Hematoma de la vaina de los rectos en un recién nacido macrosómico después de un parto distócico: A propósito de un caso / Rectus sheath hematoma in a macrosomie neonate following difficult delivery: Case report

La macrosomía es un factor de riesgo de traumatismos obstétricos y se asocia con morbimortalidad neonatal. El cefalohematoma y la fractura clavicular son los más frecuentes. Los traumatismos intrabdominales son poco frecuentes. El hematoma de la vaina de los rectos es una acumulación de sangre en la vaina del músculo recto mayor del abdomen. Se asocia con traumatismos, cirugías y tratamiento anticoagulante, en especial en los adultos y las personas de edad avanzada. En este artículo presentamos el caso de un recién nacido de sexo masculino con parto vaginal distócico. Durante el examen físico se observó un hematoma periumbilical de 1 x 1 cm y un cefalohematoma parietal de 1 x 1 cm. En la ecografía abdominal y la tomografía computada del abdomen se observó un hematoma de la vaina del recto derecho de 7 x 4 x 2 cm.

Macrosomia is a risk factor for birth injuries and is associated with neonatal morbidity and mortality. Cephalohematoma and clavicular fracture are the most frequent birth injuries. Intraabdominal injuries are uncommon birth injuries. Rectus sheath hematoma (RSH) is an accumulation of blood in the sheath of rectus abdominis muscle. It is associated with trauma, operations and anticoagulant therapy, especially in adults and elders. We present a macrosomic male neonate with difficult vaginal delivery, who had in the physical examination periumblical ecchymose of 1x1 cm and a parietal cephalohametoma of 1x1 cm. The abdominal ultrasonogram and the computed tomography scan of the abdomen showed a 7x4x2 cm right rectus sheath hematoma.

Factores asociados al trauma obstétrico en recién nacidos, atendidos en el Hospital Nacional Dos de Mayo durante el período de Enero a Diciembre del 2012 / Factors associated with obstetric trauma in newborn, treated at the National Hospital Dos de Mayo during the period January to December 2012

OBJETIVOS: Determinar los factores asociados al trauma obstétrico en recién nacidos atendidos en el Hospital Nacional Dos de Mayo durante el período de Enero a Diciembre del 2012. METODOLOGIA: Estudio Observacional, de tipo analítico, prospectivo, transversal. Se estudió un total de 151 recién nacidos con trauma obstétrico (que representaron el grupo de estudio) y 199 recién nacidos sin trauma obstétrico (que representaron el grupo comparativo) que se atendieron en los servicios de pediatría que acuden al Hospital Nacional Dos entre Enero a Diciembre 2012. Se estimaron las frecuencias absolutas y relativas y medidas de tendencia central y de dispersión. Se utilizó la prueba Chi cuadrado y t-Student, toda interpretación estadística se realizó con un nivel de significancia del 95 por ciento. RESULTADOS: con respecto al perfil sociodemográfico de las gestantes, la edad promedio es de 24.2±6 años, siendo en la mayoría de 19-35 años (80.3 por ciento). El 72 por ciento de las participantes son convivientes y el 79.1 por ciento tienen un nivel educativo secundario. El 71.5 por ciento de las pacientes del grupo de estudio fueron "Nulíparas" comparado con el 47.7 por ciento de las pacientes del grupo comparativo, hallándose frecuencias relativas estadísticamente significativas (p<0.001). El 30.5 por ciento de las pacientes del primer grupo y el 36.7 por ciento de las pacientes del segundo grupo fueron consideradas con "Sobrepeso", encontrándose diferencias significativas (p=0.005), la duración del parto fue "Adecuado" en el grupo de estudio y el grupo comparativo (78.8 por ciento y el 97 por ciento respectivamente), siendo las frecuencias relativas estadísticamente diferentes (p<0.001). En el 8.6 por ciento del grupo de estudio se realizaron maniobras externas a diferencia del grupo comparativo, que sólo se realizaron maniobras externas en el 0.5 por ciento, por lo existe diferencia significativa en ambos grupos (p=<0.001). El sexo masculino fue predominante en el...

