Birth Trauma Flashcards
Definition of birth injuriy …?
Birth injury is defined as “an impairment of the infant’s body function or structure due to adverse influences that occurred at birth
Caput succedaneum ….?
Caput succedaneum is a commonly occurring subcutaneous, extraperiosteal fluid collection that is occasionally hemorrhagic.
It has poorly defined margins and can extend over the midline and across suture lines.
It typically extends over the presenting portion of the scalp and is usually associated with molding
Caput succedaneum resolve by …?
The lesion usually resolves spontaneously without sequelae over the first several days after birth
Vacuum caput …?
Vacuum caput is a caput succedaneum with margins well demarcated by the vacuum cup
What is cephalohematoma…?
cephalohematoma is a subperiosteal collection of blood resulting from rupture of the superficial veins between the skull and the periosteum.
The lesion is always confined by suture lines and does not cross the midline although can be bilateral over occipital or parietal region
Resolution of cephalohematoma …?
Most cephalohematomas resolve within 8 weeks
What is Subgaleal hematoma …?
Subgaleal hematoma is hemorrhage under the aponeurosis of the scalp. It is more often seen after vacuum- or forceps-assisted deliveries.
Extension of Subgaleal hematoma ..?
The subgaleal or subaponeurotic space extends from the orbital ridges to the nape of the neck and laterally to the ears, the hemorrhage can spread across the entire calvarium without anatomic tamponade
A 1-cm increase in the depth of subgaleal space may hold up to………….. of blood( NEET 2022)
260 mL
Clinical presentation of subgaleal hematoma ….. ?
The clinical picture may be progressive and hence demands frequent reassessments
The initial presentation ranges from no signs at birth, just a fluctuant swelling on the scalp, to a slow insidious onset or sometimes a rapidly progressive pallor and shock.
The time to diagnosis is usually 1 to 6 hours after birth. With progressive spread, there is anterior displacement of the ears, periorbital swelling, and ecchymosis of the scalp
Anticipate a————-mL blood loss for every 1-cm increase in occipitofrontal circumference in case of subgaleal bleed …?
40ml
About Skull fractures during delivery …?
linear, usually involving the parietal bone, or
depressed, involving the parietal or frontal bones
Skull fracture associated with forceps delivery …?
Depressed type , involving the parietal or frontal bones
Skull fracture associated with breech delivery…?
Occipital bone fractures are most often associated with breech deliverie
Cause for Retinal and subconjunctival hemorrhages
They result from increased venous congestion and pressure during delivery.
Retinal hemorrhages usually resolve within how many days….?
1 to 5 days
Subconjunctival hemorrhages resorb within 1 to 2 weeks.
Cause for congenital or muscular torticollis …?
SCM injury is also referred to as congenital or muscular torticollis
The most likely cause is a muscle compartment syndrome resulting from intrauterine positioning
What is fibromatosis colli …?
Torticollis can also arise during delivery as the muscle is hyperextended and ruptured, with the development of a hematoma and subsequent fibrosis and shortening, hence also called fibromatosis colli (sternocleidomastoid tumour of infancy)
When the Recovery typically occurs in congenital torticolis…?
Recovery typically occurs within 3 to 4 months in approximately 80% of case
Indication for surgery in congenital or muscular torticollis..?
Surgery is needed if torticollis persists after 6 months of physiotherapy.
Botulinum toxin injection is also rarely considered.
Which is the most common cranial nerve injury in neonates, occurring in up to 1% of live births…?
Injury to the facial nerve
Etiology for facial nerve injury …?
compression of the facial nerve by forceps (particularly midforceps),
pressure on the nerve secondary to the fetal face lying against the maternal sacral promontory, or,
rarely, pressure of a uterine mass (e.g., fibroid).
Prognosis of facial nerve injuries..?
The prognosis of acquired facial nerve injury is excellent, with recovery usually complete by 3 weeks
Risk factors for Spinal cord injuries…?
Vaginal delivery of an infant with a hyperextended head or neck, breech delivery, and severe shoulder dystocia
Etiology for Phrenic nerve injury (C3, C4, or C5) ..?
Phrenic nerve damage leading to paralysis of the ipsilateral diaphragm may result from a stretch injury due to lateral hyperextension of the neck at birth
Cause for Brachial plexus injury ..?
The cause is excessive traction on the head, neck, and arm during birth
Duchenne–Erb palsy involves……?
the upper trunks (C5, C6, and occasionally C7)
The most common type of brachial plexus injury…?
Duchenne–Erb palsy
Klumpke palsy involves……?
C7/C8–T1
Position of limb in Duchenne–Erb palsy …?
The arm is typically adducted and internally rotated at the shoulder.
There is extension and pronation at the elbow and
flexion of the wrist and fingers in the characteristic “waiter’s tip” posture
Grasp reflex in Duchenne–Erb palsy …?
Intact
Characteristics of Total brachial plexus injury …?
The entire arm is flaccid. All reflexes, including grasp and sensation, are absent.
If sympathetic fibers are injured at T1, Horner’s syndrome may be see
Limb position in Klumpke palsy …?
The lower arm paralysis affects the intrinsic muscles of the hand and the long flexors of the wrist and fingers.
The grasp reflex is absent
ipsilateral Horner’s syndrome present in which palsy…?
Klumpke palsy
first thoracic root is usually injured, its sympathetic fibers are damaged, leading to an ipsilateral Horner’s syndrome.
When to start physical therapy in brachial plexus palsy …?
Physical therapy and passive range of motion exercises prevent contractures.
These should be started at 7 to 10 days when the postinjury neuritis has resolved
Prognosis of BPI ..?
If the nerve roots are intact and not avulsed, the prognosis for full recovery is excellent (>90%).
Other predictors of outcome (at birth) include induction of labor, birth weight, clavicle fracture, Horner’s syndrome, and pseudo meningocele on imaging.
Indication for surgery in BPI ….?
when there is a lack of biceps function at 3 months of age.
Nerve reconstruction, (nerve graft repair and nerve transfer), is generally undertaken beyond age 6 months.
Botulinum toxin has been used in older infants with contractures
When to refer to specialist in BPI…..?
If the recovery is not complete by 1 month, the infant should be referred to a specialist team
Which is the most injured bone during delivery…?
Clavicle
Risk factors for Adrenal hemorrhage…?
breech presentation and macrosomia
About Adrenal hemorrhag ..?
Ninety percent of adrenal hemorrhages are unilateral;
75% occur on the right.
Incidence is 0.2% of neonates.
Characteristics features of Subcutaneous fat necrosis …..?[NEET 2022]
It is caused by panniculitis secondary to focal pressure and ischemia to the adipose tissue within the subcutaneous space during the birth process
It usually presents during the first 2 weeks after birth
The injury may be colorless or have a deep red or purple discoloration. Calcification may occur
Affected infant needs to be followed up for hypercalcemia, which may manifest even up to 6 months from the onset of the initial lesion
