birth traumas

Question 1

risk factors

Answer 1

Macrosomia
premature infants
Abnormal fetal presentation
Breech presentation
Shoulder dystocia
Forceps-assisted delivery or vacuum delivery
Prolonged or rapid labor

Question 2

Soft tissues injuries

Answer 2

Soft tissue injuries of the scalp in infants are mostly caused by shearing forces during vacuum or forceps delivery. Whereas caput succedaneum and cephalohematoma are benign conditions and resolve spontaneously, subgaleal hemorrhages require close monitoring and fluid replacement to prevent hemorrhagic shock.
Caput succedaneum: benign edema of the scalp tissue that extends across the cranial suture lines
Cephalohematoma: subperiosteal hematoma that is limited to cranial suture lines
Subgaleal hemorrhage: rupture of the emissary veins and bleeding between the periosteum of the skull and the aponeurosis; associated with a high risk of significant hemorrhage and hemorrhagic shock

Question 3

Birth related clavicle fracture

Answer 3

Epidemiology: most common fracture during birth
Clinical features
Usually asymptomatic
Possible pseudoparalysis
Bone irregularities, crepitus, and tenderness over the clavicle possible on palpation
brachial plexus palsy
Diagnostics: clinical diagnosis; X-ray; in cases of gross bone deformation
Treatment
Reassurance and promote gentle handling
To avoid discomfort, pin shirt sleeve to the front of the shirt with the arm flexed at 90 degrees
analgesics
Follow-up 2 weeks later to confirm proper healing
Usually self-resolves within 2–3 weeks

Question 4

Infant torticollis

Answer 4

Definition: twisted or rotated neck caused by contraction of the sternocleidomastoid muscle
Pathomechanism of congenital torticollis
muscular or skeletal injury during delivery with subsequent fibrosis and contracture of the sternocleidomastoid muscle
Associated with:
Intrauterine constraint, which causes unilateral shortening of the sternocleidomastoid muscle
Oligohydramnios
Multiple gestation
Macrosomia
Clinical features
Head noticeably tilted to one side with the chin rotated towards the opposite side
Muscular tightness; limited passive range of motion
Potentially palpable thickening of the SCM
Treatment
Early initiation of physiotherapy, passive positioning
Surgery at 12 months of age if conservative management is insufficient
Complications: scoliosis of the cervical spine

Question 5

Facial nerve palsy due to birth trauma

Answer 5

Epidemiology: most common cranial nerve injury during birth
Pathomechanism
during forceps-assisted delivery
Clinical features
Peripheral facial nerve palsy; difficulty feeding; incomplete eye closure; absent nasolabial fold
Treatment: eye care with artificial tears

Question 6

Neonatal brachial plexus palsy

Answer 6

Excessive lateral traction on the neck during delivery → injury to the upper trunk of the brachial plexus → Erb palsy
Excessive traction on the arm during delivery → injury to the lower trunk of the brachial plexus → Klumpke palsy

Question 7

Shoulder dystocia

Answer 7

Definition: an obstetric emergency in which the anterior shoulder of the fetus becomes impacted behind the maternal pubic symphysis during vaginal delivery
Risk factors
History of shoulder dystocia
Fetal macrosomia
Maternal diabetes mellitus
Post-term pregnancy
Clinical features
arrested active phase of labor
Turtle sign: the fetal head is partially delivered but retracts against the perineum
Diagnosis: clinical diagnosis
Perform shoulder dystocia maneuvers:
McRobert's maneuver
Move to another maneuver if delivery is not accomplished within 20–30 seconds
Last-resort options:
Fracture of fetal clavicle
Zavanelli maneuver

Complications
Fetal
Brachial plexus injury
Clavicle or humerus fracture
Maternal
Perineal lacerations
Postpartum hemorrhage