This document discusses various types of birth injuries including:
- Head and neck injuries such as caput succedaneum, cephalhematoma, subgaleal hemorrhage, skull fractures, and intracranial hemorrhages.
- Nerve injuries including brachial plexus injuries (Erb's palsy and Klumpke's palsy) and facial nerve palsy.
- Risk factors for birth injuries include prolonged or difficult labor, fetal macrosomia, and instrument-assisted delivery. Birth injuries can cause impairments ranging from mild swelling to life-threatening hemorrhages requiring medical or surgical intervention.
Postpartum pyrexia occurs in 5–7% of births. There are many possible causes, with infection related to childbirth being the most common. In women presenting with non-specific symptoms, the diagnosis of puerperal sepsis should be considered until proven otherwise, as puerperal sepsis can result in severe maternal morbidity and occasional mortality. A comprehensive history and physical examination supported by appropriate investigations can help confirm the diagnosis. Use of an early warning chart for observations is important to detect early changes in a patient's condition. When pyrexia is due to sepsis, the clinical condition can deteriorate to a life-threatening situation rapidly; hence high dose broad-spectrum intravenous antibiotics should be commenced without waiting for microbiology results. Early involvement of senior members of the multidisciplinary team improves outcomes.
Postpartum pyrexia occurs in 5–7% of births. There are many possible causes, with infection related to childbirth being the most common. In women presenting with non-specific symptoms, the diagnosis of puerperal sepsis should be considered until proven otherwise, as puerperal sepsis can result in severe maternal morbidity and occasional mortality. A comprehensive history and physical examination supported by appropriate investigations can help confirm the diagnosis. Use of an early warning chart for observations is important to detect early changes in a patient's condition. When pyrexia is due to sepsis, the clinical condition can deteriorate to a life-threatening situation rapidly; hence high dose broad-spectrum intravenous antibiotics should be commenced without waiting for microbiology results. Early involvement of senior members of the multidisciplinary team improves outcomes.
PYLORIC STENOSIS:
Review the anatomy and physiology of digestive system
Review the incidence of pyloric stenosis
Define pyloric stenosis
Explain the causes and risk factors of pyloric stenosis
Describe the pathophysiology of pyloric stenosis
Enumerate clinical features of pyloric stenosis
Enlist the diagnostic evaluation for pyloric stenosis
Explain the management of pyloric stenosis
Enumerate the complications of pyloric stenosis
Birth injuries are inflicted during the time of delivery of the baby. it can occur in different parts of the body such as head, shoulder, eyes, nerves, etc. these injuries may be minor which resolve themselves with time while others are major and require prompt treatment. it is also very important to focu upon the prevention of occurence of such birth injuries. these injuries can be head injury, paralysis, fracture, soft tissue injury, visceral injury etc.
Newborn Birth Injuries: The Untold Story
Introduction:
As a result of the birth process some injuries occur that may be minor, whereas other may be more serious. Despite skilled midwifery and obstetric care in developed, birth trauma still occurs.
Definition:
An impairment of the infants body function or structure due to adverse influences that occur at birth.
Risk factors:
Primi parity,
Small maternal stature
Prolonged or usually rapid labor
Malpresentation of the fetus
Use of mid forceps or vaccum extraction
Fetal macrosomia or large fetal head
Classification:
Based on areas involved:
1. trauma to skin and superficial tissues
2. muscle trauma
3. nerve trauma
4. fractures
PREVENTION OF BIRTH INJURIES
- To prevent or to detect early intrauterine fetal asphyxia.
- To avoid premature delivery.
- To avoid traumatic vaginal delivery.
- To extend the use of caesarean section in abnormal & complicated presentation more liberally.
- Improve the level of doctor and nurses
THANK YOU.
PYLORIC STENOSIS:
Review the anatomy and physiology of digestive system
Review the incidence of pyloric stenosis
Define pyloric stenosis
Explain the causes and risk factors of pyloric stenosis
Describe the pathophysiology of pyloric stenosis
Enumerate clinical features of pyloric stenosis
Enlist the diagnostic evaluation for pyloric stenosis
Explain the management of pyloric stenosis
Enumerate the complications of pyloric stenosis
Birth injuries are inflicted during the time of delivery of the baby. it can occur in different parts of the body such as head, shoulder, eyes, nerves, etc. these injuries may be minor which resolve themselves with time while others are major and require prompt treatment. it is also very important to focu upon the prevention of occurence of such birth injuries. these injuries can be head injury, paralysis, fracture, soft tissue injury, visceral injury etc.
