DOCSLIB.ORG

Birth Injuries in Newborn: a Prospective Study of Deliveries in South-East Nigeria

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Birth Injuries in Newborn: a Prospective Study of Deliveries in South-East Nigeria Vol. 20(4), pp. 41-46, April 2021 DOI: 10.5897/AJMHS2021.0149 Article Number: C744A0D66422 ISSN: 2384-5589 Copyright ©2021 African Journal of Medical and Health Author(s) retain the copyright of this article http://www.academicjournals.org/AJMHS Sciences Full Length Research Paper Birth injuries in newborn: A prospective study of deliveries in South-East Nigeria Ekwochi Uchenna, Osuorah DI Chidiebere* and Asinobi Isaac Nwabueze 1Department of Pediatrics, Enugu State University of Science and Technology, Enugu State, Nigeria. 2Child Survival Unit, Medical Research Council UK, the Gambia. Received 19 January, 2021; Accepted 23 March, 2021 Birth injury is an important cause of short and long-term deformity and disability in children. It is becoming an increasing source of litigation in developing countries. Exploring the magnitude of the problem in a resource-limited setting, and, identifying associated factors, will help reduce its occurrence. This surveillance for birth injuries is a 4-year prospective study conducted in the Enugu State University Teaching Hospital (ESUTH) between 2013 and 2017. Newborns with birth injuries and controls delivered around the same time with similar clinic-anthropometric parameters were enrolled for this study. One thousand nine hundred and twenty newborns were seen during the study period. Forty-six birth injuries were recorded giving in-hospital incidence rate of 24.0 (CI 17.3-30.9) per 1000 live birth. Majority (64.1%) of the injuries seen were related to the scalp. The commonest birth injuries encountered included Caput Succedaneum (41.2), Cephalohematoma (22.9), Erb’s Palsy (17.4), and shoulder dislocation (6.5). One case fatality (2.5%) due to skull fracture secondary to forceps delivery was noted. Birth weight (P=0.034), perinatal asphyxia (P=0.001) and prolonged labour (P=0.001) were significantly associated with birth injuries in the newborns surveyed. Birth injury remains a common and serious medical issue in our setting. Being proactive during antenatal care and labour could go a long way in minimizing the incidence of birth injuries and its consequences on children especially in the presence of risk factors such as high birth weight, perinatal asphyxia and prolonged labour. Key words: Birth injuries, newborns, delivery, Enugu. INTRODUCTION Birth injuries are mechanical and physiological adverse Commonly encountered injuries include soft tissue, events that occur at birth. These injuries may occur musculoskeletal, spinal cord and peripheral nerve injuries during labour, at delivery, or after delivery in neonates (Baskett et al., 2007). The overall incidence of birth that require resuscitation in the delivery room injuries in most developed countries has drastically (Papanagiotou et al., 2009). They could be minor and declined due to improvements in obstetric care and self-limited problems such as laceration and bruising, or prenatal diagnosis (Parker, 2005). However, in resource severe injuries that may result in significant neonatal limited settings, the decline has been less remarkable morbidity or mortality (Papanagiotou et al., 2009). (Barry, 2008). Reported incidence rate of birth injuries *Corresponding author: E-mail: [email protected]. Author(s) agree that this article remain permanently open access under the terms of the Creative Commons Attribution License 4.0 International License 42 Afr. J. Med. Health Sci. varies extensively in developing countries and depends or resident doctor with or without radiological assessment to confirm on the methodology used in its assessment (Levine et al., the diagnosis. 1984; Perlow et al., 1996). (2) Prolonged labor: For the sake of this study, was defined as labor lasting more than 12 h from start of regular contractions to the Review of available literatures revealed that a wide delivery of the baby. range of factors such as macrosomia, breech (3) Perinatal asphyxia: was defined as clinical evidence of inability presentation, head circumference, shoulder dystocia, to initiate spontaneous breathing, need of resuscitation after birth neonatal height and maternal factors (such as increasing and/or an Appearance-Pulse-Grimace-Activity-Respiration (APGAR) age and parity, pelvic abnormality etc) all increase the score of less than 7 at five and 10 minutes after delivery. (4) Gestation at delivery: This was classified as ‘term’ delivery if risk of birth injuries. Other factors such as induction of baby was born after 37 completed weeks of gestation, and ‘preterm’ labour, prolonged labour and instrumental delivery may if delivery was before 37 completed weeks. also contribute to birth injury in newborns (Alexander et (5) Birth weight: This was categorized as low, normal and large if al., 2006; Awari et al., 2003). In some cases, despite best birth weight was < 2.5 kg, 2.5-4.0 kg and > 4.0 kg respectively. the obstetric care and