Anatomical and surgical considerations and outcomes in infantile Terson syndrome

Purpose: To study the presentation and outcomes of infantile Terson syndrome (TS). Methods: This was a retrospective analysis of 18 eyes of nine infants diagnosed to have TS?related intraocular hemorrhage (IOH). Results: Nine infants (seven males) were diagnosed to have IOH secondary to TS, of which eight infants had imaging features suggestive of intracranial bleed meeting our definite criteria. Median age at presentation was 5 months. In 11 eyes of six infants with suspected birth trauma, the median age of presentation was 4.5 months (range 1–5 months) of which one baby had a history of suction cup?aided delivery and four babies had a history of seizures. Vitreous hemorrhage (VH) was noted in 15 eyes (extensive in 11 eyes). Ten of these eyes showed membranous vitreous echoes, or triangular hyperechoic space with apex at the optic nerve head (ONH) posteriorly and base at the posterior lens capsule anteriorly, with or without dot echoes in the rest of the vitreous cavity, with a configuration of “tornado?like hemorrhage” suggestive of Cloquet’s canal hemorrhage (CCH). Eight eyes underwent lens?sparing vitrectomy (LSV) and one eye underwent lensectomy with vitrectomy (LV). On follow?up, disc pallor and retinal atrophy were noted in 11 and 10 eyes, respectively. The mean follow?up was 62 months (1.5 month–16 years). Visual acuity/behavior improved in all cases at the final follow?up. Developmental delay was noted in four children. Conclusion: Unexplained and altered vitreous hemorrhage with typical ultrasonography (USG) features should raise the suspicion of CCH in TS. Despite early intervention to clear visual axis, anatomical and visual behavior may remain subnormal.

Cesarean effects on adolescents' birth experiences: counterfactual analysis

Abstract Introduction The birth experience of adolescents is understudied even though they are a particularly vulnerable population to experience a negative birth event, given that they exhibit many known risk factors. Objective To ascertain whether a cesarean birth mediates the impact of infant complications on the birth experience of adolescent mothers. Methods Using a secondary analysis of data collected from 303 postpartum adolescents previously evaluated for depression and post-traumatic stress, we employed counterfactual causal analysis to determine if delivery type mediated the birth experience at different levels of depression. Noted limitations pertain to methodological assumptions and computational feasibility as well as potential sample bias. Results We found that the mediating effect of delivery mode depended on the adolescent's depression level as well as on the specific operationalization of the birth experience. At low levels of depression, the odds of a negative birth appraisal were reduced by around 30% when operationalized as a single item subjective rating. In contrast, at high levels of depression, the odds of a negative birth experience increased by 80% when operationalized as an Impact of Event Scale (IES) subconstruct. Conclusion Depression level plays a pivotal role in moderating how delivery mode mediates the birth experience. The direction of impact also depends on how the birth experience is operationalized.

Maternal and neonatal complications in macrosomic pregnancies

 Background: Fetal macrosomia is a common problem in obstetrics which leads to morbidity and mortality to both mothers as well as to the new-born due to complications of fetal macrosomia like prolonged labour, operative delivery, postpartum haemorrhage, perineal trauma, shoulder dystocia, birth trauma, perinatal asphyxia and perinatal mortality. This prospective study was conducted on fetal macrosomia to help future identification of such pregnancies, anticipate complications and to plan proper management.Methods: Maternal, fetal and neonatal consequences of macrosomia with specific attention to etiology of macrosomia in 170 pregnant women having gestational age of 37 weeks or more and high risk of fetal macrosomia were studied. Clinical estimation of fetal body weight was done using Leopold’s maneuvers and patient then referred for ultrasonography.  Data was collected about mode of delivery, nature and severity of birth trauma.Results: It was found that maternal age (51.76%), multiparity (61.76%), maternal diabetes (20.59 %) was significantly associated with macrosomia. Total caesarean rate in macrosomia was 26.4%. We got only 8 cases of birth trauma out of 170 macrosomic births.Conclusions: Pregnancies complicated by fetal macrosomia can be best managed by giving a trial of labour for babies with fetal weight below 5000 gram. Post gestation, multiparity found to be main risk factor for macrosomia.

