5.2 - Neonatal birth trauma Flashcards
1
Q
`Birth trauma
A
- are classified as a direct injury during the delivery process
- Trauma means a wound, serious injury or damage
- it can be physical or psychological
- (deeply disturbing & distressing)
2
Q
Types of HAC
A
- Subdural and cerebral haemorrhage
- Epicranial subaponeurotic haemorrhage
- other injuries to skeleton
- injury to spine and spinal cord
- facial nerve injury
- other cranial and peripheral nerve injury
- the specified birth trauma
3
Q
Subgaleal or subaponeurotic haemorrhage
A
- Most serious form of extra cranial haemorrhage
- instrumental assisted birth via vaginal delivery
- precipitous deliveries
- neonatal - macrosomia
- severe should dystocia
- blood from burst emissary and diploid veins empty into the space created between the galea and there periosteum created from shearing forces to the scalp during delivery
4
Q
Subconjunctival haemorrhage
A
- breakage of small vessels during the pressure of delivery
- red area confirmed to the limits of the sclera
- does not affect vision
- spontaneously resolves
5
Q
Injuries to the scalp
A
- bruising of the vertex of the head (fairly common in newborns)
- Affected area may be rather large (6-8cm)
- varies colouring of red & blue
- Traumatic blister or bullae
- Scalp electrode
*
6
Q
Caput Succedaneum
A
- scalp oedema
- Pitting oedema
- caput can cross over the suture lines it is predominantly unilateral
7
Q
Cephalohematoma
A
- collection of blood under the periosteum of the skull bone
- impossible for the cephalohematoma to cross suture lines
- if more than on bone is affected there will be separation between the two areas at the store line
- bilateral parietal chepolhematomes
- palpation these areas feel unstable
8
Q
Fractured Clavicle
A
- crepitus may be present over the clavicle
- very visual
- asymmetry between both sides
9
Q
Brachial plexus palsy
A
- traumatic stretching or lateral traction on the shoulder during deliver of the head and neck
- brachial plexus is as group of fevers that supply the shoulder, arm and hand
- nerve roots - cervical spinal cord C5 -C8
- traction and excessive pulling on the should at the same time as lateral or sideways stretching of the head away form the should may stretch and twist the brachial plexus
- can be accompanied by features of the humerus and/or clavicle
-
Erb’s palsy:
- cervical nerve 5 (C5 - C7) involvement - damage results in nerve root stretching and oedema occurs
-
Brachial plexus palsy:
- c5 to t1 damage
- involves upper and lower arm and hand is involved
-
Klumpke palsy (rarely occurs)
- distal upper extremity (lower arm and hand)
10
Q
Brachial plexus palsy
A
- traumatic stretching or lateral traction on the shoulder during deliver of the head and neck
- brachial plexus is as group of fevers that supply the shoulder, arm and hand
- nerve roots - cervical spinal cord C5 -C8
- traction and excessive pulling on the should at the same time as lateral or sideways stretching of the head away form the should may stretch and twist the brachial plexus
- can be accompanied by features of the humerus and/or clavicle
-
Erb’s palsy:
- cervical nerve 5 (C5 - C7) involvement - damage results in nerve root stretching and oedema occurs
-
Brachial plexus palsy:
- c5 to t1 damage
- involves upper and lower arm and hand is involved
-
Klumpke palsy (rarely occurs)
- distal upper extremity (lower arm and hand)
11
Q
Skull Fractures
A
- skull fracture are rare
- may result of the parietal bones due to compression force during forceps deliveries
- Mechanical forces of the skull pressing against the maternal pelvis during labour
- Occipital fractures may occur during breech VD
- Skull fractures - linear
- Linear (non depressed skull fractures are the most common
- most often has no associated injuries and cause no symptoms
- Skull Fracture - Depressed
- indentation without loss of bony continuity
- frequent cause application of forceps
- no symptoms
- “ping pong” indentation
*
12
Q
Intracranial haemorrhage
A
- caused by birth very rare
- should not be confused with intraventricular haemorrhage (that is associated with prematurity)
- Three major forms of intracranial bleeding occurs:
- epidural
- pathophysiologically difficult to form in the newborn
- present is usually associated with a linear skull fracture
- subdural
- most common in term infants
- occurs from trauma of tearing veins and venous sinuses
- subarachnoid
- most common type of neonatal intracranial haemorrhage
- term infants most
- preterm - hypoxia
- Sequelae Subdural haemorrhage:
- occurs in 20 - 25% of affected infants
- long term variable outcomes
- infants may appear normal on discharge
- parent teaching must emphasis the need for appropriate follow up and intervention
- epidural
13
Q
Intraventricular haemorrhage (IVH)
A
- bleed into the germinal matrix of the developing brain
- germinal matrix is a fragile network of cerebral capillaries within the subependymal layer
- susceptible to hypoxia changes during fluctuations in arterial blood pressure
- Risk factors
- no antenatal care
- Chorioamnionitis
- multiple gestation
- outworn status (needing transferring)
- resus at birth
- low birth weight
- prematurity
- unstable
- resuscitated infants
- of secondary to RDS
- Rarely occurs in term baby
- but can be a result of asphyxia or trauma
- happens within the first 72 hours of life in 70 - 90% of cases
- incidence increase with decreasing gestational age
- associated with increased mortality
- Long term outcomes
- neurodevelopment disabilities
- behavioural & cognitive
- cerebral palsy
- epilepsy
- visual & hearing impairment
- Autism spectrum disorder
*
- neurodevelopment disabilities
14
Q
exam
Identify predisposing factors that increase the risk of birth injury
A
- instrumental assisted birth via vaginal delivery
- Breech
- Pelvic size
- Over weight mother
- c-sections
- precipitous deliveries
- neonatal - macrosomia
- severe should dystocia
- Hypoxia
- Preterm
- IUFGR
15
Q
EXAM
explain the role of the midwife in the care of the infant who has sustained a birth injury
A
