Birth Trauma

Question 1

RFs for Birth Injuries: Maternal

Answer 1

DM
Obesity
Undersize pelvis
Post maturity
Primip

Question 2

RFs for Birth Injuries: Fetal

Answer 2

Macrosomia
Increased chest: head circumference
Malposition/breech

Question 3

RFs for Birth Injuries: Obstetric

Answer 3

Shoulder dystocia
forceps
vacuum
Prolonged second stage
Precipitous delivery

Question 4

Complications of Vacuum

Answer 4

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

Question 5

Caput succadaneum

Answer 5

Collection of edema in SubQ

resolves in days

Question 6

Cephalohematoma

Answer 6

involves parietal bone
RISKS
-macrosomia
-primip
-vacuum
-forceps

Question 7

Cephalohematoma course

Answer 7

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

Question 8

Subgaleal hemorrhage

Answer 8

Bleeding below epicranial aponeurosis

Vacuum

Question 9

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

Answer 9

ss

Question 10

Linear fracture

Answer 10

usu involves parietal bone

follow up but will resolve on their own

Question 11

Depressed fracture

Answer 11

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

Question 12

Subarachnoid hemorrhage sxs

Answer 12

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

Question 13

Subarachnoid hemorrhage Dx

Answer 13

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

Question 14

Subdural hemorrhage RFs

Answer 14

severe molding causes dural venous lacertations or rupture of bridging veins

CPD
breech or forceps
precipitous delivery in multip
macrosomia

Question 15

Subdural hemorrhage sxs: Posterior fossa

Answer 15

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

Question 16

Subdural hemorrhage Dx

Answer 16

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

Question 17

Subdural hemorrhage Tx

Answer 17

1/3 require shunt dt hydrocephaly

may just need supportive tx

Question 18

Rare bleeds in full term neonates

Answer 18

Intraventricular
Epidural
Intracerebral

Question 19

Retinal hemorrhage

Answer 19

up to 40% of vaginal

resolve in days to weeks

Question 20

Subconjunctival hemorrhage

Answer 20

13% births
painless, resolves in 2-3 weeks

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

Question 21

Brachial plexus injury

Answer 21

occurs in up to 10% shoulder dystocia

Question 22

Brachial plexus injury RFs

Answer 22

shoulder dystocia!
macrosomia
breech
multip
prolonged 2nd stage
forceps

Question 23

Erb’s palsy

Answer 23

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

Question 24

Klumpke’s palsy

Answer 24

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

Question 25

Diagnosing brachial plexus injury

Answer 25

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

Question 26

Tx for brachial plexus injury

Answer 26

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

Question 27

Facial Nerve Palsy | congenital or acquired, former is RARE

Answer 27

decreased forehead wrinkling, increased eye opening, decreased nasolabial folds Dx: based on birth hx, PE, imaging

Question 28

Hypoglossal nerve injury sxs

Answer 28

weak or hoarse cry | difficulty feeding

Question 29

Phrenic nerve injury sxs

Answer 29

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

Question 30

Spinal cord injury

Answer 30

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

Question 31

Spinal cord injury sxs

Answer 31

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

Question 32

Spinal cord injury Dx

Answer 32

Myelography with CT | MRI

Question 33

Spinal cord injury Tx

Answer 33

``` immobilize! conservative tx (surgery and laminectomy rarely help) ```

Question 34

Clavicle fracture

Answer 34

Most frequent fracture, usu 2nd to macrosomia/dystocia R sided (2:1) swelling, crepitus, irritability with movement Dx: on PE, XRay Tx: immobilize

Question 35

Nasal septal deformities

Answer 35

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

Question 36

Nasal septal deformities Dx & Tx

Answer 36

PE, pass a probe along floor of nose compress nose Tx: reduce manually or refer to otolaryngologist

Question 37

Torticollis

Answer 37

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

Question 38

Torticollis Tx

Answer 38

Sleep on opposite side passive stretching PT Arnica