Cesarean section of breech presentation-the prevention of newborn fracture / 中国实用妇科与产科杂志

The breech presentation is a common occurrence in the obstetrical practice,accounting for about 3-5% of singleton fetuses at delivery.The Term Breech Trial demonstrated the planned cesarean section to be associated with a significant reduction in perinatal mortality and short term morbidity.Although the safety of cesarean section is widely reported,there is still a certain proportion of neonatal injuries,especially fracture.This paper focuses on the neonatal birth injury by cesarean section of breech presentation and the corresponding preventive measures and treatment,in order to reduce the newborn injury as much as possible.

Do feto ao bebê: Winnicott e as primeiras relações materno-infantis / From fetus to baby: Winnicott and the first parent-infant relationship / De un feto al bebé: Winnicott y las primeras relaciones materno infantiles

Quando a psicanálise passou a se interessar pelos primórdios da vida psíquica do bebê, esse interesse se concentrava na relação mãe-bebê a partir do advento da natalidade. A partir da teoria das relações objetais, notabilizada pela Escola Inglesa de Psicanálise, alguns autores passaram a repensar o bebê a partir da vida pré e pós-natal e como essas experiências influenciam seu psiquismo. Nesse sentido, o presente artigo busca analisar as primeiras relações materno-infantis a partir das três proposições teóricas: o trauma do nascimento, a observação de bebês em útero com o advento da ultrassonografia e o método de observação de bebês na prevenção de traumas psíquicos. Essas teorias são analisadas através do referencial teórico de Donald W. Winnicott, a partir da teoria do desenvolvimento emocional primitivo e do conceito de memória corporal, os quais enfatizam as experiências intrauterinas sentidas pelo feto e o contato do bebê com a mãe em termos da fisicalidade dos corpos vivos, após seu nascimento. O autor conclui que as primeiras relações materno-infantis, pré e pós-natais, constituem em si mesmas a via de acesso à saúde psíquica do indivíduo adulto.

When psychoanalysis became interested in the origins of psychic life of the baby, this interest focused on the mother-child relationship and the baby birth. Some authors from the British School of Psychoanalysis started to reconsider the baby from the pre and postnatal life and how these experiences influence his psyche through the object relations theory. Thus, this paper aims analyzes the first mother-child relationship from the three theoretical propositions: the birth trauma, the observation of babies in the womb, with the advent of ultrasound and the baby observation method in preventing psychological traumas. These theories are analyzed through Donald W. Winnicott theories, named: the theory of emotional development and the concept of body memory which emphasizes intrauterine experiences felt by the fetus and the baby contact with the mother in terms of physicality of alive bodies after his birth. The author concludes that the first mother-child relations, pre and postnatal, is in itself, a way of access to mental health of the adult.

Cuando el psicoanálisis se interesó en los orígenes de la vida psíquica del bebé, este interés se centró en la relación madre-bebé desde la natalidad. A partir de la teoría de las relaciones de objeto, notada por la Sociedad Psicoanalítica Británica, algunos autores comenzaron a reconsiderar la vida del bebé pre y postnatal y cómo estas experiencias influyen en su psique. En este sentido, este trabajo analiza las primeras relaciones madre-bebé en tres proposiciones teóricas: el trauma del nacimiento, la observación de bebés en el útero con el advenimiento de la ecografía y el método de observación de bebés en la prevención de traumas psicológicos. Estas teorías son analizadas a través de referencia teórica de Donald W. Winnicott, de la teoría del desarrollo emocional y el concepto de memoria del cuerpo que hace hincapié en las experiencias intrauterinas sentidas por el feto y el contacto del bebé con su madre en cuanto a la físicalidad de cuerpos vivos después de que su nacimiento. El autor concluye que las primeras relaciones madre-bebé, pre y postnatal, es en sí misma, una forma de acceso a la salud mental del adulto.

A case of occult fronto temporo parietal meningoencephalocele in an infant.

We describe a case of an occult fronto temporo parietal meningoencephalocele discovered in a 45 days old infant baby. The most common cause for meningoenphalocele is trauma by any means during birth or during development. But here in our case there is lack of such significant history of trauma and so the possible cause of the lesion may be congenital defect only. Preoperative Clinical, CT and MR images are presented. Lesion was removed surgically with satisfactory post operative recovery.

