This document discusses various types of birth injuries that can occur during labor and delivery. It begins by defining birth injuries and noting their prevalence. It then covers predisposing risk factors and provides a classification system for birth injuries involving soft tissue, the head/neck, facial structures, nerves, fractures, and internal organs. The remainder of the document delves into specific injury types like brachial plexus palsy, skull fractures, retinal hemorrhages, and clavicle fractures, describing their causes, signs/symptoms, diagnosis, and management.
Birth Injuries are the common complications of Instrumental Delivery. So intrapartum management should be done very carefully in ordered to ensure healthy and good outcome of baby.
Birth Injuries are the common complications of Instrumental Delivery. So intrapartum management should be done very carefully in ordered to ensure healthy and good outcome of baby.
This topic contains detailed description about labour, its definition, date of onset of labour, calculations of date of delivery, causes of onset of labour, physiology of normal labour, and events, clinical course and management of each stages of labour.
BIRTH INJURIES IN NEWBORN: Definition of birth injuries , statistics, etiology, classification of birth injuries , head injuries: cephalhematoma and Caput succedaneum, skull fractures
, nerve injuries: erb's palsy and klumpke's palsy, bone injuries: clavicular and long bone fracture , intra-abdominal and soft tissue injuries, management and prevention of birth injuries
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
An impairment of the infants body function or structure due to adverse influences that occur at birth. Injuries to the infant may result from mechanical forces (i.e., compression, traction) during the birth process. 0.7% (Seven of every 1,000) births result in birth injuries, though most women give birth in modern hospitals surrounded by medical professionals. Birth injuries account for fewer than 2% of neonatal deaths. Infant mortality resulting from birth trauma fell from 64.2 to 7.5 deaths per 100,000 live births from 1970-1985. Birth injuries can be classified to Soft tissue injuries, Head and neck injuries, Facial injuries, Cranial nerve injuries, Spinal cord injuries, Peripheral Nerve injury, Fractures & Torticollis, Intra-abdominal injury. Proper management neccissates, early recognition of trauma, Careful physical and neurological evaluation, Establish whether additional injuries exist, Injury may result from resuscitation, Assess Symmetry of structure & function, Specific examination such as cranial nerve, joint range of motion, scalp/skull integrity.
This topic contains detailed description about labour, its definition, date of onset of labour, calculations of date of delivery, causes of onset of labour, physiology of normal labour, and events, clinical course and management of each stages of labour.
BIRTH INJURIES IN NEWBORN: Definition of birth injuries , statistics, etiology, classification of birth injuries , head injuries: cephalhematoma and Caput succedaneum, skull fractures
, nerve injuries: erb's palsy and klumpke's palsy, bone injuries: clavicular and long bone fracture , intra-abdominal and soft tissue injuries, management and prevention of birth injuries
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
An impairment of the infants body function or structure due to adverse influences that occur at birth. Injuries to the infant may result from mechanical forces (i.e., compression, traction) during the birth process. 0.7% (Seven of every 1,000) births result in birth injuries, though most women give birth in modern hospitals surrounded by medical professionals. Birth injuries account for fewer than 2% of neonatal deaths. Infant mortality resulting from birth trauma fell from 64.2 to 7.5 deaths per 100,000 live births from 1970-1985. Birth injuries can be classified to Soft tissue injuries, Head and neck injuries, Facial injuries, Cranial nerve injuries, Spinal cord injuries, Peripheral Nerve injury, Fractures & Torticollis, Intra-abdominal injury. Proper management neccissates, early recognition of trauma, Careful physical and neurological evaluation, Establish whether additional injuries exist, Injury may result from resuscitation, Assess Symmetry of structure & function, Specific examination such as cranial nerve, joint range of motion, scalp/skull integrity.
This presentation discusses cranial hemorrhage in a newborn baby. We have included extracranial and intracranial bleed discussion in neonates. Intraventricular hemorrhage (IVH) is further discussed in details in terms of pathophysiology, management strategies and clinical studies related to it.
Hope this presentation is helpful for the knowledge and practice of medical students, pediatricians and neonatologists and helps in practical management of your NICU babies as well.
