Birth Trauma Flashcards
What is birth traumatic what are it’s risk factors
injury to the newborn caused by mechanical forces during birth.
Macrosomia Extremely premature infants; low birth weight Abnormal fetal presentation -Breech presentation -Shoulder dystocia Forceps-assisted //vacuum delivery Prolonged or rapid labor Small maternal stature
Types of birth traumas
Neonatal soft tissue injuries
Infant torticolis
Birth related clavicle fracture
Shoulder dystocia
Facial nerve palsy
Neonatal brachial plexus palsy
List the three neonatal soft tissue injuries of the head and their cause
D/2 shearing forces in a forceps/ vacuum delivery
Caput succedaneum: spontaneous resolution
benign edema of the scalp tissue that extends across the cranial suture lines
-oedema caused by stasis of the blood and lymphatic vessels with subsequent swelling.
Cephalohematoma: spontaneous resolution
subperiosteal hematoma that’s limited to cranial suture lines
-Injury to vessels between the skull and periosteum
Subgaleal hemorrhage:
bleeding bet/w the periosteum of the skull and the aponeurosis which may extend across the suture lines & assoc w/ a high risk of hemorrhage & hemorrhagic shock if 40% of blood leaks
-Injury to the emissary veins
Summarise birth related clavicular fracture
Epi: most common fracture during birth
Clinical features
- Usually asymptomatic (incomplete fracture)
- Pseudoparalysis (to relieve strain on the clavicle)
- Bone irregularities,tender on palpation
- Possible brachial plexus palsy
Diagnostics:
clinical diagnosis
X-ray indicated in gross bone deformation
Rx
gentle handling of the arm (e.g., while dressing)
Flex arm at 90 degrees (pin shirt sleeve to the front)
Consider analgesics
Follow-up in 2 weeks to check healing
-via clinical findings of a callus formation, maybe x-ray
Prog
self-resolves in 2–3 wks w/o complications
What is torticolis and how does it occur
A twisted or rotated neck caused by contraction of the sternocleidomastoid muscle
Acquired:
Sternocleidomastoid or trapezius muscle injury
Cervical muscle spasm
Cervical nerve irritation
Congenital: Unknown but associated conditions are Decreased fetal movement Breech presentation Assisted vaginal delivery Intrauterine constraint which shortens the SCD -macrosomia, mx preg, oligohydromnious
What are the sx of torticolis
How is torticolis rx
What are the complications of in rx torticolis
Clinical features: Head ptilts to one side &chin rotated to the opposite side Muscular tightness limited passive range of motion palpable thickening of the SCM
Treatment
Early initiation of physiotherapy & passive positioning
Surgery at 12 months if conservative management fails
-myotomy
-bipolar release of the affected SCM
Complications: craniofacial asymmetry, scoliosis of the cervical spine
How does child birth cause neonatal brachial plexus
Excessive lateral traction on the neck during delivery
Causes injury to the upper trunk of the brachial plexus
This leads to Erb palsy (most common iatrogenic brachial plexus injury during delivery)
Excessive traction on the arm during delivery
Causes injury to the lower trunk of the brachial plexus
Leads to Klumpke palsy( paralysis of intrinsic hand muscles)
What is shoulder dystocia
obstetric emergency in where the anterior shoulder of the fetus becomes impacted behind the maternal pubic symphysis during vaginal delivery
What are the risk factors for shoulder dystocia
History of shoulder dystocia Fetal macrosomia Prolonged second stage of labor - 3hrs primiparous 2 hrs multi Maternal diabetes mellitus Maternal obesity Post-term pregnancy
Clinical features of shoulder dystocia
Features of arrested active phase of labor
Turtle sign: the fetal head is partially delivered but retracts against the perineum
Failed restitution of the head
Dg based on clinical features
What is the arrested stage of labour
Etiology: abnormalities of the 3 P’s of labor
Diagnosis:
≥ 6 cm cervical dilation with ruptured membranes and no cervical change for ≥ 4 hours if adequate contractions are present
or no cervical change for > 6 hours if only inadequate contractions are present
Management: cesarean section
3p,s of labour
Pelvis: size and shape of the maternal pelvis (e.g., small bony pelvis)
Passenger: size and position of the infant (e.g., fetal macrosomia or abnormal orientation)
Power: strength and frequency of contractions (e.g., dysfunctional contractions )
Rx of shoulder dystocia
Mother should lie supine with the buttocks on the edge of the bed.
Perform shoulder dystocia maneuvers:
-First-line: McRobert’s maneuver
-2nd Line internal maneuvers
Choose another maneuver if delivery is not accomplished within 20–30 seconds.
Last-resort options:
- Fracture of fetal clavicle
- Zavanelli maneuver
- Symphysiotomy
What is the mcroberts maneuver
The patient should stop bearing down and lie supine with the buttocks on the edge of the bed.
Abduct, externally rotate, and hyperflex the maternal hips (with maternal legs pulled towards the head).
What are the internal maneuver’s
Rubin’s maneuver(1&2)
Rubin I
Used with the McRobert’s maneuver
Suprapubic pressure (proximal to the symphysis pubis) is applied to the posterior part of the impacted anterior shoulder.
Rubin II
Manually rotate the fetal shoulder girdle by applying pressure to the posterior part of the anterior shoulder.
Wood’s maneuver*
Manually rotate the fetal shoulder girdle by applying pressure to the anterior part of the posterior shoulder.
The reverse Wood’s maneuver is when pressure is applied to the posterior part of the posterior shoulder in an attempt to rotate the fetus the other direction (may be attempted if all other maneuvers fail).
Delivery of posterior arm
