Clavicle is the bone most commonly fractured during labor and delivery. Although difficult delivery of the shoulder, or extended arms in breech deliveries increase the chances of a clavicle fractures, they can be present even with a history of a normal delivery.
Diagnosis: In addition to delivery history the following features may point towards the diagnosis:
-Decrease/assymetric movement of the limbs. (This may be evident by presence of an assymetric Moro's reflex)
-Palpable crepitus or bony irregularity early on
-A large callus forms quickly and is generally palpable by age 1 week.
Prognosis is excellent. Treatment, if any, is limited to immobilization of the arm and shoulder on the affected side (simply pinning the sleeve to the side of the infant's shirt does the trick). Figure of 8 bandages are no longer used.
Differential diagnosis: Congenital pseudoarthrosis of the clavicle
This condition presents as a palpable lump in the center of the clavicle that does not change or heal with any amount of time. Its cause is unknown. The condition is more common on the right side and generally does not lead to any functional impairment. Surgery is rarely indicated.
Showing posts with label ObsGyne. Show all posts
Showing posts with label ObsGyne. Show all posts
Caput succedaneum vs. Cephalhematoma
Caput succedaneum is a common and benign condition in which head compression against the cervix impedes venous return. It has the following characteristics
- Apparent usually at birth
- Crosses suture lines
- Reabsorbs within 1-3 days
Cephalhematoma (also spelled as cephalohematoma cephalhaematoma and cephalohaematoma) on the other hand is collection of blood below the periosteum. It has the following characteristics.
- Typically becomes apparent 1-2 days after birth
- It does not cross the suture lines (because it is under the periosteum).
- Takes 3-4 weeks or longer for it to be reabsorbed
- Can lead to jaundice from degradation of the extravasated blood
- Often associtated with birth trauma and a fracture in the newborn's skull bones (most commonly parietal bone)
- Apparent usually at birth
- Crosses suture lines
- Reabsorbs within 1-3 days
Cephalhematoma (also spelled as cephalohematoma cephalhaematoma and cephalohaematoma) on the other hand is collection of blood below the periosteum. It has the following characteristics.
- Typically becomes apparent 1-2 days after birth
- It does not cross the suture lines (because it is under the periosteum).
- Takes 3-4 weeks or longer for it to be reabsorbed
- Can lead to jaundice from degradation of the extravasated blood
- Often associtated with birth trauma and a fracture in the newborn's skull bones (most commonly parietal bone)
GBS (Group B Strep) infections
Group B Streptococcus (GBS, Streptococcus agalactiae) is a common gram positive coccus that colonizes the vaginal and gastrointestinal tracts in 20-40% of healthy women. About half of GBS positive mothers will pass on the bacteria to their newborns but only 1% of these newborns will have a clinical infection. Transmission and clincal GBS disease is more common in premature infants and in women who have prolonged rupture of the membranes.
Neonatal group B streptococcal disease classically presents either as early or late sepsis. Early sepsis typically presents within 24 hours of birth but by definition can be evident up to seventh day of life. With early sepsis bacteremia and pneumonia are classic findings. Late sepsis on the other had can present up to 3 months postpartum and classically has bacteremia and meningitis.
Prevention: Term women with GBS positive cultures are treated with ampicillin intrapartum. Penicillin allergic patients can be treated with clindamycin or erythromycin.
GBS infection is otherwise rare in healthy individuals but the following conditions may predispose to an infection: Diabetes mellitus, malignancy, old age with bedridden state, cirrhosis, steroids, AIDS, renal failure, peripheral vascular disease. Common manifestations in these scenarios are urinary tract infection, pneumonia, and soft-tissue infection.
Neonatal group B streptococcal disease classically presents either as early or late sepsis. Early sepsis typically presents within 24 hours of birth but by definition can be evident up to seventh day of life. With early sepsis bacteremia and pneumonia are classic findings. Late sepsis on the other had can present up to 3 months postpartum and classically has bacteremia and meningitis.
Prevention: Term women with GBS positive cultures are treated with ampicillin intrapartum. Penicillin allergic patients can be treated with clindamycin or erythromycin.
GBS infection is otherwise rare in healthy individuals but the following conditions may predispose to an infection: Diabetes mellitus, malignancy, old age with bedridden state, cirrhosis, steroids, AIDS, renal failure, peripheral vascular disease. Common manifestations in these scenarios are urinary tract infection, pneumonia, and soft-tissue infection.
Thyroid function in pregnancy
Due to increased TBG (thyroid binding globulin) total thyroid hormones may be higher in pregnancy but the free fraction is normal. TSH is normal.
Weight gain in Pregnancy
Average weight gain in pregnancy is 30 lbs. Two lb in the first trimester and about 14 each in second and third trimesters.
Prenatal screening
Commonest cause of raised MSAFP = mistaken dates.
Triple screen for antenatal diagnosis of Down's syndrome uses MSAFP, Unconjugated estriol (both are decreased in Down's) and Serum beta HCG (Increased in Down's).
All 3 are decreased in Trisomy 18.
Also remember
Chorionic villus sampling = earliest by 10-12 weeks gestation.
Amniocentesis = earliest by 14-16 weeks gestation.
Subscribe to:
Posts (Atom)