OBJECTIVE: To determine the factors associated with obstetric trauma in newborns treated at the National Hospital Dos de Mayo during the period of January to December 2012. METHODOLOGY: Observational study of type prospective analytical. We worked with a total of 151 infants with obstetric trauma (representing the study group) and 199 infants without obstetric trauma (representing the comparison group) that were treated at pediatric services attending at the National Hospital Dos de Mayo during the period of January to December 2012. We estimated absolute and relative frequencies and measures of central tendency and dispersion. We used the chi-square test and t-Student all statistical interpretation was performed with a significance level of 95 per cent. RESULTS: The demographic profile of pregnant women is average age 24.2±6 years, the majority being 19-35 years (80.3 per cent). The 72 per cent of participants are cohabiting and 79.1 per cent have a high school level. The 71.5 per cent of patients in the study were "Nulliparous" compared with 47.7 per cent of patients in the comparison group, being statistically significant the relative frequencies (p<0.001). The 30.5 per cent of patients in the first group and 36.7 per cent of patients in the second group were considered to "Overweight", finding significant differences (p=0.005), the duration of labor was "adequate" in the study group and the comparison group (78.8 per cent and 97 per cent respectively), the relative frequencies were statistically different (p<0.001). In 8.6 per cent of the study group were performed external maneuvers unlike the comparison group, only external maneuvers were performed at 0.5 per cent, so there is significant difference in both groups (p=<0.001). Males were predominant in the study group at 57.6 per cent compared to 46.2 per cent of infants in the comparison group were statistically significant both relative frequencies (p=0.035). The Apgar score in the 1st minute less than...

Bilateral clavicle fracture in two newborn infants

The fracture of clacicle is the most frequently observed bone fracture as birth trauma and it is usually unilateral. It is seen following shoulder dystocia deliveries or breech [presentation of macrosomic newborns. We report two macrosomic newborns with bilateral clavicle fracture and brachial plexus palsy due to birth trauma. Chest X-rays confirmed bilateral fracture of clavicles. Both patients were recovered without any sequel. Bilateral clavicular fracture should be considered in any neonate with bilateral absent iMoro reflexes

Mecanismos patogénicos de la parálisis braquial congénita: [revisión] / Pathogenic mechanisms of congenital brachial palsy: [review]

Antecedentes: Se define clásicamente a la parálisis braquial congénita como la paresia flácida de una extremidad superior secundaria al estiramiento traumático del plexo braquial durante el parto, en la extracción del hombro anterior, en relación a la distocia de hombro. Numerosas series han reportado la falta de relación entre la parálisis braquial congénita y el estiramiento traumático del plexo braquial durante la distocia de hombro. Objetivo: Realizar una revisión de la literatura para identificar las causas relacionadas con la parálisis braquial congénita. Resultados: Hasta en un 50 por ciento de los casos la parálisis braquial congénita no se asocia a distocia de hombro. Estos casos, son de peor pronóstico, afectan principalmente al hombro posterior y se presentan en recién nacidos de menor peso al nacer, pudiendo presentarse en un parto cesárea. La parálisis braquial congénita no asociada a distocia de hombro reconoce múltiples mecanismos patogénicos como: postura viciosa fetal in útero, tracción del hombro posterior por el promontorio sacro, neoplasias fetales, tumores uterinos, y otras. Conclusión: La parálisis braquial congénita, debe ser entendida como un síndrome, clínicamente caracterizado por parálisis flácida de una de las extremidades superiores detectada en el recién nacido, que responde a diferentes mecanismos patogénicos y de pronóstico variable según el caso.

Background: Classically congenital brachial palsy was defined as a flaccid paresis of the upper limb, secondary to traumatic brachial plexus stretching during delivery of the anterior shoulder in the context of shoulder dystocia. Numerous series have reported the lack of relationship between congenital brachial palsy and traumatic stretching of the brachial plexus during shoulder dystocia, in a significant number of cases. Objective: To review the literature to identify the causes related to congenital brachial palsy. Results: Up to 50 percent of cases of congenital brachial palsy are not associated to shoulder dystocia. These cases, have worse prognosis, mainly affect the posterior shoulder, presents in infants of lower birth weight and may even be in a cesarean delivery. Congenital brachial palsy not associated with shoulder dystocia recognizes multiple pathogenic mechanisms such as: vicious fetal position in utero, traction of the posterior shoulder on the sacral promontory, fetal tumors, uterine tumors, and others. Conclusion: Congenital brachial palsy, should be understood as a syndrome, clinically characterized by flaccid paresis/paralysis of one upper limb detected in the newborn, being the consequence of different pathogenic mechanisms and having variable prognosis.

