The incidence of skull fractures underlying cephalhematomas in newborn infants

Assisted vaginal delivery in the obese patient

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.

Pitfalls in the interpretation of pediatric head CTs: what the emergency radiologist needs to know

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.

A Unique Type of Birth Trauma Mistaken for Abuse

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.

Early neurosurgical treatment of cephalhaematomas-personal experience and review of the literature

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.

Birth injury of the cranium and central nervous system

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.

Calcified Cephalohematoma

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.

Management of birth injuries

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.

Management of birth injuries

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.

Cesarean section on demand

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.

Treatment of calcified cephalohematoma

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.

Cephalhaematoma: a 10-year review

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%).