This presentation aims at discussion of the pathophysiology , clinical presentation and management of the different types of intracranial bleeds in a neonate. Special emphasis has been laid on intraventricular hemorrhage. The germinal matrix bleed in a preterm is discussed in depth along with the various evidence based management protocols available. Radiological diagnosis of IVH in a preterm / term baby will be discussed in the upcoming presentations.
chiari or arnold chiari malformations, various types and pathophysiology, radiological and clinical presentation of the types, signs symptoms, investigations and treatment of these malformations both conservative and surgical. considerations and controversiies in management of chiari malformation associated with various conditions.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. Birth Injuries
The term birth injury is used to
denote: avoidable and
unavoidable mechanical, hypoxic
ischemic injury affecting the infant
during labor and delivery
0.7% (Seven of every 1,000) births
result in birth injuries. though
most women give birth in modern
hospitals surrounded by medical
professionals.
Birth injuries account for fewer
than 2% of neonatal deaths.
3. predisposing factors
Primiparity
maternal short stature
Maternal pelvic anomalies
Prolonged or unusually rapid
labor
Oligohydramnios
Malpresentation of the fetus
(breech)
Cephalopelvic disproportion
Deep transverse arrest of
presenting part of the fetus
4. Use of forceps or vaccum extraction
Versions and extractions
Very low birth weight or extreme prematurity
Fetal macrosomia birth weight over about 4,000 grams
Fetal macrocephaly (Large head)
Fetus anomalies
8. Abrasions and lacerations
May occur as scalpel cuts during
Cesarean delivery or during instrumental
delivery (i.e, vacuum, forceps)
Infection remains a risk, but most
uneventfully heal
Management
Careful cleaning, application of antibiotic
ointment, and observation
Lacerations occasionally require suturing
9. Subcutaneous fat necrosis
Irregular, hard, nonpitting, subcutaneous
induration with overlying dusky red-purple
discoloration on the extremities, face, trunk, or
buttocks
May be caused by pressure during delivery.
No treatment is necessary
Subcutaneous fat necrosis sometimes calcifies
14. Caput succedaneum
Oedema of the presenting part
caused by pressure during a
vaginal delivery.
This is a serosanguineous,
subcutaneous, extraperiosteal
fluid collection with poorly
defined margins and non
fluctuating.
15. Cephalhematoma
Subperiosteal collection of
blood between the skull and
the periosteum.
It may be unilateral or
bilateral, and appears within
hours of delivery as a soft,
fluctuant swelling on the side
of the head.
A cephalhaematoma never
extends beyond the edges of
the bone or crosses suture
lines.
16.
17.
18. Subgaleal hematoma
Bleeding in the potential space between skull periosteum
& scalp galea aponeurosis Crossing the suture lines.due to
rupture of emmisar veins
(і) Diffuse swelling of the head. Sutures usually are not
palpable. The amount of blood under the scalp is far more
than is estimated. Within 48 hours the blood tracks
between the fibres of the occipital and frontal muscles
causing bruising behind the ears, along the posterior hair
line and around the eyes.
(ii) Shock and pallor: tachycardia, a low blood pressure,
within 30 minutes of the haemorrhage the haemoglobin
and packed cell volume start to fall rapidly.
20. Skull fractures
May occur as a result of pressure from :
1. Forceps
2. The maternal symphysis pubis.
3. Sacral promontory, or
4. Ischial spines.
Linear skull fractures
Usually the parietal bones.
Compression forceps, or skull against
symphysis or ischealspines.
Rarely, dural tear occurs.
21. Depressed skull fractures
Depressed fractures are usually indentations similar
to a dent in a Ping-Pong ball; occurs due to
complication of forceps delivery or fetalcompression.
22. Indications for surgery
•radiographic evidence of bone
fragments in the cerebrum
•presence of neurologic deficits
•signs of increased intracranial pressure
•failure to respond to closed manipulation.
Indications for nonsurgical management
•Depressions less than 2 cm in width.
•Without neurologic symptoms.
23. Intracranial hemorrhages
Causes:
1. Sudden compression and decompression of the head as in
breech and precipitate labour.
2. Marked compression by forceps or in cephalopelvic
disproportion.
3. Fracture skull.
Bleeding can occur
– External to the brain into the epidural, subdural or
subarachnoid space.