absence of risk factors, birth (6) Place of delivery: Babies delivered in ESUTH were grouped as injuries could still occur (Barry, 2008). Because most birth ‘inborn’ while those delivered outside and referred to ESUTH were grouped as ‘outborn’ babies. Additional information on the latter injuries are preventable, knowledge of the pattern of birth group of neonates was acquired by visiting their place of birth or via injury and the related factors can serve as a guide for telephone calls. obstetricians and other birth attendants in planning safer delivery programs for mothers. It could also be of immense benefit to the neonatologist in case Data handling and analysis management and prognostication. Against this backdrop, The above measures were documented at presentation in the the authors set out to document the pattern of birth relevant sections of the questionnaire and subsequently transferred injuries and related risk factors in Enugu South-East into a Microsoft Excel Sheet. Distribution of the measures of these Nigeria. variables were analyzed and recorded in appropriate statistical units. The chi-square analysis was used to assess initial associations between the demographic parameters of newborns MATERIALS AND METHODS and birth injuries in cases and controls. Binary logistic regression analysis was later used to predict how the significant parameters on Study area chi-square analysis determine birth injuries in these newborns. Measures of this association was presented as odd ratios (OR) and The study was carried out in the Special Care Baby Unit (SCBU) of 95% confidence intervals (95% CI). Data analysis was done using Enugu State University Teaching Hospital (ESUTH), a tertiary IBM® SPSS version 18.0 (SPSS Inc, Chicago, IL) and statistical health care facility situated in Enugu metropolis, south-eastern significance was set at P ≤ 0.05. Respondents with grossly missing Nigeria. ESUTH serves as a referral center for specialized information were excluded from the data analysis obstetrics and newborn services for the entire state and its environs. The SCBU is in close proximity with the labour ward to ease communication and prompt transfer of babies that may need Ethical consideration resuscitation at birth. Ethical clearance was obtained from the ESUTH Ethics Committee. Before recruitment of each subject, informed consent was also Study design obtained from every mother or caregiver whose babies were enrolled in this study. Participation in the study was entirely This is a prospective analytical study conducted over a 4-year voluntary, and no financial inducement whatsoever was involved. period from January 2013 to January 2017. Newborn babies Participants were informed that voluntary withdrawal at any stage of presenting with birth injury were consecutively enrolled at interaction was guaranteed for them without any adverse effect to presentation after obtaining a written informed consent from the themselves or their baby. All information was handled with strict parents and/or caregivers. Diagnosis of birth injury was made after confidentiality. clinical examination and/or radiological assessments where indicated. Once the diagnosis and type of birth injury was confirmed, further information concerning the gender, presence or RESULTS absence of prolonged labour, mode of delivery, place of birth, gestational age at birth, birth weight and presence or absence of Characteristics of enrolled new-borns asphyxia were documented in a questionnaire developed specifically for the study. For every newborn with birth injury enrolled, at least 2 others admitted for other reasons other than A total of 1920 newborns were admitted during the study birth injury with as close clinico-anthropometric characteristics as period. Of these, 46 birth injuries were encountered in 40 possible to the case were also enrolled to serve as controls. newborns resulting to an hospital incidence rate of 24.0 (CI 17.3-30.9) per 1000 new-borns admitted. Table 1 shows the characteristics of new-borns surveyed. Measures Approximately 45% were delivered in the hospital where (1) Birth injury: Diagnosis of birth injury was made by clinical the study was conducted. The number of males was evidence of physical adverse events to a newborn during or just twice the number of females enrolled and 94.8% of after birth. This was done by clinical assessment of a neonatologist neonates were full-term. Majority (63.4%) of the babies Ekwochi et al. 43 Table 1. Demographic characteristics of new-borns surveyed for birth injury. Characteristic Variable Number (n) Percentage Cases 40 29.9 Birth injury (n=134) Controls 94 70.1 Male 89 66.4 Gender (n=134) Female 45 33.6 Gestation at delivery Term 127 94.8 (n=134) Preterm 7 5.2 Mode of delivery (n=134) SVD†1 85 63.4 Caesarean section 47 35.1 Assisted†2 2 1.5 Birth weight (n=134) < 2.5 kg 17 13.2 2.5-4.0 kg 95 73.6 > 4.0 kg 17 13.2 Yes 29 22.3 Prolonged labour (n=130) No 101 77.7 Perinatal Asphyxia Yes 71 53.8 (n=130) No 61 46.2 Place of delivery Inborn 60 44.8 (n=134) Out-born 74 55.2 †1 Spontaneous vertex delivery; †2 Vacuum/forceps.
