum of abnormalities in the immature hip of the baby that ranges from mild dysplasia to full dislocation (Storer & Skaggs 2006). Mild dysplasia may not become clinically apparent until adulthood (Dezateux & Rosenthal 2007) but when it is untreated can lead to long-term complications such as pain in the hips, knees and lower back, gait disturbances and degenerative hip changes and is a leading cause of arthritis in the hip (Dezateux and Rosenthal, 2007 and Mahan and Kassler, 2008). This chapter considers the assessment for developmental dysplasia, including discussion of who should undertake the assessment, when and how.
Developmental dysplasia
Developmental dysplasia of the hips (DDH) occurs in approximately 1 per 1000 births (McCarthy et al 2005) although there are cultural differences which increase the incidence. Risk factors for developing DDH include:
• Breech presentation: the risk increases further with a vaginal breech birth compared to elective prelabour caesarean section (Dezateux and Rosenthal, 2007, Lowry et al., 2005, Mahan and Kassler, 2008, McCarthy et al., 2005 and Storer and Skaggs, 2006).
• Family history (Dezateux and Rosenthal, 2007, Mahan and Kassler, 2008, McCarthy et al., 2005 and Storer and Skaggs, 2006).
• Female infants: possibly related to increased joint laxity in response to maternal hormones such as relaxin (Dezateux and Rosenthal, 2007 and Lowry et al., 2005).
• Swaddling where the hips are adducted: this is more common in countries/cultures where swaddling for long periods is undertaken, e.g. Saudi Arabia, Japan, Turkey, Navajo Indians, Lapp populations (Dezateux and Rosenthal, 2007 and Mahan and Kassler, 2008). The incidence decreases when babies are able to flex and abduct their hips when swaddled (Mahan & Kassler 2008).
• Ethnicity: increased in Caucasian babies (McCarthy et al 2005).
• High birthweight babies (Dezateux & Rosenthal 2007).
• Oligohydramnios (Dezateux & Rosenthal 2007).
Situations where the hips of the fetus/baby are maintained in prolonged periods of extension and adduction increase the incidence of DDH. McCarthy et al (2005) suggest that other musculoskeletal disorders of malpositioning or uterine crowding may also be present (e.g. talipes, torticollis).
When to assess for developmental dysplasia of the hips
The stability of the hips can be assessed at birth; some babies’ hips will appear to be dislocatable whereas others are actually dislocated. However, there is an ongoing debate about whether DDH should be assessed at birth or when the baby is older as the majority of cases of DDH detected at birth resolve spontaneously in the first week of life (Mahan & Kassler 2008). There is also concern that repeated Barlow hip tests may cause dislocation in an otherwise normal hip; despite these concerns there appear to be no reported increases in hip laxity (Mahan & Kassler 2008
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