Fetal & Maternal Birth Trauma

Question 1

What is fetal birth trauma

Answer 1

injury to the newborn caused by mechanical forces during birth.

Question 2

Risk factors for birth trauma

Answer 2

Macrosomia / anatomical abnormalities

Very premature infants/ low birth weight

Oligohydromnious (reduced fetal protection)

Abnormal fetal presentation

• Breech presentation
• Shoulder dystocia

Assisted labour: (soft tissue injuries at site of application)

• Forceps
• vacuum delivery

Prolonged or rapid labor

Small maternal stature

Question 3

Types of birth traumas

Answer 3

Neonatal soft tissue Injuries (cranial injuries)

Clavicular fracture & Long bone fractures

Infant torticolis

Facial nerve palsy

Neonatal brachial plexus palsy

Shoulder dystocia

Question 4

What are neonatal soft tissue injuries

Answer 4

Caput succedaneum:

Cephalohematoma:

Subgaleal hemorrhage:

Question 5

What is the most common fracture during birth

Answer 5

Clavicular fracture

Question 6

sx of clavicular fracture

Answer 6

Usually asymptomatic as usually incomplete fracture

Possible pseudoparalysis

Bone irregularities, crepitus, and tenderness on palpation

may lead to brachial plexus palsy

Question 7

Dg and ; rx Of clavicular fracture in birth trauma

Answer 7

Diagnostics:
X-ray only indicated in cases of gross bone deformation

Treatment
-gentle handling of the arm

• pin shirt sleeve to the front of the shirt with the arm flexed at 90 degrees for comfort
• analgesics
• Follow-up 2 weeks later to confirm proper healing: -callus formation on clinical exam /x-ray

Question 8

what is Caput succedaneum

Answer 8

• benign edema of scalp tissue extending across the [[cranial suture lines]]
• Mech pressure during delivery causes stasis of the blood and lymphatic vessels which causes swelling

Question 9

what is a Cephalohematoma

Answer 9

• subperiosteal hematoma( blood pooling between perosteum and skull)
• limited to cranial suture lines !!!
• causes by Injury to vessels betw the skull and periosteum

Question 10

What is a Subgaleal hemorrhage

Answer 10

• bleeding betw periosteum & aponeurosis that MAY extend across suture lines
• extension along suture lines caused by ruptured [emissary arteries]]
• causes high risk of hemorrhage and hemorrhagic shock

Question 11

prognosis of clavicular fracture

Answer 11

Usually self-resolves within 2–3 weeks w/o surgery low risk of long-term complications

Question 12

causes of Long bone (midshaft femur)fractures

Answer 12

Aggressive manoeuvres

Macrosomia

Question 13

sx of long long bone fractures

Answer 13

pseudoparalysis of limb

swelling

pain

Question 14

dg and rx of long bone fractures

Answer 14

dg: xray
rx: immobilization and Spica cast

Question 15

what is a spica cast

Answer 15

a type of cast that includes one or both legs as well as the waist

Question 16

what is Erb’s (brachian nerve) palsy

Answer 16

injury to C5-C6 nerve root causing paralysis to the arm and phrenic nerve of the diaphragm

Question 17

causes of erb’s palsy

Answer 17

shoulder dystocia

breech

macrosomia

assisted delivery

Question 18

sx of erb’s

Answer 18

waiter’s tip
-ARM: adduction and internal rotation
FOREARM: pronation

absent Moro reflex

respiratory distress if phrenic nerve is involved

Question 19

dg of erbs

Answer 19

check moro, 02 lvls

Question 20

rx of erbs

Answer 20

physiotherapy and observation as it may resolve in 3-6 months if nerve damage is caused by oedema

Question 21

rx of erbs if failure to resolve in 3-6 months

Answer 21

nerve damage is due to laceration = irreversible

Neuroplasty w/ Nerve graft

Question 22

dx of erb’s palsy

Answer 22

Klumpke’ palsy

C7-T1 nerve roots

sx: CLaw hand & absent grasp reflex *& HORNERS SX

Question 23

which fetal organ is most commonly injured during childbirth

Answer 23

adrenal gland d/2 mechanical compression by vertebrae

calcified ring on adrenal gland confirms dg on ????

Question 24

What is fetal

Macrosomia

Answer 24

Larger than average Fetus
Greater than 4kg/ 8pounds

Usually caused by maternal obesity and DB

Question 25

What is uterine rupture

Answer 25

A rare complication commonly in women w/ precious C-section which there’s a tear in the wall of the uterus during childbirth Rare: 1/4000 births

Question 26

causes of uterine rupture

Answer 26

1) Uterine distention (main cause) - Delay in labor progression d/2 fetal malpresentation - Fetal macrosomia - multiple gestations - Overdose of oxytocin 2) Uterine scar/prior uterine surgery (increases risk) - C-section - myomectomy) 3)Traumatic rupture (e.g., iatrogenic or caused by an accident)

Question 27

why is uterine rupture more common during labour

Answer 27

Massive force exerted during contractions increases risk of rupture

Question 28

classification of uterine prolapse

Answer 28

Uterine rupture: when the uterus is connected to the abdomen - involves all layers of the uterine wall including the visceral peritoneum; - creates an open connection from the fetus and placenta to the peritoneal cavity. - Massive intraperitoneal and vaginal hemorrhage may occur Uterine dehiscence (closed rupture): perforation is covered by the visceral peritoneum - no intraperitoneal hemmorhage - caused by scar rupture in the late months of pregnancy / when contractions begin - Most cases are an incidental finding during repeat cesarean delivery

Question 29

sx of an imminent uterine rupture

Answer 29

Sx of imminent rupture - severe pain - hyperactive labour and severe contrxn - Bandl's ring: Muscular ring is seen above the belly button d/2 powerful cntrxn of the upper uterine segment

Question 30

sx of uterine rupture

Answer 30

Sx of rupture - Severe abdominal pain - Sudden pause in contractions - Fetal distress (deteriorating fetal heart rate) - Vaginal bleeding - Hemodynamic instability d/2 haemorrhage - Loss of fetal station(typical sign w/ abd pain) - Palpable fetal parts through the rupture

Question 31

what is 'STATION'

Answer 31

the level of the presenting fetal part in the birth canal relative to the ischial spines that is detected during vaginal examination

Question 32

what is loss of station

Answer 32

Regression of the presenting fetal part that is characteristic in uterine rupture along w/ severe abdominal pain

Question 33

rx of imminent uterine rupture

Answer 33

Immediate IV tocolysis Emergency C-section

Question 34

rx of established uterine rupture

Answer 34

Immediate laparotomy with emergency C‑section Hysterectomy if the bleeding does not cease

Question 35

rx of uterine dehiscence

Answer 35

Cesarean delivery before labor begins is to avoid a complete rupture

Question 36

prognosis of uterine rupture

Answer 36

Traumatic and spontaneous ruptures increase the mortality rate of both mother and the baby. Open ruptures lead to hypovolemia and hypoxia; as a result, the fetal mortality rate is between 50–75%.