Birth injuries Flashcards
Injuries to the infant that result from —————- forces (ie, compression, traction) during the birth process are categorized as ____________ .
mechanical forces ; birth trauma.
Most birth injuries are self limiting with favourable outcome.
T/F
T
Outcome for birth injuries associated with _________ may be poor as a result of the ___________.
Significant birth injuries account for less than _____% of neonatal deaths.
Occasionally, injury may result from ___________.
asphyxia
asphyxia
2; resuscitation
Predisposing factors
Maternal factors
__________
__________ ___________
_______ maternal stature, maternal pelvic anomalies
Primigravida
Cephalopelvic disproportion
small
Predisposing factors
Fetal factors
________________ infant or extreme prematurity
Fetal __________
Large ________
Fetal anomalies
Abnormal presentations (_________)
Very ̶ low-birth-weight
macrosomia
fetal head
breech
Predisposing factors
Labour and delivery factors
_________ or _________ labor
______,______________ of presenting part of the fetus
_______hydramnios
Versions and difficult extractions
Instrumental deliveries (especially forceps or vacuum)
Abnormal or excessive ________ during delivery
Prolonged or rapid
Deep, transverse arrest
Oligo; traction
Cephalhaematoma
Cephalhaematoma is a ____________ bleed resulting from rupture of blood vessels between the ______ and the _____________ ;
The bleed is limited by _____________
Commonest site is in the _____________ region but it may also occur over the _____________ bone.
subperiosteal ; skull ; periosteum;
suture lines ; parietal region
occipital bone.
Cephaelhaematoma
It may cause __________ and __________ rarely.
The resolving haematoma may predispose to __________.
It may be a focus of infection resulting in __________ or __________ especially if it is aspirated.
anaemia ; hypotension
hyperbilirubinemia.
meningitis ; osteomyelitis
Cephaelhaematoma
It may cause __________ and __________ rarely.
The resolving haematoma may predispose to __________.
It may be a focus of infection resulting in __________ or __________ especially if it is aspirated.
anaemia ; hypotension
hyperbilirubinemia.
meningitis ; osteomyelitis
Cephalhaematoma
5-20% of cases may be associated with __________ skull fractures.
It usually resolves over __________ but may have residual __________.
linear ; weeks
calcification.
Cephalaematoma
Investigations are usually (necessary or unnecessary?) except if __________ symptoms are present.
Management is usually conservative, _______________ to correct anaemia, correct hypovolemia if present.
Skull radiography or CT scanning is also performed if a _____________________________ is a possibility.
Unnecessary
neurologic; transfuse blood
concomitant depressed skull fracture
Subgaleal hematoma
Subgaleal hematoma is bleeding in the potential space between the skull ___________ and the scalp ___________.
It (is or is not?) restricted by suture lines.
It may extend to the _______ and _______
skull periosteum ; scalp galea aponeurosis.
is not ; orbit
nape of the neck
Subgaleal Haematoma
Most of the cases (90%) occur following ________ delivery. 40% associated with _______________
The diagnosis is clinical- a ________ __________ scalp mass especially over the __________ region.
vaccum delivery.
head trauma
fluctuant boggy
occipital region.
Subgaleal haematoma
Develops gradually over _________ following delivery It may cause severe _________ and _________ shock.
In the absence of shock or intracranial injury, the long-term prognosis is generally _________.
It may also cause ________________
12-72hr
anaemia ; haemorrhagic shock.
good.
hyperbilirubinaemia
Subgaleal haematoma
Management consists of vigilant observation over _______ to detect progression and provide therapy for such problems as shock and anaemia.
____________ and ____________ may be necessary.
Investigation for ____________ may be indicated
days
Transfusion ; phototherapy
coagulopathy
Caput succedaneum
Caput succedaneum is a _____________ , subcutaneous, ______periosteal fluid collection caused by the pressure of the ____________ against the _____________.
It (extends or does not extend?) across the midline and over suture lines. May be ________ .
It usually resolves over the _________ days. Management is ____________ only.
serosanguineous ; extraperiosteal
presenting part ; dilating cervix.
extends ; pitting.
first few ; observation
Subcutaneous fat necrosis
Subcutaneous fat necrosis is not usually detected at birth. It may be caused by ___________ during delivery.
(Regular or Irregular?), (soft or hard?), (pitting or non-pitting?), subcutaneous plaques with overlying dusky, _____________ discoloration on the extremities, face, trunk, or buttocks.