– In to the parenchyma of the cerebrum or cerebellum.
– Into the ventricles from the subependymal germinal matrix
or choroid plexus.
25. Intracranial Haemorrhage Sites:
Subdural : results from damage to the superficial veins
where the vein of Galen and inferior sagittal sinus
combine to form the straight sinus.
Subarachnoid: injury to bridgin veins or leptomeningeal
anastomosis injury or AV malformation.
Intraventricular :into the brain ventricles.
Intracerebral : into the brain tissues .
26.
27.
28.
29. Intracranial Haemorrhage:
Clinical picture:
Flaccidity or rigidity
Breathing is irregular and periodic or gasping.
Eyes: no movement, pupils may be fixed and dilated.
Opisthotonus, twitches and convulsions.
Vomiting .
High pitched cry.
Anterior fontanelle is tense and bulging.
Lumbar puncture reveals bloody C.S.F.
30. Subarachnoid hemorrhages (SAH)
(i) Attacks of apnoe, irregular breathing, bradycardia.
(ii) Hyperesthesia, tremor, seizures, bulging of
fontanella,“Sunset” sign positive.
(iii) Changes of spinal fluid in lumbar puncture: it becomes
xanthochromic or/and contains blood.
31. Intraventricular (IVH) hemorrhages
Intracranial hemorrhage that originates in periventricular
subependymal germinal matrix with subsequent
entrance of blood into the ventricular system.
EARLY IVH: IVH develop within 72hrs after birth.
LATE IVH: IVH develop after 72hrs of life.
Incidence and severity is inversely proportional to
gestation age and birth weight.
32. Clinical features
1) Apnea
2) Bradycardia
3) Acidosis
4) Cutaneous mottling
5) A bulging fontanel
6) High pitched cry
7) Absent Moro reflex
8) Seizures
9) A sudden drop in hematocrit
10) Failure to suck well
11) Change in muscle tone
36. Management
No specific treatment is available for IVH, it may be
associated with other complications that require
therapy.
Maintain ABC.
Seizures are aggressively treated with anticonvulsant
drugs.
Anemia and coagulopathies requires transfusion
with packed red blood cells or fresh frozen plasma.
Shock and acidosis are treated with slow
administration of sodium bicarbonate and fluid
resuscitation.
38. Subconjunctival hemorrhage
Breakage of small blood vessels in
the eyes of a baby. One or both of
the eyes may have a bright red
band around the iris.
This is very common and does not
cause damage to the eyes.
The redness is usually absorbed in a
week to ten days
39. Other Ocular injuries
Rupture of Descemet’s membrane of the cornea
lid lacerations
hyphema (blood in anterior chamber)
vitreous hemorrhage
corneal edema,
corneal abrasion
40. Nasal Septal dislocation
Involves dislocation of the triangular cartilaginous portion of
the septum from the vomerine groove.
Clinical features
airway obstruction.
deviation of the nose to one side.
The nares are asymmetric, with flattening of the side of the
dislocation (Metzenbaum sign). Application of pressure on the
tip of the nose (Jeppesen and Windfeld test) causes collapse of
the nostrils, and the deviated septum becomes more apparent.
Management
Definitive diagnosis can be made by rhinoscopy
manual reduction
45. Erb-Duchenne palsy (C5-C6)
The most common injury.
Lack of shoulder motion.
The involved extremity lies adducted, pronated, and
internally rotated.
Moro, biceps, and supinator reflexes are absent on the
affected side.
Grasp reflex is usually present.
Erb’s palsy may be associated with injury to the phrenic
nerve, innervated with fibers from C3–C5.
46. Klumpke paralysis (C 7-8, T1)
Weakness of the intrinsic muscles of the hand; and long
flexors of the wrist and fingers (clawing not writing).
Grasp reflex is absent.
Biceps reflex is present.
If cervical sympathetic fibers of the T 1 are involved,
Horner syndrome is present (ptosis, miosis, and
anhydrosis).
Mainly due to Hematomas of the sternocleidomastoid
muscle, and fractures of the clavicle and humerus.
47.
48. Diagnosis & Management
Radiographs of the shoulder and upper arm
Initial treatment is conservative.
physiotherapy with passive range movements.
