Birth Injuries

Question 1

What should be given to babies with signs of trauma at birth?

Answer 1

Vitamin K 1mg IM

Question 2

What is moulding?

Answer 2

Skull bones can override each other to reduce the diameter of the head
Moulding is assessed by the degree of overlap of the overriding at the sutures
If moulding is absent, skull bones are felt separately
If moulding is present, the bones override but can be reduced

Question 3

What is cephalohaematoma?

Answer 3

Subperiosteal swelling on fetal head
Develops several hours after birth
Its boundaries are limited by the individual bone margins - doesn't cross suture lines
It is commonest over parietal bones
Takes up to 3 months to resolve
Jaundice may develop

Question 4

What is caput succedaneum?

Answer 4

Oedema of the scalp, superficial to the cranial periosteum (which does not therefore limit its extent) over the presenting part of the head
Result of venous congestion and exuded serum caused by pressure against the cervix and lower segment during labour
May be due to mechanical trauma of initial portion of scalp pushing through cervix in prolonged delivery or secondary to use of ventouse (chignon)

Soft puffy swelling due to localised oedema
Crosses suture lines
Gradually disappears in first days after birth

Question 5

What can shoulder dystocia cause?

Answer 5

Erb’s palsy - baby’s arm is flaccid and the hand is in the porter’s tip posture
Exclude fractured clavicle and arrange physiotherapy

Question 6

What is subaponeurotic haematoma?

Answer 6

Blood lies between aponeurosis and the periosteum
As haematoma is not confirmed to the boundaries of one bone, collections of blood may be large enough to result in anaemia or jaundice
Associated with ventouse

Question 7

What can anoxia cause?

Answer 7

Interventricular haemorrhage

Question 8

What can asphyxia cause?

Answer 8

Intracerebral haemorrhage and may result in Cerebral palsy

Question 9

What injuries can occur to the mother?

Answer 9

Anal sphincter injury - 3rd/4th degree perineal tear
- may lead to faecal incontinence

Vesicovaginal fistula - abnormal opening between bladder and vagina leading to urinary incontinence

Question 10

What is management for a vesicovaginal fistula?

Answer 10

Continuous urinary drainage for 3 months if presenting with vesicovaginal fistula early (<3 months postpartum) or surgery if later