Load more

Recommended publications
  • Extrinsic Factors Influencing Fetal Deformations and Intrauterine
    Hindawi Publishing Corporation Journal of Pregnancy Volume 2012, Article ID 750485, 11 pages doi:10.1155/2012/750485 Review Article Extrinsic Factors Influencing Fetal Deformations and Intrauterine Growth Restriction Wendy Moh, 1 John M. Graham Jr.,2 Isha Wadhawan,2 and Pedro A. Sanchez-Lara1 1 Center for Craniofacial Molecular Biology, Ostrow School of Dentistry and Children’s Hospital Los Angeles, Keck School of Medicine of the University of Southern California, 4650 Sunset Boulevard, MS 90, Los Angeles, CA 90027, USA 2 Cedars-Sinai Medical Center, Medical Genetics Institute and David Geffen School of Medicine at UCLA, 8700 Beverly Boulevard, PACT Suite 400, Los Angeles, CA 90048, USA Correspondence should be addressed to Pedro A. Sanchez-Lara, [email protected] Received 24 March 2012; Revised 4 June 2012; Accepted 4 June 2012 Academic Editor: Sinuhe Hahn Copyright © 2012 Wendy Moh et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The causes of intrauterine growth restriction (IUGR) are multifactorial with both intrinsic and extrinsic influences. While many studies focus on the intrinsic pathological causes, the possible long-term consequences resulting from extrinsic intrauterine physiological constraints merit additional consideration and further investigation. Infants with IUGR can exhibit early symmetric or late asymmetric growth abnormality patterns depending on the fetal stage of development, of which the latter is most common occurring in 70–80% of growth-restricted infants. Deformation is the consequence of extrinsic biomechanical factors interfering with normal growth, functioning, or positioning of the fetus in utero, typically arising during late gestation.
    [Show full text]
  • Neonatal Orthopaedics
    NEONATAL ORTHOPAEDICS NEONATAL ORTHOPAEDICS Second Edition N De Mazumder MBBS MS Ex-Professor and Head Department of Orthopaedics Ramakrishna Mission Seva Pratishthan Vivekananda Institute of Medical Sciences Kolkata, West Bengal, India Visiting Surgeon Department of Orthopaedics Chittaranjan Sishu Sadan Kolkata, West Bengal, India Ex-President West Bengal Orthopaedic Association (A Chapter of Indian Orthopaedic Association) Kolkata, West Bengal, India Consultant Orthopaedic Surgeon Park Children’s Centre Kolkata, West Bengal, India Foreword AK Das ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD. New Delhi • London • Philadelphia • Panama (021)66485438 66485457 www.ketabpezeshki.com ® Jaypee Brothers Medical Publishers (P) Ltd. Headquarters Jaypee Brothers Medical Publishers (P) Ltd. 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: [email protected] Overseas Offices J.P. Medical Ltd. Jaypee-Highlights Medical Publishers Inc. Jaypee Brothers Medical Publishers Ltd. 83, Victoria Street, London City of Knowledge, Bld. 237, Clayton The Bourse SW1H 0HW (UK) Panama City, Panama 111, South Independence Mall East Phone: +44-2031708910 Phone: +507-301-0496 Suite 835, Philadelphia, PA 19106, USA Fax: +02-03-0086180 Fax: +507-301-0499 Phone: +267-519-9789 Email: [email protected] Email: [email protected] Email: [email protected] Jaypee Brothers Medical Publishers (P) Ltd. Jaypee Brothers Medical Publishers (P) Ltd. 17/1-B, Babar Road, Block-B, Shaymali Shorakhute, Kathmandu Mohammadpur, Dhaka-1207 Nepal Bangladesh Phone: +00977-9841528578 Mobile: +08801912003485 Email: [email protected] Email: [email protected] Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2013, Jaypee Brothers Medical Publishers All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher.
