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Traumatism of the fetus during childbirth - Coggle Diagram
Traumatism of the fetus during childbirth
Shoulder dystocia
❖ Brachial plexus injury! = Erb‘s palsy
excessive lateral traction (flexion)
breach deliviery
of neck during delivery ➔ injury to upper trunk of brachial plexus (C5-C6)
Asymmetric moro reflex in infants: absent or impaired on the affected side
Neonatal soft tissue injuries
➔ Caput succedaneum
❖ Definition: normal occurrence of serous effusion collecting in subcutaneous tissue of scalp and disappears few hours after birth
► Benign edema of scalp tissue that extends across cranial suture lines
➔ Cephalohematoma
❖ Defintion: collection of blood between periosteum and skull bone
► Limited by the periosteal attachments and suture lines.
► May not appear until several hours after birth
➔ Subgaleal hemorrhage
❖ Defintiom: bleeding between periosteum of skull and aponeurosis
► May extend across the suture lines
❖ Cause: injury to emissary veins
❖ Treatment: requires close monitoring and fluid replacement to prevent hemorrhagic shock
► Associated with high risk of significant hemorrhage and hemorrhagic shock
► Up to 40% of neonate’s blood volume may bleed into the space between periosteum and aponeurosis.
Fractures
➔ Depression fracture of the skull
may occasionally be caused by tip of forceps bade in a difficult delivery
❖ Treatment: usually no treatment is necessary
► If cerebral irritation or paresis is observed, surgical intervention may be required
➔ Clavicular fracture
❖ Cause: result of too forcible delivery
❖ Epidemiology: most common fracture during birth (~2% of birth deliveries)
► Usually asymptomatic incomplete and are not detected until a callus develops at the fracture site several week after birth
❖ Treatment:
► Reassurance and promote gentle handling of the arm (e.g. while dressing)
► Avoid discomfort, pin shirt sleeve to the front of the shirt with the arm flexed at 90°
► Consider analgesics
► Follow up 2 weeks later to confirm proper healing: via clinical findings of callus formation, and possibly an x-ray
► Usually self-resolves within 2-3 weeks without surgical interventions or long-term complications
➔ Long bone fractures
❖ Definition: fracture of humerus and femur
❖ Diagnosis: clinical ➔ x-ray
► Moro reflex will be absent in that limb
❖ Treatment: in healthy infants, callus formation is rapid and splinting is not needed.
Facial palsy
❖ Cause:
► Pressure from forceps made on the nerve as it emerges from stylomastoid foramen
► Prolonged birth in which the head is pressed against the maternal sacral promontory
clinical feautures
► Peripheral facial nerve palsy: difficulty feeding, incomplete eye closure, absent nasolabial fold
■ Nasolabial fold: skin creases that course from lat edge of nose to lat edge of corner of the mouth
► Central facial palsy indicated intracranial hemorrhage or a developmental CNS anomaly
treat
spont recovery in 90% occurs in matter of days
► Eye care with artificial tears and ointment to protect cornea.
► Any delay is an indication for further investigation.
Infant torticollis
D:Twisted/tilted neck caused by spasm of sternocleidomastoid mm→Congenital/Acquired
CF: Head tilted to one side w/chin rotated toward opposite side, Muscular tightness
Th:Physical therapy(stretching), Myotomy(if conserv fails 12month)→Incision of both head of affected SCM
❖ Complications:
► Craniofacial asymmetry, scoliosis of the cervical spine
GENERAL RISK FACTORS
❖ Macrosomia or anatomical abnormalities
❖ Extremely premature infants, low birth weight
❖ Abnormal fetal presentation
❖ Breech presentation
❖ Shoulder dystocia: particularly brachial plexus injury and clavicular fracture
❖ Forceps-assisted delivery or vacuum delivery: particularly cranial ST and neurological injuries
❖ Prolonged or rapid labor
❖ Small maternal stature