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Management of pregnancy with one or more early neonatal deaths
Published in Minakshi Rohilla, Recurrent Pregnancy Loss and Adverse Natal Outcomes, 2020
Common birth defects that lead to early neonatal death include heart anomalies (hypoplastic left heart syndrome, transposition of great vessels, critical pulmonary stenosis, interrupted aortic arch, myocardial infarction), genetic disorders, and neural tube defects. Other causes include disorders of metabolism (urea cycle defect, congenital lactic acidemia), hypovolemia (subgaleal hemorrhage, placenta previa, and placental abruption), and airway abnormalities (prolapsed epiglottis with laryngomalacia) [15].
Water-Related Deaths by Manner
Published in Kevin L. Erskine, Erica J. Armstrong, Water-Related Death Investigation, 2021
The investigative and autopsy findings in the above case support a cause of death consistent with asphyxia by drowning, but what is the manner of death? A number of significant factors are apparent in this case, making more than one manner of death a possibility. Collapse with drowning from alcoholic seizures due to alcohol withdrawal could constitute an accidental death and is supported by the finding of chronic liver disease, tongue contusion, subgaleal hemorrhage, and lack of ethanol on toxicological analysis. A suicidal death by drowning is not unfathomable due to this man’s history of a number of significant life stressors and empty medication bottles found at the scene. However, the overall scene, with the position of his feet and lower legs against the shower curtain and resting on the edge of the bathtub, suggests a sudden collapse, perhaps while getting ready to bathe, which in this man could have been precipitated by a medical- or medication-induced event (cardiac arrhythmia vs. adverse effects of prescription medication, including withdrawal effects) that, combined with drowning, constitutes an accidental death. The prescription medication zolpidem provides sedation and facilitates sleep but has a risk for the development of tolerance and dependence, and its use must be monitored by a physician. Adverse effects with chronic high-dose usage and subsequent withdrawal may cause joint and muscle pain, hallucinations, mood disturbances, agitation, and suicidal ideation, and induce grand mal seizures.33–36 Homicidal violence must also be ruled out in this case, starting with an additional investigation regarding the existence of a mysterious woman visitor, although it is interesting and provocative that one of the side effects of zolpidem is hallucinations. Cases such as the above require an informed analysis, and the lack or unavailability of information, equivocal results, or uninterpretable findings may require a ruling of the manner of death as undetermined.
Raccoon eyes in a newborn
Published in Fetal and Pediatric Pathology, 2022
Subgaleal hematoma develops due to birth trauma, when blood accumulates in the loose areolar tissue in the space between the periosteum and the aponeurosis. The subaponeurotic space extends anteriorly to the orbital margins and posteriorly to the nuchal ridge [2]. Neonates with subgaleal hemorrhage are at high risk for rapid decompensation with hypovolemic shock, including tachycardia, hypotension and acidosis. When subgaleal hemorrhage is not associated with hemodynamic instability, outcomes are usually very good [3]. Raccoon eyes are believed to be a common complication of basal skull fractures [4] or, in cases without a history of trauma, they are associated with systemic conditions such as neuroblastoma [5]. In this case, as the cerebral ultrasound, hematologic and coagulation studies were normal, these serious situations were excluded. At the follow-up on the DOL 38 the baby was thriving and raccoon eyes were no longer present. The correct interpretation of all related conditions avoided more unnecessary extensive evaluations and parental anxiety.
Hairpulling causing vision loss: a case report
Published in Orbit, 2019
Sidharth Puri, Sarah Madison Duff, Brett Mueller, Mark Prendes, Jeremy Clark
In approaching patients with suspicion of SGH with proptosis and possible subperiosteal extension, it is important to conduct a thorough ophthalmologic exam (e.g. ascertain a baseline VA, intraocular pressure, afferent pupillary defect, any ophthalmoplegia, and optic nerve findings). Coordination with emergency room physicians is necessary so that proper precautions are provided to patients about possible ophthalmologic complications of subgaleal hemorrhage. Acute intervention for resulting orbital compartment syndrome may be necessary with canthotomy/cantholysis or urgent surgical drainage.4,6 Delay in these steps may result in vision loss due to compressive optic neuropathy. These patients should be followed closely to ensure that reaccumulation in the subperiosteal space does not occur and that control of hemorrhage from the subgaleal source has been maintained.4,6
Comparison of ‘push method’ with ‘Patwardhan’s method’ on maternal and perinatal outcomes in women undergoing caesarean section in second stage
Published in Journal of Obstetrics and Gynaecology, 2019
Anish Keepanasseril, Nafeez Shaik, NS Kubera, B Adhisivam, Dilip K Maurya
The neonatal outcomes according to the method of delivery of the foetal head are shown in Table 3. There were five (1.7%) intrapartum still births and six (2.0%) neonatal deaths. The neonatal deaths were secondary to the sepsis (three cases), Hypoxic ischemic encephalopathy (HIE) (two cases) and Meconium Aspiration syndrome (one case). Its occurrence was similar in both of the groups (3 [1.4%] vs. 3 [4.0%], p = .166). Neonatal morbidity was observed in 34 (11.44%) of the live born babies, as shown in Table 2. Birth injuries included a subgaleal haemorrhage (2 in Group A vs. 1 in Group B), laceration over the forehead/scalp (6 in Group A vs. 1 case in Group B), and fracture of a rib and humerus (1 case each, both in Group B).