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NCB V > Birth Trauma > Flashcards

Birth Trauma Flashcards

1
Q

RFs for Birth Injuries: Maternal

A 
DM
Obesity
Undersize pelvis
Post maturity
Primip
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2
Q

RFs for Birth Injuries: Fetal

A

Macrosomia
Increased chest: head circumference
Malposition/breech

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3
Q

RFs for Birth Injuries: Obstetric

A 
Shoulder dystocia
forceps
vacuum
Prolonged second stage
Precipitous delivery
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4
Q

Complications of Vacuum

A 
Cephalohematoma
Scalp abrasions
Necrosis/avulsions of scalp
Subaponeurotic hemorrhage
Skull factures
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5
Q

Caput succadaneum

A

Collection of edema in SubQ

resolves in days

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6
Q

Cephalohematoma

A 
involves parietal bone
RISKS
-macrosomia
-primip
-vacuum
-forceps
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7
Q

Cephalohematoma course

A

resolves over weeks
Complications: hyperbilirubinemia, scalp infxn, osteomyelitis
OBSERVE, maybe arnica/hypericum oil

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8
Q

Subgaleal hemorrhage

A

Bleeding below epicranial aponeurosis

Vacuum

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9
Q

What type of bleeding is most common in full term infant?

A

ss

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10
Q

Linear fracture

A

usu involves parietal bone

follow up but will resolve on their own

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11
Q

Depressed fracture

A

dt excessive molding and compression of fetal skull OR forceps
if neuro and behavior asx: no tx needed

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12
Q

Subarachnoid hemorrhage sxs

A

asx or..
intermittent seizures on day 2-3
lethargy, irritability, retinal hemorrhages

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13
Q

Subarachnoid hemorrhage Dx

A

RBCs in cerebrospinal fluid
xanthochromia in centrifuged supernatant and count RBCs
CT

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14
Q

Subdural hemorrhage RFs

A

severe molding causes dural venous lacertations or rupture of bridging veins

CPD
breech or forceps
precipitous delivery in multip
macrosomia

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15
Q

Subdural hemorrhage sxs: Posterior fossa

A

lethargy, irritability, vomiting, irreg resp
tense anterior fontanelle, split sutures
increasing head circumference, blood in CSF
hypotonia, nystagmus, CN palsies, seizures, apnea

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16
Q

Subdural hemorrhage Dx

A

US to screen
CT to dx
(avoid lumbar dt risk of herniation)

17
Q

Subdural hemorrhage Tx

A

1/3 require shunt dt hydrocephaly

may just need supportive tx

18
Q

Rare bleeds in full term neonates

A

Intraventricular
Epidural
Intracerebral

19
Q

Retinal hemorrhage

A

up to 40% of vaginal

resolve in days to weeks

20
Q

Subconjunctival hemorrhage

A

13% births
painless, resolves in 2-3 weeks

** if something wrong with eye (besides retinal/subconjunctival hemorrhage)–immediate opthalmologic consultation

21
Q

Brachial plexus injury

A

occurs in up to 10% shoulder dystocia

22
Q

Brachial plexus injury RFs

A 
shoulder dystocia!
macrosomia
breech
multip
prolonged 2nd stage
forceps
23
Q

Erb’s palsy

A

injury to C5-C6 nerve roots
asymmetric Moro
shoulder internally rotated, forearm supinated, wrists flexed
R side predominates
fetal asphyxia, facial palsy, fractured clavicle/humerus

24
Q

Klumpke’s palsy

A

injury to C7, C8-T1
hand is flaccid
similar to Erb’s plus ipsilateral Horner’s syndrome

25
Q

Diagnosing brachial plexus injury

A

PE
EMG and nerve conduction studies
Xray clavicles, shoulder, humerus

26
Q

Tx for brachial plexus injury

A

first 7-10 days wrap arm against body
after 10 days, PROM
Arnica + hypericum

will resolve spontaneously

27
Q

Facial Nerve Palsy

congenital or acquired, former is RARE

A

decreased forehead wrinkling, increased eye opening, decreased nasolabial folds

Dx: based on birth hx, PE, imaging

28
Q

Hypoglossal nerve injury sxs

A

weak or hoarse cry

difficulty feeding

29
Q

Phrenic nerve injury sxs

A

resp distress
cyanosis
flaring of chest on involved side
R sided (mostly)

Dx: fluoroscopy

30
Q

Spinal cord injury

A 
10% neonatal deaths have this injury
RFs
-difficult vaginal delivery or breech
-mid to high forceps delivery
-premie
-shoulder dystocia
-precipitous
31
Q

Spinal cord injury sxs

A 
*snap* or *pop*
hypotonia, absent DTRs
T instability
absent resp effort
neurogenic bladder
hypoxic-ischemic encephalopathy, seizures, dev delay
32
Q

Spinal cord injury Dx

A

Myelography with CT

MRI

33
Q

Spinal cord injury Tx

A 
immobilize!  
conservative tx (surgery and laminectomy rarely help)
34
Q

Clavicle fracture

A

Most frequent fracture, usu 2nd to macrosomia/dystocia
R sided (2:1)
swelling, crepitus, irritability with movement

Dx: on PE, XRay
Tx: immobilize

35
Q

Nasal septal deformities

A

outward deformity of nose to one side or columella leaning to opposite side
flattening of nasal aperture
diminished movement of ala with inspiration

36
Q

Nasal septal deformities Dx & Tx

A

PE, pass a probe along floor of nose
compress nose

Tx: reduce manually or refer to otolaryngologist

37
Q

Torticollis

A

blood and fibrous tissue in muscle due to tearing of muscle or impingement of blood supply
RFs: breech, macrosomia, dystocia

38
Q

Torticollis Tx

A

Sleep on opposite side
passive stretching
PT
Arnica

NCB V (7 decks)

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