A cross-sectional study of non-diabetic macrosomic infants.

Objective: To determine risk factors and short term outcomes in infants with fetal macrosomia independent of gestational diabetes. Method: Patient records of babies born in Bolu Izzet Baysal Obstetrics-Gynaecology and Paediatrics Hospital between 1st January 2007 and 31st December 2010 with weights of 4000g or more were assessed retrospectively. Data were analysed using SPSS version 17.0. Babies born outside hospital and infants of diabetic mothers were excluded. Control group comprised 500 healthy infants weighing 2500-3999g, born during the same period. Chi-square test, student-t test, Mann-Whitney test and multiple regression analysis were the statistical tests used. Results: Of 10,898 babies delivered in our hospital during the 4 year study period, 509 (4.7%) weighed 4000g or more. Significantly more non-diabetic macrosomic babies were male compared to controls (p<0.001). Significantly more non-diabetic pregnant women older than 35 years delivered macrosomic infants compared to non-diabetic pregnant women 35 years or less (p<0.001). Significantly more non-diabetic pregnant women who delivered macrosomic infants were multipara compared to controls (p<0.001). No significant statistical differences were detected in mode of delivery between cases and controls (p>0.05). The 5th minute Apgar scores in the non-diabetic macrosomic group was significantly lower than in controls (p<0.001). Non-diabetic macrosomic babies had significantly more birth injuries than controls (p=0.009). Risk of developing hypoglycaemia and hypocalcaemia were significantly higher in non-diabetic macrosomic babies compared to controls (p<0.05). Conclusion: In our study the risk factors for non-diabetic fetal macrosomia were advanced age pregnancy, multiparity and male sex.

Otto Rank y la controversia sobre el trauma del nacimiento / Otto Rank and the controversy on birth trauma

Al analizar los efectos psíquicos del nacimiento, Rank concluyó que la separación del vientre materno debía ser considerada como un evento traumático, a partir del cual podría explicarse, no sólo la neurosis, sino la humanización en general. Lo que parecía ser una nueva contribución a la causa psicoanalítica, sería, finalmente, un desafió a los supuestos freudianos que definían el complejo de Edipo, la función paterna, la castración y la represión, como los fundamentos de la teoría y la práctica del Psicoanálisis. El presente trabajo buscará ilustrar los debates generados por la difusión de las tesis de Rank entre los miembros del Comité, para concluir que las hipótesis sobre el trauma del nacimiento provocaron una verdadera controversia en la historia del movimiento psicoanalítico y, a su vez, marcaron la ruptura definitiva de Rank con Freud y los miembros del Comité.

In the analysis of the psychic effects of birth, Rank concluded that the separation of the womb should be considered a traumatic event, from which, not only neurosis, but also humanization in general, could be explained. What appeared to be a new contribution to the psychoanalytic cause would finally be a challenge to Freudian assumptions that defined the Oedipus complex, the father's function, castration and re pression, as the foundations of psychoanalytical theory and practice. The current work will seek to illustrate the discussions generated by the dissemination of Rank's thesis among the members of the Committee and will conclude that the hypothesis about the trauma of birth led to a genuine controversy in the history of the psychoanalytic movement and, in turn, will define Rank's final break with Freud and the members of the Committee.

Sequelae of surgical options in the older brachial plexus birth palsy pronation deformity / 中华显微外科杂志

