Fetal & Maternal Birth Trauma Flashcards
What is fetal birth trauma
injury to the newborn caused by mechanical forces during birth.
Risk factors for birth trauma
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
Types of birth traumas
Neonatal soft tissue Injuries (cranial injuries)
Clavicular fracture & Long bone fractures
Infant torticolis
Facial nerve palsy
Neonatal brachial plexus palsy
Shoulder dystocia
What are neonatal soft tissue injuries
Caput succedaneum:
Cephalohematoma:
Subgaleal hemorrhage:
What is the most common fracture during birth
Clavicular fracture
sx of clavicular fracture
Usually asymptomatic as usually incomplete fracture
Possible pseudoparalysis
Bone irregularities, crepitus, and tenderness on palpation
may lead to brachial plexus palsy
Dg and ; rx Of clavicular fracture in birth trauma
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
what is Caput succedaneum
- 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
what is a Cephalohematoma
- subperiosteal hematoma( blood pooling between perosteum and skull)
- limited to cranial suture lines !!!
- causes by Injury to vessels betw the skull and periosteum
What is a Subgaleal hemorrhage
- 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
prognosis of clavicular fracture
Usually self-resolves within 2–3 weeks w/o surgery low risk of long-term complications
causes of Long bone (midshaft femur)fractures
Aggressive manoeuvres
Macrosomia
sx of long long bone fractures
pseudoparalysis of limb
swelling
pain
dg and rx of long bone fractures
dg: xray
rx: immobilization and Spica cast
what is a spica cast
a type of cast that includes one or both legs as well as the waist
what is Erb’s (brachian nerve) palsy
injury to C5-C6 nerve root causing paralysis to the arm and phrenic nerve of the diaphragm
causes of erb’s palsy
shoulder dystocia
breech
macrosomia
assisted delivery
sx of erb’s
waiter’s tip
-ARM: adduction and internal rotation
FOREARM: pronation
absent Moro reflex
respiratory distress if phrenic nerve is involved
dg of erbs
check moro, 02 lvls
rx of erbs
physiotherapy and observation as it may resolve in 3-6 months if nerve damage is caused by oedema
rx of erbs if failure to resolve in 3-6 months
nerve damage is due to laceration = irreversible
Neuroplasty w/ Nerve graft
dx of erb’s palsy
Klumpke’ palsy
C7-T1 nerve roots
sx: CLaw hand & absent grasp reflex *& HORNERS SX
which fetal organ is most commonly injured during childbirth
adrenal gland d/2 mechanical compression by vertebrae
calcified ring on adrenal gland confirms dg on ????
What is fetal
Macrosomia
Larger than average Fetus
Greater than 4kg/ 8pounds
Usually caused by maternal obesity and DB
What is uterine rupture
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
causes of uterine rupture
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)
why is uterine rupture more common during labour
Massive force exerted during contractions increases risk of rupture
classification of uterine prolapse
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
sx of an imminent uterine rupture
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
sx of uterine rupture
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
what is ‘STATION’
the level of the presenting fetal part in the birth canal relative to the ischial spines that is
detected during vaginal examination
what is loss of station
Regression of the presenting fetal part that is characteristic in uterine rupture along w/
severe abdominal pain
rx of imminent uterine rupture
Immediate IV tocolysis
Emergency C-section
rx of established uterine rupture
Immediate laparotomy with emergency C‑section
Hysterectomy if the bleeding does not cease
rx of uterine dehiscence
Cesarean delivery before labor begins is to avoid a complete rupture
prognosis of uterine rupture
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%.