Newborn Birth Injuries: The Untold Story
Introduction:
As a result of the birth process some injuries occur that may be minor, whereas other may be more serious. Despite skilled midwifery and obstetric care in developed, birth trauma still occurs.
Definition:
An impairment of the infants body function or structure due to adverse influences that occur at birth.
Risk factors:
Primi parity,
Small maternal stature
Prolonged or usually rapid labor
Malpresentation of the fetus
Use of mid forceps or vaccum extraction
Fetal macrosomia or large fetal head
Classification:
Based on areas involved:
1. trauma to skin and superficial tissues
2. muscle trauma
3. nerve trauma
4. fractures
PREVENTION OF BIRTH INJURIES
- To prevent or to detect early intrauterine fetal asphyxia.
- To avoid premature delivery.
- To avoid traumatic vaginal delivery.
- To extend the use of caesarean section in abnormal & complicated presentation more liberally.
- Improve the level of doctor and nurses
THANK YOU.
"Mastering the Basics: General Physical Examination in Neurology with Dr. Ganeshgouda"
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Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
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A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
8. CAPUT SUCCEDANEUM
• A caput succedaneum is a
serosanguinous fluid collection above the
periosteum. It presents as a soft tissue
swelling with purpura and ecchymosis
over the presenting portion of the scalp. It
may extend across the midline and across
suture lines.
9. • The edema disappears within the 1st few
days of life.
• Molding of the head and overriding of the
parietal bones disappear during the 1st
weeks of life.
• Rarely, a hemorrhagic caput may result in
shock and require blood transfusion.
10. MANAGEMENT
• No specific treatment is needed
• But if extensive ecchymoses are
present, hyperbilirubinemia may develop
• Shock – Blood transfusion
12. Clinical features
• Swelling, usually over a parietal or
occipital bone
• Swelling does not cross a suture line and
is often not associated with discoloration
of the overlying scalp.
• Limited to the surface of one cranial bone.
14. • If infection is suspected, aspiration of the
mass
• If sepsis, antibiotics
• hyperbilirubinemia – photo therapy
15.
16. SUBGALEAL HEMORRHAGE
• A subgaleal hemorrhage is bleeding
between the galea aponeurosis of the
scalp and the periosteum.
17. FEATURES
• A subgaleal hemorrhage presents as a
firm-to-fluctuant mass that crosses suture
lines.
• The mass is typically noted within 4 hours
of birth.
18. LABORATORY FINDINGS
• serial hemoglobin and hematocrit
monitoring,
• coagulation profile to investigate for the
presence of a coagulopathy.
• Bilirubin levels also need to be monitored
19. TREATMENT
• Supportive
• Transfusions may be required if blood loss
is significant.
• In severe cases, surgery may be required
to cauterize the bleeding vessels.
• These lesions typically resolve over a 2–3
week period
21. LINEAR SKULL FRACTURES
• Usually affect the parietal bones.
• The pathogenesis is related to
compression from the application of
forceps, or from the skull pushing against
the maternal symphysis or ischeal spines.
• Rarely, a linear fracture may be
associated with a dural tear, with
subsequent development of a
leptomeningeal cyst.
22. DEPRESSED SKULL FRACTURES
• Indications for surgery include
• radiographic evidence of bone
fragments in the cerebrum
• presence of neurologic deficits
• signs of increased intracranial pressure
• signs of cerebrospinal fluid beneath the
galea
• failure to respond to closed manipulation.
23. • Indications for nonsurgical management
include
• Depressions less than 2 cm in width and
depressions over a major venous sinus
• Without neurologic symptoms
26. INTRACRANIAL HAEMORRHAGE
• 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
27. RISK FACTORS
• forceps delivery
• vacuum extraction
• precipitous deliver
• prolonged second stage of labor
• macrosomia
29. EPIDURAL HEMORRHAGE
• Epidural hemorrhage primarily arises from
injury to the middle meningeal artery, and
is frequently associated with a
cephalhematoma or skull fracture.
