Birth injuries Flashcards
(23 cards)
What is Caput succedaneum?
- Oedema collecting on the scalp, outside the periosteum.
- Caput is caused by pressure to a specific area of the scalp during a traumatic, prolonged or instrumental delivery.
What is the periosteum?
A layer of dense connective tissue that lines the outside of the skull and doesn’t cross the sutures. The fluid is outside the periosteum, which means it’s able to cross the suture lines.
How does Caput succedaneum present and how is it managed?
Usually no, or only mild, discolouration of the skin. The swelling is soft and diffuse and may cross the suture lines of the skull. It doesn’t require any treatment and will resolve within a few days.
What is Cephalohaematoma?
A collection of blood between the skull and periosteum, caused by **damage to the blood vessels **during a traumatic, prolonged or instrumental delivery. It can be described as a traumatic subperiosteal haematoma.
How can Cephalohaematoma be distinguished from Caput succedaneum?
- The blood is below the periosteum, therefore the lump does not cross the sagittal suture lines of the skull.
- The blood can cause discolouration of the skin in the affected area.
What is the management for Cephalohaematoma?
Usually resolves without treatment within a few months and doesn’t need any intervention.
What are some of the risks associated with Cephalohaematoma?
Anaemia and jaundice due to the blood that collects within the haematoma and breaks down, releasing bilirubin. Therefore, should monitor baby for anaemia, jaundice and resolution of the haematoma.
What facial injury is typically associated with forceps delivery?
Facial nerve injury
What can facial nerve injury lead to?
This can result in facial palsy (weakness of facial nerve on one side) - unilateral facial weakness.
What is the management for facial nerve injury?
Function normally returns spontaneously within a few months. If it doesn’t return, neurosurgical input may be needed.
What is Erb’s palsy?
Damage to the C5/6 nerves in the brachial plexus during birth, associated with shoulder dystocia, traumatic or instrumental delivery and large birth weight.
What does Erb’s palsy lead to?
Weakness of shoulder abduction and external rotation, arm flexion and finger extension, leading to ‘waiters tip’ appearance.
What is the presentation of Erb’s palsy?
- Waiter’s tip appearance
- internally rotated shoulder
- extended elbow
- flexed wrist facing backwards (pronated)
- lack of movement in the affected arm.
What is the management for Erb’s palsy?
Function normally returns spontaneously within a few months. If function does not return then they may require neurosurgical input.
What can a fractured clavicle be associated with?
Clavicle can be fractured during birth due to shoulder dystocia, traumatic or instrumental delivery, and large birth weight.
How will a fractured clavicle present?
Noticeable lack of movement or asymmetry of movement in the affected arm, asymmetry of the shoulders, with the affected shoulder lower than the normal shoulder, pain and distress on movement of the arm.
How can a fractured clavicle be confirmed?
USS or x-ray.
What is the management for a fractured clavicle?
Conservative, immobilisation of the affected arm, usually heals well within 6 weeks.
What can form during healing of a fractured clavicle?
A callus can form during healing and may be felt as a lump over the affected area (this disappears as the bone remodels).
What are the complications of a fractured clavicle?
Injury to the brachial plexus with a subsequent nerve palsy.
What is Frey’s syndrome?
Also known as auriculotemporal syndrome, occurs due to damage to the auriculotemporal nerve (branch of the trigeminal nerve) during forceps delivery.
What does the auriculotemporal nerve do?
It provides parasympathetic innervation to the salivary gland. After trauma, the parasympathetic fibres may be rewired to send signals to the sympathetic fibres of the sweat and blood vessels.
How does Frey’s syndrome present?
Presents during weaning. After eating certain foods, unilateral facial erythema occurs across the child’s cheek. It may be misdiagnosed as a food allergy.
