fetal trauma during labour Flashcards
what are the classifications of foetal injuries ?
fractures soft tissue injuries bone injuries nerve injuries visceral and muscular injuries
what is the aetiology of cranial bone injuries ?
difficult forceps delivery
delivery through a contracted pelvis
what are the types of cranial bone injuries ?
fracture of vault
fracture of base of the skull
fracture of the mandible
what are the types of cranial soft tissue injuries ?
caput succedaneum
subgleal hematoma
cephalhematoma
intracranial hemorrhage
what is caput succedaneum ?
fluid accumulation above the periosteum but under the galeal aponeurosis
what is a subgaleal hematoma ?
blood under galeal aponeurosis crossing suture lines
what are the causes of caput succedaneum ?
- prolonged obstructed labour before full cervical dilatation
- instrumental delivery
what are the causes of cephalhematoma ?
- instrumental delivery (Ventouse)
2. contracted pelvis
how can we differentiate between caput succedaneum and cephalhematoma ?
palpable periosteal edges can only be found with cephalhematoma
what is the management for caput succedaneum ?
no management , btroo7 lwa7daha
what is the management for cephalhematoma ?
expectant management , disappears in a few weeks
how do intracranial haemorrhages happen ?
severe molding of the fetal head during labour
along with marked overlapping of the parietal bones which causes compression and may rupture blood vessels
what is the prognosis of intracranial haemorrhages ?
depends
- if it is subdural or subarachnoid, there is minimal damage or minimal neurological deficit
- if there is parenchymal affection there may be marked neurological deficit
what is the aetiology behind cranial soft tissue injuries ?
prematurity breech excessive compression asphyxia haemorrhagic disease of the newborn
what is the clinical picture of intracranial haemorrhages ?
neonatal asphyxia or stillbirth drowsy baby, refusing suckling with a sudden sharp cry convulsions and rigidity tense bulging anterior fontanelle vomiting jaundice kernicterus
what is the management for intracranial haemorrhages ?
resuscitation with minimal handling if there is a seizure - chloral hydrate (sedative) , MgSo4 dehydration measures Vit k for fetus Ab for prophylaxis
what are the different types of nerve injuries that could happen ?
brachial plexus injury
facial nerve injury ( Bell’s Palsy)
what are the causes of facial nerve palsy?
compression of the facial nerve by blade or forceps, resulting in oedema or hematoma around the nerve
what is the clinical picture of bells palsy ?
unilateral and temporary
absent nasolabial fold
angle of mouth deviated towards the healthy side
no blinking on the affected side
what are brachial plexus injuries commonly associated with ?
shoulder dystocia
what is the management for bells palsy ?
conservative management , corticosteroids may play a role
what is the cause of brachial plexus injuries ?
forced lateral flexion of the head during delivery
what are the different types of brachial plexus injuries ?
upper injury ( Erb's Palsy) lower injury ( Klumpke's Palsy)
what is the presentation of Erb’s palsy ?
affected limb is adducted to the torso
elbow extended
wrist flexion
what is the management of Erb’s Palsy ?
early physiotherapy
what is the presentation of Klumpke’s palsy ?
wrist drop
absent grasp reflex
paralysis of the small muscles of the hand
what is the management of Klumpke’s Palsy ?
early physiotherapy
what dermatomes are affected in each of the brachial plexus injuries ?
Erb’s Palsy - C5, C6
Klumpke’s Palsy - C7, 8, T1
what is the result of muscular and visceral trauma ?
will either subside
or cause permanent torticollis ( raso ma3wooga)
what is the prognosis of bone fractures ?
good prognosis unless associated with vascular injury