34. • Laceration of the tentorium, with rupture of
the straight sinus, vein of Galen transverse
sinus, or infratentorial veins causing a
posterior fossa clot and brainstem
compression
• Laceration of the falx, with rupture of the
inferior sagittal sinus resulting in a clot in
the longitudinal cerebral fissure
35. • Laceration of the superficial cerebral
vein, causing bleeding over the cerebral
convexity
• Occipital osteodiastasis, with rupture of
the occipital sinus, resulting in a posterior
fossa clot
36. CLINICAL FEATURES
• Respiratory symptoms such as apnea
• Seizures
• Focal neurologic deficits
• Lethargy
• Hypotonia
• Other neurologic symptoms
42. INTRAPARENCHYMAL
HAEMORRHAGE
• TYPES
• Intra cerebral
Causes:
• rupture of an av malformation or aneurysm
• coagulation disturbances
• extracorporeal membrane oxygenation
therapy
• secondary to a large ICH in any other
compartment
43. • Intracerebellar :
more common in preterm than the
term babies. May be a primary
haemorrhage or may result from venous
hemorrhagic infarction or from extension
of GMH/ IVH
44. CLINICAL FEATURES
• In the preterm infant
– IPH is often clinically silent in either
intracranial fossa , unless the hemorrhage is
quite large
• In the term infant, manifestations are
– Seizures
– Hemiparesis
– Gaze preference
– Irritability
– Depressed level of consciousness
48. FACTORS IN THE PATHOGENESIS
• Intra vascular factors
– Ischemia / reperfusion
– Fluctuating cerebral blood flow
– Increase in CBF
– Increase in cerebral venous pressure
– Platelet dysfunction
– Coagulation disturbances
49. • Vascular factors
– Tenuous involuting capillaries with large
diameter lumen
• Extra vascular factors
– Deficient vascular support
– Excessive fibrinolytic activity
50. CLINICAL FEATURES
In the preterm newborn
• Usually clinically silent
• Decreased levels of consciousness and
spontaneous movement
• Hypotonia
• Abnormal eye movement
• Skew deviation
51. In term newborns
• Seizures
• Irritability
• Apnea
• Lethargy
• Vomiting with dehydration
• Full fontanels
57. ERB-DUCHENNE PARALYSIS
• 5th and 6th cervical nerves injury
• The infant loses the power to abduct the
arm from the shoulder, rotate the arm
externally, and supinate the forearm
• Erb’s palsy may also be associated with
injury to the phrenic nerve,
which is innervated with
fibers from C3–C5
58. • Adduction and internal rotation of the arm
with pronation of the forearm.
• Biceps reflex is absent
• Moro reflex is absent on the affected side.
• The involved arm is held in the ‘‘waiter’s
tip’’ position, with adduction and internal
rotation of the shoulder, extension of the
elbow, pronation of the forearm, and
flexion of the wrist and fingers.
59. KLUMPKE’SPALSY
• Involves the C8 and T1 nerves, resulting in
weakness of the intrinsic hand muscles
and long flexors of the wrist and fingers
60. • The grasp reflex is absent but the biceps
reflex is present.
• Flaccid extremity with absent reflexes.
61. ASSOCIATED LESIONS
• Hematomas of the sternocleidomastoid
muscle, and fractures of the clavicle and
humerus.
• Ipsilateral Horner’s syndrome
(ptosis, miosis, and anhydrosis) when
there is accompanying injury to the
sympathetic fibers of T1.
62. TYPES
• Neuropraxia with temporary conduction
block
• Axonotmesis with a severed axon, but with
intact surrounding neuronal elements
• Neurotmesis with complete postganglionic
disruption of the nerve
• Avulsion with preganglionic disconnection
from the spinal cord
64. MANAGEMENT
• Initial treatment is conservative.
• The arm is immobilized across the upper
abdomen during the first week
• Physical therapy with passive range-of-
motion exercises at the shoulder, elbow
and wrist should begin after the first week.
• Infants without recovery by 3 to 6 months
of age may be considered for surgical
exploration
66. Clinical manifestations
• weakness of both upper and lower facial
muscles.
