Birth Injuries To The Baby (Due to Labour) Flashcards
What is moulding?
A natural phenomenon (not an injury)
The skull bones can override each other to reduce the diameter of the head
Describe the degrees of moulding
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
What is a cephalhaematoma?
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
A cephalhaematoma is commonest where?
Over parietal bones
How should a cephalhaematoma be managed?
Spontaneous absorption occurs but may take 2-3 weeks
What can a cephalhaematoma cause or contribute to?
Jaundice
Is a cephalhaematoma severe?
Rarely
What is caput succedaneum?
An oedematous swelling of the scalp, superficial to periosteum, so it’s extent of spread is not limited
What causes a caput succedaneum?
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
What features are associated with a caput succedaneum?
Vaguely demarcated
Pitting oedema, shifts with gravity
Maximal size and firmness at birth
Resolves 48-72 hours
What is a chignon?
When ventouse extraction used in labour a particularly large caput called a chignon is formed under the ventouse cup
Is treatment needed for a caput succedaneum?
No
What is a subgleal haematoma?
Bleed located between the aponeurosis of the skull and the periosteum - not confined so can spread to orbit
Describe the characteristics of a subgaleal haematoma
Firm to fluctuant
Poorly defined borders
May shift with movement
Progressive after birth
The collection of blood in a subgaleal haematoma may be large enough to cause…
Rapid loss of intravascular volume causing tachycardia, pallor, anaemia, jaundice
Most subgaleal haematoma are a result of …
Vacuum assisted delivery
So should be monitored for after these deliveries
How are subgaleal haematomas managed?
Monitor with serial haematocrit and frontal circumference
If needed: resuscitation with packed red cells, FFP, fluids
May need surgical evacuation
What are skull fractures associated with?
Difficult forceps delivery
May also occur after difficult second stage CS delivery where the head is impacted
Commonest over parietal and frontal bones
What can Erb’s palsy result from?
Shoulder dystocia - so increased x10 in diabetic pregnancies
Describe the characteristics of Erb’s palsy
Baby arm is flaccid and hand in waiter’s tip position
How should Erb’s palsy be managed?
Exclude fractured clavicle
Arrange physio
Most resolve, but if not by 6 months it is unlikely to improve further
Damage to what nerves cause Erb’s palsy?
The upper trunk: C5-6
Fetal lacerations occur in what percentage of CS deliveries?
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
Intracranial injuries are associated with…
Difficult or fast labour
Instrumental delivery
Breech delivery