It may also occur as a complication of ________ . No treatment is necessary. It may calcifies.
pressure
Irregular ; hard ; non-pitting
red-purple ; birth asphyxia.
Brachial Plexus Injury
This occurs commonly in _______ babies and may be associated with _____________ igo or __________ delivery.
It may involve the entire brachial plexus (10%) of cases.
Associated injuries
Fractured clavicle (10%) Fractured humerus (10%) Subluxation of cervical spine (5%) Cervical cord injury (5-10%) Facial palsy (10-20%)
large; shoulder dystocia
Breech
Brachial plexus injury
Erb’s palsy (_______) is most common – there is __________ , __________, and __________ rotation of the affected limb.
Moro, biceps, and radial reflexes are __________ on the affected side. The __________ reflex is usually present. There may be phrenic nerve paresis in 5% of cases.
(C5-C6)
adduction, pronation, and internal rotation
absent ; grasp
Klumpke’s paralysis (C7-8, T1) is (common or rare?), there is weakness of the ————— muscles of the hand; the _________ reflex is absent.
If cervical sympathetic fibres of the first thoracic spinal nerve are involved, _____________ is present.
Investigation- Cxray to rule out phrenic nerve involvement– Shoulder and upper arm Xrays to rule out fractures
rare ; intrinsic
grasp ; Horner syndrome
Facial nerve palsy
Cranial nerves can be damaged during delivery as a result of _____________ , _____________, and _____________ with simultaneous rotation.
Damage may range from _____________ _____________ to complete nerve or cord _____________.
____lateral branches are most commonly involved and result in temporary or permanent paralysis.
hyperextension ; traction
overstretching
localized neurapraxia ; transection.
Unilateral
Facial nerve palsy
The compression appears to occur as the head passes by the __________ or by the __________ in __________ delivery.
Clinical features - _______________ ________ when crying with the mouth drawn towards the ________ side, wrinkles are deeper on the ___________ side, and movement of the forehead and eyelid is ____________.
sacrum ; forceps blade ; forceps
asymmetrical facies ; normal side
normal ; unaffected.
Facial nerve palsy
The paralyzed side is __________ with a __________ appearance, the nasolabial fold is __________, and the corner of the mouth __________. __________ may be present.
With peripheral nerve branch injury, the paralysis is limited to the __________, __________, or __________.
smooth ; swollen
absent ; droops.
Forceps marks ; forehead
eye ; mouth.
Referral to a neurologist and a surgeon should be sought if no improvement is observed in 7-10 days.
Facial nerve palsy
The differential diagnosis includes nuclear agenesis (Möbius syndrome), congenital absence of the facial muscles, unilateral absence of the orbicularis oris muscle, and intracranial haemorrhage.
Recovery begins in the ______ week, but full resolution may take several _______.
Management consists of _________ and _____________ to protect the opened eye.
Referral to a neurologist and a surgeon should be sought if no improvement is observed in ________
First ; months
eye patches
synthetic tears
7-10 days.
Fractures
May be associated with large babies, forceps delivery, and shoulder dystocia.
1. __________ fracture - is the most frequent fracture encountered during birth.
The infant may present with inability to move the arm on the affected side - ____________.
Examination may reveal _______, palpable bony irregularity, and ___________ muscle spasm.
May be missed and only picked up when healing starts and ________ has formed.
Radiographic studies confirm the fracture.
Usually heals in 7-10 days.
- Humeral or femoral fractures – treated by _________ and only immobilized if there is _________. Healing occurs in 2-4 weeks
Clavicular; pseudoparalysis
crepitus; sternocleidomastoid
callus; splinting
dislocation
Intra-abdominal injury
Intra-abdominal birth injuries are (common or rare?) but are a cause of neonatal mortality if not identified and treated.
________ or ________ ________ may occur around delivery. _____ rupture commoner than ________ rupture.
Predisposing factors include prematurity, postmaturity, coagulation disorders, and asphyxia (following dangerous methods of stimulation).
rare
Liver ; splenic rupture
Liver rupture ; splenic rupture.
Intra-abdominal injury
Babies usually present soon after birth with unexplained ___________ , abdominal ___________, ________ discolouration over abdominal wall and circulatory ___________.
Urgent resuscitation with blood transfusion is required to prevent death especially when bleeding is rapid and large volume.
anaemia ; distension
bluish; collapse
