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McTiernan AM, Ruprai CK, Lindow SW. Assisted vaginal delivery in the obese patient. Best Pract Res Clin Obstet Gynaecol 2023; 91:102403. [PMID: 37683519 DOI: 10.1016/j.bpobgyn.2023.102403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/08/2023] [Accepted: 08/06/2023] [Indexed: 09/10/2023]
Abstract
Appropriate use of ventouse or obstetric forceps as options in the management of the second-stage of labor is good medical practice. The instruments are not inherently dangerous, however, the manner in which they are used may be. In addition to a working knowledge of the instruments, the operator must have the willingness to abandon an unsuccessful procedure. Awareness that failure of assisted vaginal delivery is more likely in women with BMI >30, hence, gives pause to consider trial in theatre with early recourse to cesarean delivery if unsuccessful Awareness that obesity is associated with increased risk of intrapartum complications, such as the need for second-stage assistance to achieve delivery, shoulder dystocia and postnatal complications, such as obstetric anal sphincter injury and febrile morbidity.
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Affiliation(s)
- Aoife M McTiernan
- Specialist Registrar in Obstetrics and Gynaecology, The Coombe Hospital, Dublin, Ireland.
| | - Chetan K Ruprai
- Consultant in Obstetrics and Gynaecology, Tawam Hospital, Al Ain, United Arab Emirates.
| | - Stephen W Lindow
- Director of Masters Projects, The Coombe Hospital, Cork Street, D 08 XW7X, Dublin, Ireland.
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Hodges H, Epstein KN, Retrouvey M, Wang SS, Richards AA, Lima D, Revels JW. Pitfalls in the interpretation of pediatric head CTs: what the emergency radiologist needs to know. Emerg Radiol 2022; 29:729-742. [PMID: 35394570 DOI: 10.1007/s10140-022-02042-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022]
Abstract
Pediatric radiology studies can be some of the most anxiety-inducing imaging examinations encountered in practice. This can be in part due to the wide range of normal anatomic appearances inherent to the pediatric population that create potential interpretive pitfalls for radiologists. The pediatric head is no exception; for instance, the inherent greater water content within the neonatal brain compared to older patients could easily be mistaken for cerebral edema, and anatomic variant calvarial sutures can be mistaken for skull fractures. This article reviews potential pitfalls emergency radiologists may encounter in practice when interpreting pediatric head CTs, including trauma, extra-axial fluid collections, intra-axial hemorrhage, and ventriculoperitoneal shunt complications.
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Affiliation(s)
- Hannah Hodges
- Department of Radiology, University of New Mexico, MSC 10 5530, 1, Albuquerque, NM, 87131, USA
| | - Katherine N Epstein
- Department of Radiology, University of New Mexico, MSC 10 5530, 1, Albuquerque, NM, 87131, USA
| | - Michele Retrouvey
- Department of Radiology, Eastern Virginia Medical School, Diagnostic Radiology, P.O. Box 1980, Norfolk, VA, 23501, USA
| | - Sherry S Wang
- Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East #1A71, Salt Lake City, UT, 84132, USA
| | - Allyson A Richards
- Department of Radiology, University of New Mexico, MSC 10 5530, 1, Albuquerque, NM, 87131, USA
| | - Dustin Lima
- Department of Radiology, University of New Mexico, MSC 10 5530, 1, Albuquerque, NM, 87131, USA
| | - Jonathan W Revels
- Department of Radiology, University of New Mexico, MSC 10 5530, 1, Albuquerque, NM, 87131, USA.
