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Semelhante a Birth Trauma update 2013.pptx
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Birth Trauma update 2013.pptx
- 1. Cha-6- Birth Trauma/Injuries • Definition: impairment of infants body structure/function • Sustained during the birth process • A voidable or unavoidable. • Causes morbidity and mortality • Risk Factors: • Prematurity,CPD, Prolonged Labor,MalPo/Pre, Intrumental Delivery and Macrosomal infant
- 2. Examination of Birth Injuries • Physical examination, • Neurological Examination • Asymmetric structures and Function • Ranges of Motion • Integrity of scalps and Skin
- 3. Type of Birth Injuries 1. Skull Injuries 2. Cervical Nerves Injuries 3. Phrenic nerve injury (C3, 4 or 5 ) 4. Fractures of Skull and Bone 5. Intra- abdominal injuries 6. Splenic Injuries
- 4. 1. Skull Injuries 1.1. Caput succedaneum B/t subcutaneous and extra periosteal --fluid rarely B Poorly defined margins usually associated with molding. The lesion usually resolves spontaneously Rarely causes significant blood loss or jaundice. Management ?????
- 5. 1.2. Cephalohematoma • It is a subperiosteal collection of blood • It is always confined by suture lines • Extensive causes hyperbilirubinemia and rarely • The risk of infection is very rare. • Skull fractures 5 – 20% of cases • Management: • Anemia and jaundice should be treated as needed
- 6. 1.3. Subgaleal hemorrhage • It is hemorrhage under the aponeurosis of the scalp. • Hemorrhage can spread across the entire calvarium. • Signs are pallor, poor tone, and a fluctuant swelling on the scalp, which cross the suture lines. • There may hematoma, Ecchymosis, Pain and shock • The blood is absorbed slowly & swelling resolves gradually • Management: ?????
- 7. 2.Cervical nerve root injuries 2.1 Brachial plexus injury • The cause is excessive traction on the head, neck, and arm during birth. • Risk factors include macrosomia, shoulder dystocia, breech presentation. • Injury usually involves the nerve root • Type • A: Duchenne-Erb’s palsy • B:Klumpke’s palsy:
- 8. A. Duchenne-Erb’s palsy: - • Upper trunks (C5, C6 and occasionally C7) and is the most common type • S/s: the arm is typically adducted and internally rotated at the shoulder. • There is extension and pronation at the elbow and flexion at the wrist • Moro is absent on the affected side. • The grasp reflex is intact and sensation is variably affected. B. Klumpke’s palsy: - injury C7/C8 to T1 and is the least common injury. • The grasp reflex is absent and there is sensory impairment on the ulnar side of the forearm and hand. • Management: • Physical therapy and passive range of motion
- 9. 3. Phrenic nerve injury • Phrenic nerve injury leading to paralysis of the diaphragm due to lateral hyperextension of the neck at birth. • R/f: breech and difficult forceps deliveries. • At least 75%of patients also have brachial plexus injury. • C/F • Respiratory distress, cyanosis, tachypnea and dec. Mov; hemi thorax • Dx– confirmed by U/S opposite movt at inspiration • Mgt: - the initial treatment is supportive. • CPAP or mechanical ventilation • avoid atelectasis & pneumonia.
- 10. 4. Bone and Skull Fractures 4.1 Skull fracture 4.2 Clavicular fracture: 4.3 Humeral fracture 4.4 Femoral fracture
- 11. • Thank You
Notas do Editor
- occurring subcutaneous, extra periosteal fluid collection that is occasionally hemorrhagic. It has poorly defined margins and can extend over the midline and across suture lines. It extends over the presenting portion of the scalp and is usually associated with molding. The lesion usually resolves spontaneously without sequelae over first several days after birth. It rarely causes significant blood loss or jaundice.
- It is a subperiosteal collection of blood resulting from rupture of the superficial veins between the skull and periosteum. It is always confined by suture lines and cannot cross the suture lines. An Extensive cephalohematoma can result in significant hyperbilirubinemia and rarely serious
- Subgaleal hemorrhage It is hemorrhage under the aponeurosis of the scalp. Because subaponeurotic space extends from the orbital ridges to the nap of the neck and laterally to the ears, the hemorrhage can spread across the entire calvarium. The initial presentation typically includes pallor, poor tone, and a fluctuant swelling on the scalp, which cross the suture lines. The hematoma may grow slowly or increase rapidly and result in shock. With progressive spread, the ears may be displaced anteriorly and periorbital swelling can occur. Ecchymosis of the scalp may develop and it is very painful on manipulation. The blood is desorbed slowly and swelling resolves gradually . Management and follow up;- 1. New born with this lesion should be admitted 2. Assess and treat shock 3. Daily HC measurement and HCT follow-up 4. Minimize manipulation because it is painful 5. Manage anemia and jaundice if needed.
- Cervical nerve root injuries Brachial plexus injury The cause is excessive traction on the head, neck, and arm during birth. Risk factors include macrosomia, shoulder dystocia, breech presentation. Injury usually involves the nerve root, specially where the roots come together to form the nerve trunk of the plexus . A. Duchenne-Erb’s palsy: - involves the upper trunks (C5, C6 and occasionally C7) and is the most common type of brachial plexus injury. Clinical presentation: - the arm is typically adducted and internally rotated at the shoulder. There is extension and pronation at the elbow and flexion at the wrist and fingers in the characteristic “waiter’s tip” posture. Moro is absent on the affected side. The grasp reflex is intact and sensation is variably affected. B. Klumpke’s palsy: - involves injury C7/C8 to T1 and is the least common injury. In this case, the grasp reflex is absent and there is sensory impairment on the ulnar side of the forearm and hand.
- Humeral fracture: - this fracture usually occurs during a difficult delivery of the arms in the breech presentation and/or of the shoulder in vertex presentation. Direct pressure on the hummers may also result in fracture Clinical presentation: Loss of spontaneous arm movement on affected side, followed by swelling and pain on passive motion. B. Femoral fracture: - this fracture follows usually a breech delivery. Infants with congenital hypotonia are at increased risk Clinical features: - obvious deformity of the thigh and swelling of thigh, decreased movement and paint on palpation or passive motion. Diagnosis: - confirmed by X-ray Management - fractures, even if unilateral, should be treated with traction and suspension of both legs with a spica cast. Casting is maintained for about four weeks. Complete healing without limb shortening is expected