• At rest, the nasolabial fold is flattened and
the eye remains persistently open on the
affected side.
• During crying, there is inability to wrinkle
the forehead or close the eye on the
ipsilateral side, and the mouth is drawn
awayfrom the affected side.
68. TREATMENT
• protection of the involved eye 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
69. PHRENIC NERVE INJURY
• The phrenic nerve arises from the third
through fifth cervical nerve roots.
• Injury to the phrenic nerve leads to
paralysis of the ipsilateral diaphragm.
70. CLINICAL MANIFESTATIONS
• 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 or fluoroscopy can
confirm the diagnosis by showing
paradoxical diaphragmatic movement
during inspiration
71. TREATMENT
• Initial treatment is supportive
• Oxygen
• Respiratory failure may be treated with
continuous positive airway pressure or
mechanical ventilation.
• Gavage feedings.
• Plication of the diaphragm
74. 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
75. SPINAL CORD INJURY
• 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.
76. • 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
77. MANAGEMENT
• If cord injury is suspected in the delivery
room, the head, neck, and spine should be
immobilized.
• Therapy is supportive.
79. NASAL SEPTAL
DISLOCATION
• Nasal septal dislocation involves
dislocation of the triangular cartilaginous
portion of the septum from the vomerine
groove
80. 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.
81. MANAGEMENT
• Definitive diagnosis can be made by
rhinoscopy
• manual reduction performed by an
otolaryngologist using a nasal elevator.
• Reduction should be performed by 3 days
of age
82. OCULAR INJURIES
• Rupture of Descemet’s membrane of the
cornea
• lid lacerations
• hyphema (blood in anterior chamber)
• vitreous hemorrhage
• Purtscher’s retinopathy
• corneal edema,
• corneal abrasion
83. CONGENITAL MUSCULAR
TORTICOLLIS
• atrophic muscle fibers surrounded by
collagen and fibroblasts.
• tearing of the muscle fibers or fascial
sheath with hematoma formation and
subsequent fibrosis.
84. CLINICAL FEATURES
• 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.
85. DIAGNOSIS
• physical examination
• Radiographs should be obtained to rule
out abnormalities of the cervical spine.
• Ultrasonography may be useful both
diagnostically and prognostically.
89. Risk factors
• higher birth weight
• prolonged second stage of labor
• shoulder dystocia
• instrumented deliveries
90. MANAGEMENT
• Asymptomatic incomplete fractures require
no treatment.
• Complete fractures are treated with
immobilization of the arm for 7 to 10 days
94. TREATMENT
• immobilization and splinting
• Closed reduction and casting are required
only when the bones are displaced.
• Proximal femoral fractures may require a
spica cast or use of a Pavlik harness
95. INTRA-ABDOMINAL INJURY
Liver injury is the most common
• Three potential mechanisms lead to intra-
abdominal 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
96. CLINICAL MANIFESTATIONS
• With hepatic or splenic rupture, patients
develop sudden pallor, hemorrhagic
shock, abdominal distention, and
abdominal discoloration.
• Presentation of a liver rupture with scrotal
swelling and discoloration has been
described.
97. • Subcapsular hematomas may present
more insidiously, with anemia, poor
feeding, tachypnea, and tachycardia.
• Adrenal hemorrhage may present as a
flank mass
98. DIAGNOSIS
• abdominal ultrasound
• Computed tomography
• Abdominal radiographs may show
nonspecific intraperitoneal fluid or
hepatomegaly.
• Abdominal paracentesis is diagnostic if a
hemoperitoneum is present
99. TREATMENT
• volume replacement and correction of any
coagulopathy.
• If the infant is hemodynamically
stable, conservative management is
indicated.
• With rupture or hemodynamic instability, a
laparotomy is required to control the
bleeding.
• Patients with adrenal hemorrhage may
require hormone replacement therapy.
100. SOFT TISSUE INJURIES
• Petechiae and ecchymoses
• Lacerations and abrasions
• Subcutaneous fat necrosis
101. Assignment
• What are some of the nursing diagnoses related to birth injuries?
• What nursing care would you offer to a newborn with caput
succedaneum?