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Correlation of Neonatal Birth-Associated Greenstick Skull Fractures with Perinatal Factors and Long-Term Outcome: Children with a Greater Number of Greenstick Skull Fractures Showed Poor Results in Terms of Long-Term Neurodevelopment. World Neurosurg 2019; 126:e1197-e1205. [DOI: 10.1016/j.wneu.2019.03.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 11/23/2022]
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Cho SM, Kim HG, Yoon SH, Chang KH, Park MS, Park YH, Choi MS. Reappraisal of Neonatal Greenstick Skull Fractures Caused by Birth Injuries: Comparison of 3-Dimensional Reconstructed Computed Tomography and Simple Skull Radiographs. World Neurosurg 2018; 109:e305-e312. [DOI: 10.1016/j.wneu.2017.09.168] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/24/2017] [Accepted: 09/25/2017] [Indexed: 11/29/2022]
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Isaac CV, Cornelison JB, Castellani RJ, deJong JL. A Unique Type of Birth Trauma Mistaken for Abuse. J Forensic Sci 2017; 63:602-607. [PMID: 28605024 DOI: 10.1111/1556-4029.13557] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 04/20/2017] [Accepted: 04/21/2017] [Indexed: 11/30/2022]
Abstract
Pediatric abusive head trauma is a challenging subject across many disciplines. Of particular importance is the identification of mimics of abuse, so cause and manner of death can be properly assigned. We present the case of suspected child abuse involving an infant who presented unresponsive to the hospital with hypoglycemia, hypothermia, and bilateral parietal fractures. An autopsy revealed fractures associated with organizing scalp hemorrhage and gross leptomeningeal congestion and hemorrhage. The fractures were circular with external displacement, rounded margins, and subperiosteal new bone formation indicative of healing. Birth records revealed vacuum assist and cesarean section delivery. Although vacuum extraction-related injuries are typically cephalohematomas and/or linear fractures, the outbending and circular morphology of the fractures are consistent with vacuum extraction. Moreover, microscopic neuropathological examination revealed hemorrhagic purulent leptomeningitis. This unique case demonstrates the importance of considering birth trauma in the determination of cause and manner of death of an infant.
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Affiliation(s)
- Carolyn V Isaac
- Department of Pathology, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI
| | - Jered B Cornelison
- Department of Pathology, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI
| | - Rudolph J Castellani
- Department of Pathology, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI
| | - Joyce L deJong
- Department of Pathology, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI
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Brichtová E. Early neurosurgical treatment of cephalhaematomas-personal experience and review of the literature. Childs Nerv Syst 2009; 25:95-101. [PMID: 18958480 DOI: 10.1007/s00381-008-0722-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A group of 123 children suffering from cephalhaematoma were treated at the Clinic of Pediatric Surgery, Orthopaedics and Traumatology in Brno Faculty Hospital within 5 years. MATERIALS AND METHODS One hundred and nine patients were treated by aspirations and 14 patients underwent neurosurgery; it means that all patients were treated with determined surgical intervention. The surgery was indicated and performed very early, so that the calvaria bone under the ossified cephalhaematoma was intact and there was no need of cranioplasty. The results were excellent, as all patients were treated successfully and no infectious or other complications were observed in all cases. CONCLUSION Based on our results, we suggest a more radical therapeutic approach and to perform aspirations if the cephalhaematoma is diagnosed. If calcification develops, early neurosurgery is much easier, allows to achieve better cosmetic result and cranioplasty is not necessary. Early indicated and performed surgery treatment of cephalhaematomas can be considered as simple, safe and effective procedure, therefore a more radical therapeutic approach and early surgical treatment of cephalhaematomas should be recommended.
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Affiliation(s)
- Eva Brichtová
- Clinic of Pediatric Surgery, Orthopaedics and Traumatology, Brno Faculty Hospital, Brno, Czech Republic.
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Abstract
Birth injury of the scalp, skull and central nervous system (CNS) is a well-recognized complication of a difficult delivery. The rate of birth trauma has dropped precipitously and now accounts for less than 2% of neonatal deaths. Despite this dramatic decrease in birth-trauma mortality significant injuries still occur. A variety of risk factors clearly predispose certain infants to birth-related injury. Recent neuroradiology studies indicate that intracranial hemorrhage, even in asymptomatic infants, is not rare. Pathologists' (neuropathologists and forensic pathologists) appreciation of the spectrum of birth injuries and their sequelae is critical in order to be able to distinguish these from inflicted injuries and post-mortem changes.
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Affiliation(s)
- Ross Reichard
- Department of Pathology, University of New Mexico, Albuquerque, NM 87131-0001, USA.
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Abstract
While calcified cephalohematoma is eminently correctable, a clear description of indications for surgery and surgical techniques are currently lacking in the literature. In this paper we propose a simple classification and an algorithm for the management of cephalohematomas. Three patients were treated for large calcified parietal cephalohematomas. Craniectomy and cranioplasty were performed with excellent outcome. Cranioplasty was performed with the cap radial craniectomy technique in two patients and the flip-over bull's-eye technique in one patient. The literature was reviewed on this entity and an algorithm based on the timing of presentation, extent of calcification and type of calcified cephalohematoma is proposed. Aspiration and compressive dressings can be used for early, incompletely calcified cephalohematomas. Calcified cephalohematoma causing significant distortion of the calvarium requires surgical correction and is classified as Types 1 or 2 depending on the contour of the inner lamella. Type 1, with a normal contoured inner lamella, can be corrected by ostectomy of the outer lamella. Type 2 calcified cephalohematoma has a depressed inner lamella. Elevation of the inner lamella is necessary and the cap radial craniectomy technique can be used. We describe a novel technique, the flip-over bull's-eye techniques as an alternative technique for Type 2 lesions in selected patients. In conclusion, calcified cephalohematomas can safely be treated surgically with excellent outcome. It is hoped that this algorithm will serve as a useful and logical guide in decision making for the management of this condition.