Infants without recovery by 3 to 6 months of age
may be considered for surgical exploration
49. Phrenic nerve injury
The phrenic nerve arises from the third to fifth cervical
nerve roots.(c3-c5)
Injury to the phrenic nerve leads to paralysis of the
ipsilateral diaphragm.
respiratory distress, with diminished breath sounds on
the affected side.
Chest radiographs show elevation of the affected
diaphragm, with mediastinal shift to the contralateral
side.
Ultrasonography can confirm the diagnosis by showing
paradoxical diaphragmatic movement during inspiration
50. Treatment
Initial treatment is supportive
Oxygen
Respiratory failure may be treated with continuous
positive airway pressure or mechanical ventillation.
51. Laryngeal nerve injury
Symptoms
Stridor
respiratory distress
hoarse cry
dysphagia,
Aspiration
Diagnosis
By direct laryngoscopy.
Treatment
Small frequent feedings may be required to decrease the risk of
aspiration.
Intubation
Tracheostomy
Bilateral paralysis tends to produce more severe distress, and therefore
requires intubation and tracheostomy placement more frequently
52. Facial paralysis
It can be caused by pressure on the facial nerves during birth
or by the use of forceps during birth.
The affected side of the face droops and the infant is unable to
close the eye tightly on that side. When crying the mouth is
pulled across to the normal side.
involved eye is protected by application of artificial tears and
taping to prevent corneal injury.
neurosurgical repair of the nerve should be considered only
after lack of resolution during 1 year of observation.
53. Spinal cord injury
Occurs due to Excessive traction or rotation.
The baby usually is posing as frog.
“oscillation” test is positive.
(prick leg of the newborn with needle leg will flex
and extend in all joints several times)
54. Clinical findings
decreased or absent spontaneous movement.
absent deep tendon reflexes.
absent or periodic breathing.
lack of response to painful stimuli below the level of the
lesion.
Lesions above C4 are almost always associated with apnea.
Lesions between C4 and T4 may have respiratory distress
secondary to varying degrees of involvement of the phrenic
nerve and innervation to the intercostal muscles.
Management
If cord injury is suspected in the delivery room,
The head, neck, and spine should be immobilized.
Therapy is supportive.
56. The clavicle & long bonefracture
Clavicle is the most frequently bone injured in the
neonate during birth and most often is an
unpredictable unavoidable complication of normal
delivery.
The infant may present with pseudoparalysis.
Examination may reveal crepitus, palpable bony
irregularity, and sternocleidomastoid muscle spasm.
Desault's bandage should be used for 7-10 days.
57.
58. Sternocleido-mastoid injury
Tearing of the muscle fibers or fascial
sheath with hematoma formation and
subsequent fibrosis.
The head is tilted toward the side of
the lesion and rotated to the
contralateral side,
chin is slightly elevated.
If a mass is present, it is firm, spindle-
shaped, immobile, and located in the
midportion of the
sternocleidomastoid muscle, without
accompanying discoloration or
inflammation.
60. INTRA-ABDOMINAL INJURIES
Liver injury is the most common
Three potential mechanisms lead to intraabdominal
injury:
(1) direct trauma,
(2) compression of the chest against the surface of the
spleen or liver
(3) chest compression leading to tearing of the
ligamentaous insertions of the liver or spleen.
61. Clinical manifestations
With hepatic or splenic rupture, patients develop sudden
pallor, hemorrhagic shock, abdominal distention, and
abdominal discoloration.
Subcapsular hematomas may present more insidiously,
with anemia, poor feeding, tachypnea, and tachycardia.
Adrenal hemorrhage may present as a flank mass.
Diagnosis
abdominal ultrasound.
Computed tomography.
Abdominal radiographs may show nonspecific
intraperitoneal fluid or hepatomegaly.
Abdominal paracentesis is diagnostic if a
hemoperitoneum is present
62. Treatment
volume replacement
Correction of coagulopathy
Hemodynamically stable infant, conservative
management is indicated.
With rupture or hemodynamic instability, a laparotomy
is required to control the bleeding.
With adrenal hemorrhage hormone replacement
therapy may be required.