Birth Trauma Flashcards
RFs for Birth Injuries: Maternal
DM Obesity Undersize pelvis Post maturity Primip
RFs for Birth Injuries: Fetal
Macrosomia
Increased chest: head circumference
Malposition/breech
RFs for Birth Injuries: Obstetric
Shoulder dystocia forceps vacuum Prolonged second stage Precipitous delivery
Complications of Vacuum
Cephalohematoma Scalp abrasions Necrosis/avulsions of scalp Subaponeurotic hemorrhage Skull factures
Caput succadaneum
Collection of edema in SubQ
resolves in days
Cephalohematoma
involves parietal bone RISKS -macrosomia -primip -vacuum -forceps
Cephalohematoma course
resolves over weeks
Complications: hyperbilirubinemia, scalp infxn, osteomyelitis
OBSERVE, maybe arnica/hypericum oil
Subgaleal hemorrhage
Bleeding below epicranial aponeurosis
Vacuum
What type of bleeding is most common in full term infant?
ss
Linear fracture
usu involves parietal bone
follow up but will resolve on their own
Depressed fracture
dt excessive molding and compression of fetal skull OR forceps
if neuro and behavior asx: no tx needed
Subarachnoid hemorrhage sxs
asx or..
intermittent seizures on day 2-3
lethargy, irritability, retinal hemorrhages
Subarachnoid hemorrhage Dx
RBCs in cerebrospinal fluid
xanthochromia in centrifuged supernatant and count RBCs
CT
Subdural hemorrhage RFs
severe molding causes dural venous lacertations or rupture of bridging veins
CPD
breech or forceps
precipitous delivery in multip
macrosomia
Subdural hemorrhage sxs: Posterior fossa
lethargy, irritability, vomiting, irreg resp
tense anterior fontanelle, split sutures
increasing head circumference, blood in CSF
hypotonia, nystagmus, CN palsies, seizures, apnea
Subdural hemorrhage Dx
US to screen
CT to dx
(avoid lumbar dt risk of herniation)
Subdural hemorrhage Tx
1/3 require shunt dt hydrocephaly
may just need supportive tx
Rare bleeds in full term neonates
Intraventricular
Epidural
Intracerebral
Retinal hemorrhage
up to 40% of vaginal
resolve in days to weeks
Subconjunctival hemorrhage
13% births
painless, resolves in 2-3 weeks
** if something wrong with eye (besides retinal/subconjunctival hemorrhage)–immediate opthalmologic consultation
Brachial plexus injury
occurs in up to 10% shoulder dystocia
Brachial plexus injury RFs
shoulder dystocia! macrosomia breech multip prolonged 2nd stage forceps
Erb’s palsy
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
Klumpke’s palsy
injury to C7, C8-T1
hand is flaccid
similar to Erb’s plus ipsilateral Horner’s syndrome
Diagnosing brachial plexus injury
PE
EMG and nerve conduction studies
Xray clavicles, shoulder, humerus
Tx for brachial plexus injury
first 7-10 days wrap arm against body
after 10 days, PROM
Arnica + hypericum
will resolve spontaneously
Facial Nerve Palsy
congenital or acquired, former is RARE
decreased forehead wrinkling, increased eye opening, decreased nasolabial folds
Dx: based on birth hx, PE, imaging
Hypoglossal nerve injury sxs
weak or hoarse cry
difficulty feeding
Phrenic nerve injury sxs
resp distress
cyanosis
flaring of chest on involved side
R sided (mostly)
Dx: fluoroscopy
Spinal cord injury
10% neonatal deaths have this injury RFs -difficult vaginal delivery or breech -mid to high forceps delivery -premie -shoulder dystocia -precipitous
Spinal cord injury sxs
*snap* or *pop* hypotonia, absent DTRs T instability absent resp effort neurogenic bladder hypoxic-ischemic encephalopathy, seizures, dev delay
Spinal cord injury Dx
Myelography with CT
MRI
Spinal cord injury Tx
immobilize! conservative tx (surgery and laminectomy rarely help)
Clavicle fracture
Most frequent fracture, usu 2nd to macrosomia/dystocia
R sided (2:1)
swelling, crepitus, irritability with movement
Dx: on PE, XRay
Tx: immobilize
Nasal septal deformities
outward deformity of nose to one side or columella leaning to opposite side
flattening of nasal aperture
diminished movement of ala with inspiration
Nasal septal deformities Dx & Tx
PE, pass a probe along floor of nose
compress nose
Tx: reduce manually or refer to otolaryngologist
Torticollis
blood and fibrous tissue in muscle due to tearing of muscle or impingement of blood supply
RFs: breech, macrosomia, dystocia
Torticollis Tx
Sleep on opposite side
passive stretching
PT
Arnica