    [Show full text]
  • SUBGALEAL HEMATOMA Sarah Meyers MS4 Ilse Castro-Aragon MD CASE HISTORY
    SUBGALEAL HEMATOMA Sarah Meyers MS4 Ilse Castro-Aragon MD CASE HISTORY Ex-FT (37w6d) male infant born by low transverse C-section for arrest of descent and chorioamnionitis to a 34-year-old G2P1 mother. The infant had 1- and 5-minute APGAR scores of 9 and 9, weighed 3.625 kg (54th %ile), and had a head circumference of 34.5 cm (30th %ile). Following a challenging delivery of the head during C/s, the infant was noted to have left-sided parietal and occipital bogginess, and an ultrasound was ordered due to concern for subgaleal hematoma. PEDIATRIC HEAD ULTRASOUND: SUBGALEAL HEMATOMA Superficial pediatric head ultrasound showing moderately echogenic fluid collection (green arrow), superficial to the periosteum (blue arrow), crossing the sagittal suture (red arrow). Findings on U/S consistent with large parieto-occipital subgaleal hematoma. PEDIATRIC HEAD ULTRASOUND: SUBGALEAL HEMATOMA Superficial pediatric head ultrasound showing moderately echogenic fluid collection (green arrow), consistent with large parieto-occipital subgaleal hematoma. CLINICAL FOLLOW UP - Subgaleal hematoma was confirmed on ultrasound and the infant was transferred from the newborn nursery to the NICU for close monitoring, including hourly head circumferences and repeat hematocrit measurements - Serial head circumferences remained stable around 34 cm and hematocrit remained stable between 39 and 41 throughout hospital course - The infant was subsequently treated with phototherapy for hyperbilirubinemia, thought to be secondary to resorption of the SGH IN A NUTSHELL:
    [Show full text]
  • Prevalence and Characterization of Neonatal Skin Disorders in the First
    J Pediatr (Rio J). 2017;93(3):238---245 www.jped.com.br ORIGINAL ARTICLE Prevalence and characterization of neonatal skin ଝ,ଝଝ disorders in the first 72 h of life a,∗ b b Flávia Pereira Reginatto , Damie DeVilla , Fernanda M. Muller , c c b a,c Juliano Peruzzo , Letícia P. Peres , Raquel B. Steglich , Tania F. Cestari a Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-graduac¸ão em Saúde da Crianc¸a e Adolescente, Porto Alegre, RS, Brazil b Complexo Hospitalar Santa Casa de Porto Alegre, Departamento de Dermatologia, Porto Alegre, RS, Brazil c Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Departamento de Dermatologia, Porto Alegre, RS, Brazil Received 9 May 2016; accepted 16 June 2016 Available online 19 November 2016 KEYWORDS Abstract Newborn; Objective: To determine the prevalence of neonatal dermatological findings and analyze Neonatology; whether there is an association between these findings and neonatal and pregnancy charac- teristics and seasonality. Child health services; Methods: Newborns from three maternity hospitals in a Brazilian capital city were randomly Child health; selected to undergo dermatological assessment by dermatologists. Infant care; Results: 2938 neonates aged up to three days of life were randomly selected, of whom 309 Skin manifestations were excluded due to Intensive Care Unit admission. Of the 2530 assessed neonates, 49.6% were Caucasians, 50.5% were males, 57.6% were born by vaginal delivery, and 92.5% of the moth- ers received prenatal care. Some dermatological finding was observed in 95.8% of neonates; of these, 88.6% had transient neonatal skin conditions, 42.6% had congenital birthmarks, 26.8% had some benign neonatal pustulosis, 2% had lesions secondary to trauma (including scratches), 0.5% had skin malformations, and 0.1% had an infectious disease.
