1/16. Coincident metopic synostosis and deformational plagiocephaly.A male infant is described in whom coincident pathologies of metopic synostosis and deformational plagiocephaly were observed. The role in causation of localized pressure (in particular, extreme constraint) is addressed.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/16. Occipital osteodiastasis: presentation of four cases and review of the literature.BACKGROUND: Occipital osteodiastasis (OOD) is a form of birth injury characterized by a tear along the innominate (posterior occipital or supraoccipital-exoccipital) synchondrosis with separation of the occipital squama from the lateral or condylar parts of the occipital bone. The condition, frequently mentioned in the older literature as relatively common and invariably fatal, has been attributed to excessive pressure exerted over the subocciput during delivery, resulting in a forward and upward displacement of the anterior margin of the occipital squama into the posterior cranial fossa, with posterior fossa hemorrhage and other intracranial complications. Most likely as the result of improved obstetric techniques, this severe form of OOD has become quite rare or non-existent. A less severe form compatible with survival has been suggested, but so far only one case has been reported in some detail. MATERIALS AND methods: This paper reports the occurrence of this less severe form of OOD diagnosed roentgenographically in two infants who survived: a newborn and a 3-month-old child. Two additional cases of a similar lesion but of postnatal onset are also described: a 3-month-old infant with the diagnosis of child abuse who also survived and a 2-year-old girl who was involved in a fatal motor-pedestrian collision. RESULTS: Based on cases in the literature and the present material, three forms of OOD can be considered: a classic, fatal form; a less severe variant compatible with survival; and OOD of postnatal onset. The diagnosis can be made on lateral skull or cervical spine roentgenograms showing specific changes in the area of the innominate synchondrosis.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/16. Traumatic hypopituitarism due to maternal uterine leiomyomas.hypopituitarism has been associated with different types of head trauma including traumatic delivery. We report a case of hypopituitarism in a boy with a history of induced traumatic labor associated with maternal uterine leiomyomas. He also had head and face deformations that were apparently caused by spatial restriction due to the enlarging leiomyomas while the patient was growing in utero. Trauma to the pituitary stalk could have occurred by cerebral entrapment and the pressures of labor. Although hypopituitarism has been associated with traumatic delivery and breech delivery, there are no reported cases related to uterine leiomyomas.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/16. Neonatal subgaleal hematoma causing brain compression: report of two cases and review of the literature.OBJECTIVE AND IMPORTANCE: Neonatal subgaleal hematomas (SGHs) are infrequent but underdiagnosed collections of blood beneath the galea, often caused by vacuum delivery. With massive bleeding into the subgaleal space, exsanguination and hypovolemic shock can cause death in 20 to 60% of newborn infants. We report the first two known patients with extracranial cerebral compression caused by SGH. Also, the surgical evacuation of neonatal SGH has not been described previously. CLINICAL PRESENTATION: One patient was a full-term boy who was delivered via vacuum extraction after an uncomplicated pregnancy. Within a few hours, he developed an expanding fluid collection of the scalp and disseminated intravascular coagulation and shock requiring intubation, inotropic support, and blood transfusions. His head circumference grew from 33 cm at birth to 42 cm. He became progressively lethargic and developed posturing movements. Computed tomography of the head revealed a massive SGH causing gross overlapping of the cranial sutures and diffuse cerebral edema. The other patient was a full-term boy delivered via cesarean section after an unsuccessful attempt at vacuum extraction and forceps delivery. The initial head circumference was 34 cm. Within a few hours, he developed an expanding fluid collection of the scalp and became progressively lethargic with posturing. magnetic resonance imaging of the head revealed a massive SGH with cranial compromise and diffuse cerebral edema. INTERVENTION: Both children had radiographic features indicative of elevated intracranial pressure as well as neurological decompensation. The first patient was taken to the operating room, and the hematoma was evacuated through a small scalp incision. Initially, approximately 150 ml of blood was removed, and a Jackson-Pratt drain diverted another 200 ml of blood during the next 2 days. The infant made a good recovery. In the second case, the patient remained too unstable for operative intervention and died. CONCLUSION: Extracranial cerebral compression represents another way by which neonatal SGH may jeopardize the infant's life. Management consists of measures to correct hypovolemic shock and disseminated intravascular coagulation, as well as surgical intervention to control elevated intracranial pressure.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
