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O&G > Fetal & Maternal Birth Trauma > Flashcards

Fetal & Maternal Birth Trauma Flashcards

1
Q

What is fetal birth trauma

A

injury to the newborn caused by mechanical forces during birth.

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2
Q

Risk factors for birth trauma

A

Macrosomia / anatomical abnormalities

Very premature infants/ low birth weight

Oligohydromnious (reduced fetal protection)

Abnormal fetal presentation

  • Breech presentation
  • Shoulder dystocia

Assisted labour: (soft tissue injuries at site of application)

  • Forceps
  • vacuum delivery

Prolonged or rapid labor

Small maternal stature

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3
Q

Types of birth traumas

A

Neonatal soft tissue Injuries (cranial injuries)

Clavicular fracture & Long bone fractures

Infant torticolis

Facial nerve palsy

Neonatal brachial plexus palsy

Shoulder dystocia

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4
Q

What are neonatal soft tissue injuries

A

Caput succedaneum:

Cephalohematoma:

Subgaleal hemorrhage:

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5
Q

What is the most common fracture during birth

A

Clavicular fracture

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6
Q

sx of clavicular fracture

A

Usually asymptomatic as usually incomplete fracture

Possible pseudoparalysis

Bone irregularities, crepitus, and tenderness on palpation

may lead to brachial plexus palsy

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7
Q

Dg and ; rx Of clavicular fracture in birth trauma

A

Diagnostics:
X-ray only indicated in cases of gross bone deformation

Treatment
-gentle handling of the arm

  • pin shirt sleeve to the front of the shirt with the arm flexed at 90 degrees for comfort
  • analgesics
  • Follow-up 2 weeks later to confirm proper healing: -callus formation on clinical exam /x-ray
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8
Q

what is Caput succedaneum

A
  • benign edema of scalp tissue extending across the [[cranial suture lines]]
  • Mech pressure during delivery causes stasis of the blood and lymphatic vessels which causes swelling
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9
Q

what is a Cephalohematoma

A
  • subperiosteal hematoma( blood pooling between perosteum and skull)
  • limited to cranial suture lines !!!
  • causes by Injury to vessels betw the skull and periosteum
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10
Q

What is a Subgaleal hemorrhage

A
  • bleeding betw periosteum & aponeurosis that MAY extend across suture lines
  • extension along suture lines caused by ruptured [emissary arteries]]
  • causes high risk of hemorrhage and hemorrhagic shock
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11
Q

prognosis of clavicular fracture

A

Usually self-resolves within 2–3 weeks w/o surgery low risk of long-term complications

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12
Q

causes of Long bone (midshaft femur)fractures

A

Aggressive manoeuvres

Macrosomia

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13
Q

sx of long long bone fractures

A

pseudoparalysis of limb

swelling

pain

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14
Q

dg and rx of long bone fractures

A

dg: xray
rx: immobilization and Spica cast

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15
Q

what is a spica cast

A

a type of cast that includes one or both legs as well as the waist

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16
Q

what is Erb’s (brachian nerve) palsy

A

injury to C5-C6 nerve root causing paralysis to the arm and phrenic nerve of the diaphragm

17
Q

causes of erb’s palsy

A

shoulder dystocia

breech

macrosomia

assisted delivery

18
Q

sx of erb’s

A

waiter’s tip
-ARM: adduction and internal rotation
FOREARM: pronation

absent Moro reflex

respiratory distress if phrenic nerve is involved

19
Q

dg of erbs

A

check moro, 02 lvls

20
Q

rx of erbs

A

physiotherapy and observation as it may resolve in 3-6 months if nerve damage is caused by oedema

21
Q

rx of erbs if failure to resolve in 3-6 months

A

nerve damage is due to laceration = irreversible

Neuroplasty w/ Nerve graft

22
Q

dx of erb’s palsy

A

Klumpke’ palsy

C7-T1 nerve roots

sx: CLaw hand & absent grasp reflex *& HORNERS SX

23
Q

which fetal organ is most commonly injured during childbirth

A

adrenal gland d/2 mechanical compression by vertebrae

calcified ring on adrenal gland confirms dg on ????

24
Q

What is fetal

Macrosomia

A

Larger than average Fetus
Greater than 4kg/ 8pounds

Usually caused by maternal obesity and DB

25
Q

What is uterine rupture

A

A rare complication commonly in women w/ precious C-section which there’s a tear in the wall of the uterus during childbirth

Rare: 1/4000 births

26
Q

causes of uterine rupture

A

1) Uterine distention (main cause)
- Delay in labor progression d/2 fetal malpresentation
- Fetal macrosomia
- multiple gestations
- Overdose of oxytocin

2) Uterine scar/prior uterine surgery (increases risk)
- C-section
- myomectomy)

3)Traumatic rupture (e.g., iatrogenic or caused by an accident)

27
Q

why is uterine rupture more common during labour

A

Massive force exerted during contractions increases risk of rupture

28
Q

classification of uterine prolapse

A

Uterine rupture: when the uterus is connected to the abdomen

  • involves all layers of the uterine wall including the visceral peritoneum;
  • creates an open connection from the fetus and placenta to the peritoneal cavity.
  • Massive intraperitoneal and vaginal hemorrhage may occur

Uterine dehiscence (closed rupture): perforation is covered by the visceral peritoneum

  • no intraperitoneal hemmorhage
  • caused by scar rupture in the late months of pregnancy / when contractions begin
  • Most cases are an incidental finding during repeat cesarean delivery
29
Q

sx of an imminent uterine rupture

A

Sx of imminent rupture

  • severe pain
  • hyperactive labour and severe contrxn
  • Bandl’s ring: Muscular ring is seen above the belly button d/2 powerful cntrxn of the upper uterine segment
30
Q

sx of uterine rupture

A

Sx of rupture

  • Severe abdominal pain
  • Sudden pause in contractions
  • Fetal distress (deteriorating fetal heart rate)
  • Vaginal bleeding
  • Hemodynamic instability d/2 haemorrhage
  • Loss of fetal station(typical sign w/ abd pain)
  • Palpable fetal parts through the rupture
31
Q

what is ‘STATION’

A

the level of the presenting fetal part in the birth canal relative to the ischial spines that is
detected during vaginal examination

32
Q

what is loss of station

A

Regression of the presenting fetal part that is characteristic in uterine rupture along w/
severe abdominal pain

33
Q

rx of imminent uterine rupture

A

Immediate IV tocolysis

Emergency C-section

34
Q

rx of established uterine rupture

A

Immediate laparotomy with emergency C‑section

Hysterectomy if the bleeding does not cease

35
Q

rx of uterine dehiscence

A

Cesarean delivery before labor begins is to avoid a complete rupture

36
Q

prognosis of uterine rupture

A

Traumatic and spontaneous ruptures increase the mortality rate of both mother and the baby.

Open ruptures lead to hypovolemia and hypoxia; as a result, the fetal mortality rate is between 50–75%.

O&G (43 decks)

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