ObjectiveTo evaluate the radial rotation osteotomy and ulnadouble rotation osteotomy obstetric brachial plexus injury (obstetric brachial plexus palsy) forearm pronation deformity sequelae value.MethodsFrom August 2007 to August 2011, twenty cases of obstetric brachial plexus palsy sequelae in children with forearm pronation deformity, the implementation of a simple radial rotating radial osteotomy (5cases),double-rotation radius and ulna osteotomy (15 cases) and two surgical type,and by 6 to 54 months after surgery (mean 25 months) follow-up.The groupfunctions to forearm pronation angle and conscious function improvement as the evaluation criteria. ResultsThe 15 cases of radius and ulna osteotomy in children with dual function and appearance in 14 cases significandy improved,one case of supination deformity;five underwent simple radial pronation osteotomy,three patients had improved function and appearance,followed up for 6 months, eight months after the merger which radial head dislocation in 2 cases due to poor efficacy of dual-line radius and ulna osteotomy, twenty patients in this group did not appear nonunion.ConclusionSimple radial rotation osteotomy surgery in obstetric brachial plexus palsy forearm pronation deformity complications without radial head dislocation has some value, radius and ulna double osteotomy in forearm pronation deformity with radial head dislocation aftermath of the effect is more excellent.

Occipital Osteodiastasis.

Occipital osteodiastasis (OOD) is a prominent traumatic lesion in neonates born by breech, during delivery of after coming head. The lesion consists of traumatic separation of the cartilaginous joint between the squamous and lateral portion of the occipital bone resulting in a posterior fossa subdural haemorrhage associated with laceration of the cerebellum. We report a term female baby with OOD born by breeach extraction with X-ray skull showing separation of squamous and lateral portion of occipital bone and NCCT brain revealing large extra axial bleed in the right temporo-parieto-occiptal region.

Factores de riesgo asociados a traumatismo al nacimiento / Risk factors for birth injuries

Objective. To identify risk factors associated with birth trauma. Setting. Servicio de Neonatología, Hospital General "Dr. Manuel Gea González", Secretaría de Salud. Design. Case-control, prolective study. Patients. There were 129 cases and 134 controls. Measures. We recorded the following variables: a) maternal and delivery: age, weight, height, prenatal care, pre-existing disease or gestational disease, mode of delivery, anesthetic management during labor, use of external maneuvers or forceps; b) newborn: birth weight, gestational age, academic degree of attendant physician at delivery, and type of birth injury. Results. The independent risk factors associated to birth injury were: for ecchymoses; general anesthesia (OR 13.7, 95% CI - 3 - 62.6), breech presentation (OR 6.4, 95% IC 95% = 1.4 - 27.9) and gestational age < 32 weeks (OR 6.4, 95% CI = 1.3 - 31.1); for lacerations, vaginal dystocic delivery or cesarean section (OR 19, 95% CI = 4.4 - 81.1) and use of external maneuvers (OR 5.6, 95% CI = 1.5 - 21.6); for cephalhematoma maternal height < 1.54 m (OR 7.4, 95% CI = 2.3 - 23.7) and external maneuvers (OR 7.2, 95% CI = 2.3 - 23.7); for caput succedaneum, external maneuvers (OR 3.4, 95% CI = 1.5-7.7) and maternal age < 19 or > 36 years (OR 3.0, 95% CI = 1.4 - 6.4). Conclusions. Risk factors associated with birth injuries identified in this study involved maternal conditions, neonatal conditions and mechanism of delivery.

Objetivo. Identificar los factores de riesgo asociados a lesiones originadas durante el nacimiento en recién nacidos. Lugar. Servicio de Neonatología, Hospital General "Dr. Manuel Gea González", SS. Diseño. Casos y controles, prolectivo. Pacientes. 129 casos y 134 controles. Mediciones. Las variables estudiadas fueron, a) maternas y del parto: edad, peso, talla, control prenatal, enfermedad previa o durante el embarazo, características del trabajo de parto, tipo de anestesia, aplicación de maniobras externas, uso de fórceps; b) en el recién nacido: peso al nacer, edad gestacional, grado académico del médico que atendió el nacimiento y tipo de lesión. Resultados. Los factores que se asociaron en forma independiente a la presentación de traumatismo al nacimiento fueron para equimosis: anestesia general (RM 13.7, IC 95% = 3 - 62.6), presentación pélvica (RM 6.4, IC 95% = 1.4 - 27.9 y edad gestacional < 32 semanas (RM 6.4, IC 95% =1.3 - 31.1); para laceración, nacimiento vaginal distócico o cesárea (RM 19, IC 95% = 4.4 - 81.1), y maniobras externas (RM 5.6, IC 95% = 1.5 - 21.6); para cefalohematoma talla materna < 1.54 m (RM 7.4, IC 95% = 2.3 - 23.7) y maniobras externas (RM 7.2, IC 95% = 2.2 - 23.7); para caput succedaneum maniobras externas (RM 3.4, IC 95% = 1.5 - 7.7) y edad materna < 19 o > 36 años (RM 3.0, IC 95% = 1.4 - 6.4). Conclusiones. Los factores de riesgo asociados a lesiones durante el nacimiento identificados en este estudio involucran tanto características maternas como del recién nacido y de la atención del parto.

