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Neurologic examination of the infant and child
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Karthik Madhavan, George M. Ghobrial, Stephen S. Burks, Michael Y. Wang
Caput succedaneum and cephalhematoma are often noted during the first visit. Cephalohematoma is a traumatic subperiosteal hematoma that occurs underneath the skin, in the periosteum of the infant’s skull bone. Cephalohematoma does not pose any risk to the brain, as it is extracranial accumulation and is limited at the suture. Caput succedaneum is a neonatal condition involving a serosanguinous, subcutaneous, extraperiosteal fluid collection with poorly defined margins caused by the pressure of the presenting part of the scalp against the dilating cervix; it does not follow the suture lines.
Fetal and birth trauma
Published in Prem Puri, Newborn Surgery, 2017
Caput succedaneum is a diffuse edematous, occasionally hemorrhagic swelling of the scalp, superficial to the periosteum, occurring secondary to compression of the presenting part during prolonged labor. Usually, caput succedaneum requires no treatment, and the swelling disappears spontaneously in a week or so. Rarely, hemorrhage into soft tissue may cause anemia that requires blood transfusion or may lead to hyperbilirubinemia, or both.18
Birth Injuries, Neonatal
Published in Tony Hollingworth, Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
Caput succedaneum is a diffuse subcutaneous, extra-periosteal fluid collection with poorly defined margins. Unlike a cephalohaematoma, it can extend across the suture lines and the midline (Fig. 1). It can be caused by the pressure of the presenting part against the birth canal or by vacuum extraction. Caput succedaneum is occasionally haemorrhagic. The majority of cases do not cause any complications and will resolve within a few days after birth.
Agreement between digital vaginal examination and intrapartum ultrasound for labour monitoring
Published in Journal of Obstetrics and Gynaecology, 2022
Kaouther Dimassi, Aymen Hammami
Some observational studies have suggested that repeat ultrasound examinations to assess the change of head station over time (‘progression’) performs better than does DVE in documenting FHD and in demonstrating slow labour or lack of progress in both the first and second stages (level of evidence: 2+). Nonetheless, the sonographic measurement of HPD assimilates the descent of the foetal head to a linear movement and does not take into account the rotational movement of the head during its descent (Fouché et al. 2012). Consequently, the sonographic definition of the HPD cannot be analogous to the clinical assessment. Both methods have limitations during APL. The clinical evaluation is subjective with an error rate of 34% for a trained practitioner (Dupuis et al. 2005) and its subjectivity is further increased by the presence of caput succedaneum. On the other hand, sonographic HPD is associated with a high intra- and inter-observer variability (Eggebø et al. 2006) partly due to the fact that there is no clear landmark to place the transducer. The variability is further increased by the compression of the soft tissues, especially with high BMI (Fouché et al. 2012). In this study, in order to decrease these variabilities, we recommend placing the probe in the area located between the ‘fourchette’ and the anus in order to reduce the risk of soft tissue compression. The probe should be placed, as much as possible, horizontally and parallel to the plane of the examination table.
Red herring: Acute back pain after combined spinal epidural for labor analgesia
Published in Egyptian Journal of Anaesthesia, 2018
Yoong Chuan Tay, Kian Hian Tan
We present a 40-year old, 152 cm, gestational diabetic primigravid parturient with distressing acute back pain after delivery of a macrosomic baby at 37 + 6 weeks of pregnancy. She had previous history of left ovarian cystectomy 10 years ago with diet-controlled gestational diabetes during her current IVF pregnancy. Fetal growth scans at 21 and 31 weeks were normal but at 36 + 6 weeks showed polyhydramnios and fetal macrosomia (EFW 3.6 kg). Blood investigations were normal. Combined spinal epidural (CSE) analgesia was given to provide rapid onset of analgesia for her labor pain after use of Entonox. CSE insertion (18G Tuohy needle with 27G Whitacre spinal needle, 22G epidural catheter) was inserted uneventfully. Her labor lasted for 4 h with a second stage of 60 min. During delivery, her obstetrician required a Neville-Barnes forceps in a lithotomy position. A baby boy was delivered with caput succedaneum, forceps marks over cheeks. The epidural catheter was removed after delivery. She reported a severe hammer-like pain over her lower back the following morning, worsened by transition from supine to sitting and was unable to stand nor ambulate without assistance by two nurses precluding child care. Urinary incontinence accompanied intense pain episodes. There was no pain at rest. Her pain was noted over the L5 and S1 region on the right, however not radicular in nature. There were no overlying skin changes nor trigger points. An MRI to rule out an epidural hematoma was ordered, but declined by patient citing financial concerns, and upon a review by the Orthopaedics team, a lumbosacral spine X-ray was performed. Her analgesia included oral tramadol, Anarex (paracetamol and orphenadrine citrate) with ketoprofen patch to complement intramuscular pethidine. Physiotherapy was prescribed for mobilization exercises post-partum.