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Affiliation(s)
- Chin-Ho Wong
- Department of Plastic and Reconstructive Surgery, KK Women's and Children's Hospital, Singapore.
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Abstract
Birth injuries are a significant cause of neonatal morbidity and mortality. Although often associated with traumatic delivery, birth injuries often occur in normal spontaneous deliveries in the absence of any risk factors. This article discusses the diagnosis and management of the most common birth injuries that are encountered by health care providers who care for newborns.
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Affiliation(s)
- Michael R Uhing
- Division of Neonatology, Medical College of Wisconsin, 8701 Watertown Plank Road, CHOB 213A, Milwaukee, WI 53226, USA.
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Abstract
Birth injuries are a significant cause of neonatal morbidity and mortality. Although they are frequently associated with traumatic delivery, birth injuries often occur in normal spontaneous deliveries in the absence of any risk factors. This article discusses the diagnosis and management of the most common birth injuries encountered by health care providers caring for newborns.
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Affiliation(s)
- Michael R Uhing
- Department of Pediatrics, Medical College of Wisconsin, Neonatal Intensive Care Unit, Children's Hospital of Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
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Abstract
The safety of cesarean section has improved dramatically over the past 50 years. During the past 20 years a greater awareness of and discussion about the symptomatic morbidity that can result for women following vaginal delivery has occurred and women's expectations for the outcome of pregnancy for them and their babies has increased. A culture of choice has been promoted in recent years, but contrary to the anticipated demand for less obstetric intervention by those promoting choice, there has been an increase in demand for delivery by cesarean section rather than the reverse. With the balance in favor of benefit for the baby from delivery by cesarean section, it is now difficult to sustain the argument favoring vaginal delivery rather than planned cesarean section, using maternal morbidity and mortality statistics. A critical evaluation of the costs indicates that there are probably few grounds for denying women their request for cesarean section for economic reasons. It seems likely, therefore, that in the near future those advising women on the options for delivery will need to ensure that the risks of vaginal delivery are explained as well as those for planned cesarean section.
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Affiliation(s)
- Joanne Morrison
- Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford, United Kingdom
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Affiliation(s)
- C M Choy
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin
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Treatment of Calcified Cephalohematoma. Neurosurgery 1993. [DOI: 10.1097/00006123-199306000-00029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kaufman HH, Hochberg J, Anderson RP, Schochet SS, Simmons GM. Treatment of calcified cephalohematoma. Neurosurgery 1993; 32:1037-9; discussion 1039-40. [PMID: 8327081 DOI: 10.1227/00006123-199306000-00029] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
This is a case report concerning the surgical treatment of a calcified cephalohematoma, which was possibly caused by an intrauterine fetal monitor. This is the first report of this particular entity as a complication of an intrauterine fetal monitor. As far as we can determine, there is no detailed information available about surgical decision making or surgical techniques for removing such lesions. We operated because of the size and persistence of the lesion. We developed a procedure in which we used the bony cap of the cephalohematoma for a cranioplasty, securing it with microplates.
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Affiliation(s)
- H H Kaufman
- Department of Neurosurgery, West Virginia University Medical School, Morgantown
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Abstract
The incidence of cephalhaematoma at the Mercy Maternity Hospital over a 10-year period was 2.5%; of the 1,030 infants 68.4% were born to primiparas, 65.6% were males, the majority (91.1%) were between 37 and 42 weeks' gestation and 3,000 and 4,000 g birth-weight (71.6%). Forceps delivery and vacuum extraction were associated with increased incidences of cephalhaematoma (5.1% and 22.9% respectively), and the incidence was slightly increased (3.8%) when a scalp electrode had been applied. Hyperbilirubinaemia was more prevalent (12.9%) in infants with a cephalhaematoma as was exchange transfusion (0.8%) and the need for phototherapy (4.9%).
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Affiliation(s)
- K E Thacker
- Mercy Maternity Hospital, East Melbourne, Victoria
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Rosman NP, Herskowitz J, Carter AP, O'Connor JF. Acute head trauma in infancy and childhood. Clinical and radiologic aspects. Pediatr Clin North Am 1979; 26:707-36. [PMID: 537846 DOI: 10.1016/s0031-3955(16)33779-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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