Clavicle Fracture in Newborn

PURPOSE: The purpose of this study is to identify the incidence of clavicle fracture in birth trauma associated with delivery, fetal presentation, birth weight and to identify the difference of the prognosis of clavicle fracture when immobilization was performed or not. MATERIALS AND METHODS: Among the 12,738 live births from March 1996 to December 2000, we reveiwed retrospectively the medical records and radiographs of 39 cases of clavicle fracture which were followed for more than 6 months. Statistical analysis was measured P-value. Except 11 cases that diagnosis was delayed, 27 cases were treated with figure of 8-bandage, and 1 case, which was combined with humerus fracture, was treated with long arm cast. RESULTS: Among 39 cases infants of clavicle fracture, 36 cases (0.57%) were delivered through vaginal delivery, 3 cases (0.04%) through ceasarean section. Fetal presentations were cephalic presentation in 29 cases, shoulder dystocia in 8 cases, breech presentation in 2 cases. The mean birth weight was 3.8 kg, the high prevalence (8.5%) was identified on large birth weight infants more than 4 kg (p<0.05). The fracture site was proximal portion in 12 cases, middle portion in 27 cases and right clavicle in 24 cases, left clavicle in 13 cases and both clavicle in 1 case. The combined injuries were the brachial plexus palsy (2 cases), skull fracture (1 case) and cephalhematoma (1 case). Finally all cases of clavicle fracture were shown radiographically bony union within 3 weeks. CONCLUSION: The newborn clavicle fractures were remarkably low incidence in cesarean section delivery and were easily neglected, and were detected accidentally on simple chest X-ray that was performed for upper respiratory infection. As a conclusion, it is necessary of screening test through careful physical examination and X-ray interpretation.

Birth Trauma / 대한정형외과학회잡지

Birth injury is defined as any condition that affects the fetus adversely during the labor or delivery. These traumatic injuries are subdivided further into those that from hypoxia and mechanical factors. We analyzed 57 patients of birth trauma including fractures, nerve injuries and head injuries during the delivery at Severance Hospital from Jan. 1980. to Dec. 1985 and 24 patients which were transfered from other hospital after delivery and the following results were obtained. 1. The rates of birth trauma in our hospital were 0.36% including clavicle fractures 0.27%,femoral fractures 0.006%, brachial plexus injuries 0.031%, skull fractures 0.025% and intracranial hemorrhage 0.025%. 2. The site of clavicle fractures were all middle one third, and 71.4% of cases were displaced. 3. Five cases of brachial plexus injuries were found, and each type was Erb's palsy 3 cases, Klumpke's palsy 1 case and whole arm palsy 1 case. Three cases were recovered completely and 2 cases were recovered partially. 4. Methods of delivery were as followed; normal delivery 50.6%, breech delivery 3.7%, forcep 7.5%, vacuum 21.0%, and Cesarian section 17.2%. 5. The primipara was 65.4% of the patients of birth trauma. 6. There was no statistical significances in the birth weight, head circumferences, and chest circumferences of the patients comparing to the normal infants.

Post-Traumatic Arachnoid Cyst by Delivery Forceps

The first report of growing skull fractures of children was in 1861 by John How ship who noted partial absorption of the right parietal bone, arising from a blow on the head in a child aged 9 months. The cases of cranial defects that develope from fractures of the skull in childhood are not common but post-traumatic arachnoid cyst by delivery forceps had rarely reported in world literature. Consequently the author had a case of post-traumatic arachnoid cyst by delivery forceps with its common features and evaluated on various aspects of this syndrome. This case had been treated by surgery with removal of cyst, cranioplasty and V-P shunt.