[Birth injuries and related risk factors in neonates born in Emam Sajad hospital in Yasuj in 2005 to 2006]

The first days of life has the highest risk in everyone's life and the mortality rate in these days is equal to the mortality rate of the whole life. One of the causes of mortality in these days is birth injuries. Determining the type and incidence of birth injuries and their risk factors can be useful in reducing the mortality rate in neonates. In this descriptive analytical study, 2005 neonates who were born in Imam Sajad Hospital in Yasouj/ Iran, between the years 2005 to 2006 were studied. The rate of birth injuries and their risk factors were evaluated. Collected data were analyzed by SPSS software using chi-square test. Out of 2005 neonates, 70.4% born by NVD and 29.6% by cesarian section. The study showed that 10.8% of NVD and 3.7% of cesarian section neonates had birth injuries. Two hundered and four of these injuries which occurred in 175 of neonates were incude: capute succedaneum [36.75], sub conjectival hemorrhage [27.9%], cephal hematoma [10.2%], facial erythema and abrasion [8.8%], facial echymosis [6.3%], hypoxic-ischemic encephalopathy [3.4%], brachial plexus palsy [3.4%], clavicular fractures [1.4%], facial nerve palsy [0.4%] and other skin lesions [0.9%]. Risk factors were included NVD [difficult vaginal delivery], high gestation age, and low Apgar score at first minute of life, shoulder dystocia, vaccum and birth at night. The present study revealed that the incidence of birth injuries in this area is high. Considering the serious complications of birth injuries and hypoxic-ischemic encephalopathy with no treatment for some cases, it seems that using the preventing methods to reduce the prevalence of birth injuries is necessary

Estudios realizados en neonatos con diagnóstico-clínico de hipoxia neonatal: en el Hospital Samuel Dario Maldonado de San Antonio del Táchira en el período de enero-diciembre 2001 / Studies in neonates with clinical diagnose of neonatal hypoxia in Hospital Samuel Dario Maldonado of San Antonio del Tachira in the period january-december 2001

A partir de las ultimas décadas la hipoxia neonatal representa un gran problema; por la morbilidad tan elevada; y con el propósito de conocer que sucedía con los niños que durante su nacimiento presentaron hipoxia neonatal se realizó un estudio analítico retrospectivo de 100 niños que presentaron diagnóstico clínico de hipoxia neonatal moderada severa durante el período enero-diciembre 2001 en el Hospital Samuel Dario Maldonado San Antonio del Táchira fueron seleccionados 30 casos, presentándose el mayor porcentaje por cesárea segmentaria (23,33 por ciento) seguida de parto eutocico (20 por ciento) y período expulsivo prolongado (16,66 por ciento), parto prematuro (13,33 por ciento). También observamos el test de apgar donde el mayor porcentaje encontrado fue de 6 puntos en 7 casos con (23,33 por ciento) tiempo durante 24-28 horas (16.66 por ciento) siendo el sexo masculino el más predominante (56,66 por ciento) acorde a la edad.

Comparison of vacuum extraction delivery between the conventional metal cup and the new soft rubber cup.

To compare the effectiveness and complications of vacuum extraction delivery between the conventional metal cup and the silicone rubber cup. A prospective randomized clinical trial of 90 pregnant women requiring assisted vaginal delivery who met the predetermined criteria for vacuum extraction were allocated to delivery by the Malstrom metal cup (46 cases) or the silicone rubber cup (44 cases). The two groups were similar in respect of age, parity gestational age and indications for assisted vaginal delivery. The mean and median numbers of tractions and time from cup application to delivery were not significantly different between the groups. The overall success rate was higher in the metal cup (89.1%) than in the rubber cup (79.5%) but not significantly different. The silicone cup was more likely to fail in cases of occiput posterior position, excessive caput, and severe degree of molding. There were no significant differences between groups in terms of Apgar scores, birth canal injury, and maternal blood loss. Scalp injuries occurred more frequently with the metal than with the rubber cup (P = 0.006). Vacuum extraction delivery with the silicone rubber cup is associated with reduced scalp injuries but has a greater tendency to fail when the fetus presents in occiput posterior position, has excessive caput or severe degree of molding.

