Birth Injuries To The Baby (Due to Labour)

Question 1

What is moulding?

Answer 1

A natural phenomenon (not an injury)

The skull bones can override each other to reduce the diameter of the head

Question 2

Describe the degrees of moulding

Answer 2

If moulding absent - skull bones felt separately
With slight moulding the bones just touch, then they override but can be reduced
They can also override so much that they cannot be reduced

Question 3

What is a cephalhaematoma?

Answer 3

A subperiostial swelling - due to rupture of vessels
Does not cross suture lines
It is fluctuant
Increases in size after birth for 12-24 hours

Question 4

A cephalhaematoma is commonest where?

Answer 4

Over parietal bones

Question 5

How should a cephalhaematoma be managed?

Answer 5

Spontaneous absorption occurs but may take 2-3 weeks

Question 6

What can a cephalhaematoma cause or contribute to?

Answer 6

Jaundice

Question 7

Is a cephalhaematoma severe?

Answer 7

Rarely

Question 8

What is caput succedaneum?

Answer 8

An oedematous swelling of the scalp, superficial to periosteum, so it’s extent of spread is not limited

Question 9

What causes a caput succedaneum?

Answer 9

Venous congestion and exuded serum caused by pressure against the cervix and lower segment during labour. The presenting part of the head has the swelling over it - usually their vertex

Question 10

What features are associated with a caput succedaneum?

Answer 10

Vaguely demarcated
Pitting oedema, shifts with gravity
Maximal size and firmness at birth
Resolves 48-72 hours

Question 11

What is a chignon?

Answer 11

When ventouse extraction used in labour a particularly large caput called a chignon is formed under the ventouse cup

Question 12

Is treatment needed for a caput succedaneum?

Answer 12

No

Question 13

What is a subgleal haematoma?

Answer 13

Bleed located between the aponeurosis of the skull and the periosteum - not confined so can spread to orbit

Question 14

Describe the characteristics of a subgaleal haematoma

Answer 14

Firm to fluctuant
Poorly defined borders
May shift with movement
Progressive after birth

Question 15

The collection of blood in a subgaleal haematoma may be large enough to cause…

Answer 15

Rapid loss of intravascular volume causing tachycardia, pallor, anaemia, jaundice

Question 16

Most subgaleal haematoma are a result of …

Answer 16

Vacuum assisted delivery

So should be monitored for after these deliveries

Question 17

How are subgaleal haematomas managed?

Answer 17

Monitor with serial haematocrit and frontal circumference
If needed: resuscitation with packed red cells, FFP, fluids
May need surgical evacuation

Question 18

What are skull fractures associated with?

Answer 18

Difficult forceps delivery
May also occur after difficult second stage CS delivery where the head is impacted
Commonest over parietal and frontal bones

Question 19

What can Erb’s palsy result from?

Answer 19

Shoulder dystocia - so increased x10 in diabetic pregnancies

Question 20

Describe the characteristics of Erb’s palsy

Answer 20

Baby arm is flaccid and hand in waiter’s tip position

Question 21

How should Erb’s palsy be managed?

Answer 21

Exclude fractured clavicle
Arrange physio
Most resolve, but if not by 6 months it is unlikely to improve further

Question 22

Damage to what nerves cause Erb’s palsy?

Answer 22

The upper trunk: C5-6

Question 23

Fetal lacerations occur in what percentage of CS deliveries?

Answer 23

1-2%
It is the most common fetal risk in CS
More common in breech CS and after membrane rupture
Most are superficial and heal without scarring

Question 24

Intracranial injuries are associated with…

Answer 24

Difficult or fast labour
Instrumental delivery
Breech delivery

Question 25

Which babies are especially vulnerable to intracranial haemorrhage?

Answer 25

Premature