5/16. Spiral fracture of the radius: an unusual case of shoulder dystocia-associated morbidity.BACKGROUND: The most common neonatal complications associated with shoulder dystocia include transient brachial plexus palsy, clavicular fracture, and humeral fracture. Fracture of the fetal radius has not been previously reported. CASE: We encountered a shoulder dystocia with the fetal head in the right occiput anterior position that necessitated the McRoberts maneuver, suprapubic pressure, the wood and Rubin maneuvers, and extraction of the posterior fetal arm to effect delivery. The 4610-g infant experienced a spiral fracture of the right (anterior) radius and a fracture of the left (posterior) midhumeral shaft. CONCLUSION: Neonatal radial fracture can result from shoulder dystocia or the maneuvers employed for the alleviation of the shoulder dystocia.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/16. Diabetes, hypertension and birth injuries: a complex interrelationship.Seemingly coincidental occurrence of various pathological conditions may derive from common etiologic denominators. While reviewing 240 malpractice claims involving shoulder dystocia related fetal injuries, we found two antenatal complications in the background conspicuously often. Chronic or pregnancy induced hypertension was identifiable in 80 instances (33%). pregnancy induced or preexisting diabetes was diagnosed 48 times (20%). Many of these patients were poorly controlled. The blood pressure was usually checked during the antenatal visits. However, about one-half of all patients received no diabetic screening. Therefore, this study may underestimate the actual incidence of diabetes. It has been calculated that the frequency of diabetes in pregnancy and that of hypertension, is about 5% in the united states. Thus, the rates of these complications in this selected group of gravidas was severalfold higher than in the general population. Since hypertension causes retarded fetal growth, it cannot be a direct cause of arrest of the shoulders at delivery. The likely common denominator is maternal diabetes a known predisposing factor both for preeclampsia and shoulder dystocia at birth. In the course of litigations for fetal injuries, demonstration of the predisposing role of seemingly unrelated shortcomings of the medical management may profoundly influence the outcome. This principle is demonstrated by the presentation of an actual malpractice action which resulted in a substantial settlement.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/16. Contralateral occipital depression related to obstetric forceps injury to the eye.Obstetric forceps pressure strong enough to leave a periorbital depression and corneal injury would probably be severe enough to leave an occipital depression from the opposite forceps blade. The presence of a depression at the correct occipital position would support the diagnosis of forceps injury when the birth history is unknown and the cornea has decompensated enough to make observation of the Descemet's membrane scrolls difficult. We studied six patients with known or suspected obstetric forceps injury to the cornea. Complete ocular examinations included examination for periorbital forceps depressions and posterior skull depressions 180 degrees from the affected cornea (which correlates with the opposite blade of the forceps). All of the patients with Descemet's scrolls had posterior skull depressions. This method of palpation for a contralateral skull depression may assist in the diagnosis of forceps-induced corneal decompensation.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/16. Constant negative pressure in the treatment of diaphragmatic paralysis secondary to birth injury.A newborn infant with right Erb palsy and diaphragmatic paralysis was treated with CNP for respiratory failure. There was clinical and arterial blood gas improvement. Several months after treatment, respiratory symptoms had disappeared, but fluoroscopy demonstrated persistence of diaphragmatic paralysis. A review of the literature is included. CNP may allow spontaneous recovery while permitting adequate nutrition.- - - - - - - - - - ranking = 4keywords = pressure (Clic here for more details about this article) |
9/16. Bilateral diaphragmatic paralysis in the newborn infant: treatment with nasal continous positive airway pressure.A newborn infant with severe respiratory distress from bilateral diaphragmatic paralysis caused by birth injury was successfully treated with nasal continuous positive airway pressure (CPAP). Improvement gradually occurred, and CPAP was discontinued after he was 23 days of age. This therapy has advantages over alternative methods.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
10/16. Congenital depression of the neonatal skull.Congenital depression of the neonatal skull has had an incidence of 0.1% (1/10 000) in our newborn population during the past 8 years. These skull depressions have two pathogenetic types: deformation without fracture and fracture accompanied by depression. The cause of skull depression being the pressure exerted by the digits and fist of the newborn on his skull has not been previously reported. The treatment of choice for selected cases is nonsurgical elevation with an obstetric vacuum extractor. A CT scan should be performed prior to this treatment to rule out intracranial complications such as hemorrhage.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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