Operaçåo a fórcipe: repercussöes neonatais precoces / Forceps delivery: immediate neonatal morbidity

Objetivando avaliar as repercussöes neonatais precoces da operaçåo a fórcipe, compararam-se 979 partos a fórcipe em gestaçåo a termo com 937 partos transpélvicos nåo operatórios, ocorridos na Maternidade do Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro, entre maio de 1968 e abril de 1991. As parturientes nåo apresentavam antecedentes de partos vaginais ou intercorrências clínicas ou obstétricas. A mortalidade neonatal precoce, o número de toecotraumatismos, o tempo de internaçåo e a freqüência de intercorrências durante a internaçåo nåo diferiram em ambos os grupos. Excluídos os casos de sofrimento fetal agudo, nåo se verificou diferença referente à vitabilidade neonatal. O índice de Apgar inferior a 7 no quinto minuto foi mais freqüente no grupo de partos espontâneos. Houve apenas maior freqüência de pressåo neonatal e tocotraumatismo nos partos a fórcipe médio-baixo, embora tenham ocorrido em pequeno número de casos e se mostrando de pouca gravidade. Conclui-se que as repercussöes neonatais imediatas do parto a fórcipe nåo constituem impedimento para a criteriosa utilizaçåo do instrumento

Retinal hemorrhages in newborns

Of 150 live newborns examined within 3 hours of birth, 54 [36%] were found to have retinal hemorrhages. Head circumference was significantly correlated [P < 0.05] with retinal hemorrhage, while gestational age, sex, birth weight, fetal distress, and Apgar rating of the newborn showed no significant correlation. Birth injuries, especially ocular and periocular ones, were associated with a significantly higher incidence of retinal hemorrhages [83%]

Nerve injuries in neonates.

A clinical study of 40 cases of nerve injuries in neonates with one-year follow-up is presented. The total incidence of such injuries was 1.50%. Thirty-three cases sustained nerve injury due to obstetrical trauma and in 7 cases it was due to postnatal trauma like intragluteal injection and tight splintage. Almost in all cases there was history of prolonged or obstructed labour. Upper limb nerve injuries were commonest followed by facial palsy. Twenty-three cases (76%) showed complete recovery while 17% had partial and 7% no recovery at all. Hence nerve injuries are not uncommon in neonates. If managed properly the recovery is good. Intragluteal injection in the neonatal period should not be recommended.

Trauma obstétrico del neonato en el Hospital Civil de Guadalajara / Obstetrical trauma of the newborn infant at the Hospital Civil de Guadalajara

En el hospital Civil de Guadalajara en 1985 se analizaron 1,000 recién nacidos vivos de 32 semanas o más de gestación en los cuales se investigó trauma obstétrico (T.O.) 37.4% presentó un solo T. O., 2.8% presentó dos tipos de T.O. Los tipos de T.O. fueron: caput 307, hipoxia 55, huella de forceps 47, cefalohematoma 9, luxación de cadera 6, fractura de clavícula, parálisis braquial 1, parálisis facial 1 y fractura de cráneo 1. Las variables de mayor significancia estadística en su relación con el T. O. fueron: edad materna, paridad, apgar a los 5 minutos, uso de fórceps y líquido amniótico mecolos 5 minutos, uso de fórceps y líquido amniótico meconial (AL)

Tocotraumatismo fetal: análise dos fatores predisponentes / Fetal tocotrauma: analysis of predisposing factors

Foram estudados retrospectivamente 154 casos de tocotraumatismos fetais quanto aos fatores predisponentes. Verificou-se que a nuliparidade, macrossomia fetal, idade materna e uso do fórcipe estäo significativamente associados ao trauma do feto durante a parturiçäo