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fetal trauma during labour Flashcards

1
Q

what are the classifications of foetal injuries ?

A 
fractures 
soft tissue injuries 
bone injuries 
nerve injuries 
visceral and muscular injuries
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2
Q

what is the aetiology of cranial bone injuries ?

A

difficult forceps delivery

delivery through a contracted pelvis

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3
Q

what are the types of cranial bone injuries ?

A

fracture of vault
fracture of base of the skull
fracture of the mandible

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4
Q

what are the types of cranial soft tissue injuries ?

A

caput succedaneum
subgleal hematoma
cephalhematoma
intracranial hemorrhage

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5
Q

what is caput succedaneum ?

A

fluid accumulation above the periosteum but under the galeal aponeurosis

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6
Q

what is a subgaleal hematoma ?

A

blood under galeal aponeurosis crossing suture lines

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7
Q

what are the causes of caput succedaneum ?

A
  1. prolonged obstructed labour before full cervical dilatation
  2. instrumental delivery
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8
Q

what are the causes of cephalhematoma ?

A
  1. instrumental delivery (Ventouse)

2. contracted pelvis

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9
Q

how can we differentiate between caput succedaneum and cephalhematoma ?

A

palpable periosteal edges can only be found with cephalhematoma

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10
Q

what is the management for caput succedaneum ?

A

no management , btroo7 lwa7daha

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11
Q

what is the management for cephalhematoma ?

A

expectant management , disappears in a few weeks

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12
Q

how do intracranial haemorrhages happen ?

A

severe molding of the fetal head during labour

along with marked overlapping of the parietal bones which causes compression and may rupture blood vessels

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13
Q

what is the prognosis of intracranial haemorrhages ?

A

depends

  1. if it is subdural or subarachnoid, there is minimal damage or minimal neurological deficit
  2. if there is parenchymal affection there may be marked neurological deficit
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14
Q

what is the aetiology behind cranial soft tissue injuries ?

A 
prematurity 
breech 
excessive compression 
asphyxia 
haemorrhagic disease of the newborn
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15
Q

what is the clinical picture of intracranial haemorrhages ?

A 
neonatal asphyxia or stillbirth 
drowsy baby, refusing suckling with a sudden sharp cry
convulsions and rigidity 
tense bulging anterior fontanelle 
vomiting 
jaundice 
kernicterus
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16
Q

what is the management for intracranial haemorrhages ?

A 
resuscitation with minimal handling 
if there is a seizure - chloral hydrate (sedative) , MgSo4 
dehydration measures 
Vit k for fetus 
Ab for prophylaxis
17
Q

what are the different types of nerve injuries that could happen ?

A

brachial plexus injury

facial nerve injury ( Bell’s Palsy)

18
Q

what are the causes of facial nerve palsy?

A

compression of the facial nerve by blade or forceps, resulting in oedema or hematoma around the nerve

19
Q

what is the clinical picture of bells palsy ?

A

unilateral and temporary
absent nasolabial fold
angle of mouth deviated towards the healthy side
no blinking on the affected side

20
Q

what are brachial plexus injuries commonly associated with ?

A

shoulder dystocia

21
Q

what is the management for bells palsy ?

A

conservative management , corticosteroids may play a role

22
Q

what is the cause of brachial plexus injuries ?

A

forced lateral flexion of the head during delivery

23
Q

what are the different types of brachial plexus injuries ?

A 
upper injury ( Erb's Palsy)
lower injury ( Klumpke's Palsy)
24
Q

what is the presentation of Erb’s palsy ?

A

affected limb is adducted to the torso
elbow extended
wrist flexion

25
Q

what is the management of Erb’s Palsy ?

A

early physiotherapy

26
Q

what is the presentation of Klumpke’s palsy ?

A

wrist drop
absent grasp reflex
paralysis of the small muscles of the hand

27
Q

what is the management of Klumpke’s Palsy ?

A

early physiotherapy

28
Q

what dermatomes are affected in each of the brachial plexus injuries ?

A

Erb’s Palsy - C5, C6

Klumpke’s Palsy - C7, 8, T1

29
Q

what is the result of muscular and visceral trauma ?

A

will either subside

or cause permanent torticollis ( raso ma3wooga)

30
Q

what is the prognosis of bone fractures ?

A

good prognosis unless associated with vascular injury

WH (68 decks)

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