Birth Trauma

Question 1

Definition of birth injuriy …?

Answer 1

Birth injury is defined as “an impairment of the infant’s body function or structure due to adverse influences that occurred at birth

Question 2

Caput succedaneum ….?

Answer 2

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

Question 3

Caput succedaneum resolve by …?

Answer 3

The lesion usually resolves spontaneously without sequelae over the first several days after birth

Question 4

Vacuum caput …?

Answer 4

Vacuum caput is a caput succedaneum with margins well demarcated by the vacuum cup

Question 5

What is cephalohematoma…?

Answer 5

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

Question 6

Resolution of cephalohematoma …?

Answer 6

Most cephalohematomas resolve within 8 weeks

Question 7

What is Subgaleal hematoma …?

Answer 7

Subgaleal hematoma is hemorrhage under the aponeurosis of the scalp. It is more often seen after vacuum- or forceps-assisted deliveries.

Question 8

Extension of Subgaleal hematoma ..?

Answer 8

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

Question 9

A 1-cm increase in the depth of subgaleal space may hold up to………….. of blood( NEET 2022)

Answer 9

260 mL

Question 10

Clinical presentation of subgaleal hematoma ….. ?

Answer 10

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

Question 11

Anticipate a————-mL blood loss for every 1-cm increase in occipitofrontal circumference in case of subgaleal bleed …?

Answer 11

40ml

Question 12

About Skull fractures during delivery …?

Answer 12

linear, usually involving the parietal bone, or

depressed, involving the parietal or frontal bones

Question 13

Skull fracture associated with forceps delivery …?

Answer 13

Depressed type , involving the parietal or frontal bones

Question 14

Skull fracture associated with breech delivery…?

Answer 14

Occipital bone fractures are most often associated with breech deliverie

Question 15

Cause for Retinal and subconjunctival hemorrhages

Answer 15

They result from increased venous congestion and pressure during delivery.

Question 16

Retinal hemorrhages usually resolve within how many days….?

Answer 16

1 to 5 days

Subconjunctival hemorrhages resorb within 1 to 2 weeks.

Question 17

Cause for congenital or muscular torticollis …?

Answer 17

SCM injury is also referred to as congenital or muscular torticollis

The most likely cause is a muscle compartment syndrome resulting from intrauterine positioning

Question 18

What is fibromatosis colli …?

Answer 18

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)

Question 19

When the Recovery typically occurs in congenital torticolis…?

Answer 19

Recovery typically occurs within 3 to 4 months in approximately 80% of case

Question 20

Indication for surgery in congenital or muscular torticollis..?

Answer 20

Surgery is needed if torticollis persists after 6 months of physiotherapy.

Botulinum toxin injection is also rarely considered.

Question 21

Which is the most common cranial nerve injury in neonates, occurring in up to 1% of live births…?

Answer 21

Injury to the facial nerve

Question 22

Etiology for facial nerve injury …?

Answer 22

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).

Question 23

Prognosis of facial nerve injuries..?

Answer 23

The prognosis of acquired facial nerve injury is excellent, with recovery usually complete by 3 weeks

Question 24

Risk factors for Spinal cord injuries…?

Answer 24

Vaginal delivery of an infant with a hyperextended head or neck, breech delivery, and severe shoulder dystocia

Question 25

Etiology for Phrenic nerve injury (C3, C4, or C5) ..?

Answer 25

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

Question 26

Cause for Brachial plexus injury ..?

Answer 26

The cause is excessive traction on the head, neck, and arm during birth

Question 27

Duchenne–Erb palsy involves……?

Answer 27

the upper trunks (C5, C6, and occasionally C7)

Question 28

The most common type of brachial plexus injury…?

Answer 28

Duchenne–Erb palsy

Question 29

Klumpke palsy involves……?

Answer 29

C7/C8–T1

Question 30

Position of limb in Duchenne–Erb palsy …?

Answer 30

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

Question 31

Grasp reflex in Duchenne–Erb palsy …?

Answer 31

Intact

Question 32

Characteristics of Total brachial plexus injury …?

Answer 32

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

Question 33

Limb position in Klumpke palsy …?

Answer 33

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

Question 34

ipsilateral Horner’s syndrome present in which palsy…?

Answer 34

Klumpke palsy

first thoracic root is usually injured, its sympathetic fibers are damaged, leading to an ipsilateral Horner’s syndrome.

Question 35

When to start physical therapy in brachial plexus palsy …?

Answer 35

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

Question 36

Prognosis of BPI ..?

Answer 36

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.

Question 37

Indication for surgery in BPI ….?

Answer 37

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

Question 38

When to refer to specialist in BPI…..?

Answer 38

If the recovery is not complete by 1 month, the infant should be referred to a specialist team

Question 39

Which is the most injured bone during delivery…?

Answer 39

Clavicle

Question 40

Risk factors for Adrenal hemorrhage…?

Answer 40

breech presentation and macrosomia

Question 41

About Adrenal hemorrhag ..?

Answer 41

Ninety percent of adrenal hemorrhages are unilateral;

75% occur on the right.

Incidence is 0.2% of neonates.

Question 42

Characteristics features of Subcutaneous fat necrosis …..?[NEET 2022]

Answer 42

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