Musculoskeletal Problems And Birth Injury

Question 1

Feet

Answer 1

Extra digits
Syndactyly. Abnormal fusion of digits
Talipes - refers to ankle
- postural - gentle message or referral to physiotherapist may be required
- talipes equinovarus - equini= turned down and Varus= inwards.
Metatarsus adductus- the metatarsus bones in the foot adduct

Question 2

Fractured clavicle

Answer 2

Mode of delivery
Palpate length of clavicel to exclude fractures
Symptoms
- baby is unsettled or crie on palpation of the clavicle
Check for crepitus swelling or tenderness
Assess for restricted, abnormal or absent movements of one or both arms
Observe for absen or poor grasp reflex

Question 3

Skull

Answer 3

Examine vault of skull and scalp, include inspection and palpation of the 7 bones, suture lines and fontanelles
- trauma and lesions
- excessive moulding
- swelling
- ridges
- decompressions
- unusual measurements
- birthmarks and rashes
- bulging/sunken fontanelles

Question 4

Moulding

Answer 4

Normal processes resulting from the movement of the skull bones when compressed before or during labour
Degree and direction depend on fetal positioning and pressure exerted
Excessive moulding may damage the bones or intracranial membranes, vessels or tissues

Question 5

Chignon

Answer 5

May result after application of a vacuum extraction cup to the fetal scalp during delivery
The scalp is drawn into the cup by section
Movement of the scalp layers = oedema=a and bruising
Variable positioning
Crosses suture lines
Resolves 2 hours - 2 weeks

Question 6

Caput succedaneum

Answer 6

Oedematous swelling within the superficial connective tissue layer of the scalp
Resulting from pressure exerted on the fetal head by the cervix during labour where oedema collects in the unsupported are of the head which protrudes through the opening of the dilating cervix
Characteristically
- present at birth
- moulding of the skull is present
- a soft swelling. That pits on pressure
- may cross suture lines Resolves
Increases chance of jaundice
Decreases in size after delivery - 24-48

Question 7

Cephalhaematoma

Answer 7

Bleeding between the periosteum and the bone of the fetal skull
Caused y friction of the skull against the pelvis or forceps during labour where oedema
Associated with asyncitic head position or trauma following a ventous birth
Characteristically
- most common over parietal bones
- doesn’t cross suture lines affected area is initially soft but firms with time
- appears 12-72 hours after labour

Question 8

Subgaleal haemorrhage

Answer 8

Medical emergency
Worsens over time
Baby may look pale
Head circumference may grow
Boggy swelling- often extends to the base fo the neck, no clear margins often crepitus can be felt on palpation
Baby may be unwell or appear well until they collapse

Question 9

Head circumference

Answer 9

Measuring HC indirectly measures the brain, cerebral fluids and skull
Measure my is occipital frontal circumference
Widest diameter typicallly 1-2cm above the flagella
Using a disposable n on stretchable tape
Take 3x measurement and record the largest
Term averages - 15th -85th centile
Boys - 33.1-35.8cm
Girls 32.7-35.8cm
>38cm risk of hydrocephalus
<32cm should raise the possibility of microcephaly

Question 10

Trauma

Answer 10

Forceps mark from vaginal birth and LSCS
Breech - swollen scrotum
Congestion
Generalised bruising - finger marks from fetal head decompression
Lacerations from instruments - think category 1 sections
Fractured skull
Scalp abrasions FSE clips, FBS
Document on body map

Question 11

Subconjunctival haemmorhage

Answer 11

Often seen on the stela around the margin of the iris, particularly after a difficult vaginal birth
Resolve after 2-3 weeks
Document on body map