    [Show full text]
  • Epidemiological Aspects of Neonatal Jaundice and Its Relationship with Demographic Characteristics in the Neonates Hospitalized in Government Hospitals in Ilam, 2013
    Original article J Bas Res Med Sci 2014; 1(2):48-52. Epidemiological aspects of neonatal jaundice and its relationship with demographic characteristics in the neonates hospitalized in government hospitals in Ilam, 2013 Ashraf Direkvand-Moghadam 1, Ali Delpisheh 2, Mosayeb Mozafari *3, Azadeh Direkvand-Moghadam 4, Parvaneh Karzani 4, Parvin Saraee 4, Zahra Safaripour 4, Nasim Mir-Moghadam 4, Mrjan Teimour Pour4 1. Prevention of Psychosocial Injuries Research Center; Department of Midwifery, Ilam University of Medical Sciences, Ilam, Iran 2. Department of Clinical Epidemiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran 3. Department of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran 4. Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran * Corresponding author: Tel: +98 8412227123; fax: +98 8412227123 Address: Dept of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran E-mail: [email protected] Receive d 21/7/2014; revised 28/7/2014; accepted 2/8/2014 Abstract Introduction: Jaundice is one of the hospitalization causes in term and preterm infants. Considering to the side effects of jaundice, the present study aimed to investigate the prevalence and risk factors associated with jaundice in neonates hospitalized in government hospitals in Ilam. Materials and methods: In a case - control study, 384 neonates were enrolled. All neonates hospitalized in Mustafa Khomeini and Imam Khomeini hospital were enrolled in the study. Neonates’ deaths due other causes were excluded from the study. Data collected through a questionnaire. The validity of the questionnaire was determined using content validity and its reliability was determined 84% using Cronbach's alpha coefficient.
    [Show full text]
  • MNCY SCN Postpartum Newborn Pathway
    Alberta Pregnancy Pathways Adopted from Perinatal Services BC, 2015. While every attempt has been made to ensure that the information contained herein is clinically accurate and current, AHS acknowledges that many issues remain controversial, and, therefore, may be subject to practice interpretation. Developed by the Maternal Newborn Child & Youth Strategic Clinical Network™ – Version 4.2 September 2020 Revision Control Version Revision Date Summary of Revisions Author V-1.0 September 2016 Original Document MNCY SCN™ Postpartum Newborn Working Group V-2.0 April 2017 Refer to Summary of Revisions – separate document Ursula Szulczewski, Manager, MNCY SCN™ V-2.1 September 2017 Revisions based on provincial chart audit and staff evaluation Debbie Leitch, Executive Director, MNCY SCNTM V-2.2 March 2018 Revisions to pathway forms Debbie Leitch, Executive Director, MNCY SCNTM Clarification around sedation score and assessment criteria for intrapsinal and intrathecal blocks and epidurals. V-3.0 September 2018 Addition to initial newborn assessment completion guide – Debbie Leitch, Executive Director, MNCY SCNTM assessment of newborn palette to include palpation and visualization. V-3.1 October 2018 Clarification of assessment for motor block. Debbie Leitch, Executive Director, MNCY SCNTM Addition of safe swaddling to comfort or soothe and link to V-4.0 January 2019 Healthy Families, Healthy Children video. Debbie Leitch, Executive Director, MNCY SCNTM Addition of supplementation volumes for breast fed infants. Pg 86 Supplementation volumes to refer to term babies only (not late preterm). Pg 90 Formula volume (for baby not breastfeeding) returned to previous 30ml/kg/24 hours – follow hunger cues. TM V-4.1 March 2019 Pg 108 Newborn stools 48-72 hours: 3 or more transitional Debbie Leitch, Executive Director, MNCY SCN stools/day; 72 hours – 4-6 weeks: 3 or more stools/day Pg 104 Lab bilirubin or transcutaneous bilirubin measured on all infants within 24 hours of birth and prior to discharge.
    [Show full text]
  • Perinatal Asphyxia in a Specialist Hospital in Port Harcourt, Nigeria
    Niger J Paed 2013; 40 (3): 206 - 210 ORIGINAL West BA Perinatal asphyxia in a specialist Opara PI hospital in Port Harcourt, Nigeria DOI:http://dx.doi.org/10.4314/njp.v40i3,1 Accepted: 7th December 2012 Abstract Objectives: To find the Sixty two (39.5%) of their mothers prevalence, and identify risk fac- had no antenatal care (ANC). ( ) West BA tors and outcome in neonates who Mode of delivery in 98 (62.4%) Department of Paediatrics, were admitted into the Braithe- was caesarian section, of which 80 University of Port Harcourt Teaching Hospital. Port Harcourt, Rivers State. waite Memorial Specialist Hospi- (81.6%) were emergencies, many E-mail: [email protected] tal (BMSH) for perinatal as- of whom had complications before Tel: +2348037078844 phyxia. presentation. One hundred and Method: This was a descriptive seven (68.2%) and 38(24.2%) ba- Opara PI cross sectional observational bies, had Apgar Score of 4-5 and 0 Department of Paediatrics, Braithewaite study of neonates with low Apgar -3 in one minute respectively. The Memorial Specialist Hospital, scores admitted over a period of commonest risk factors were Port Harcourt. Rivers State ten months into the Special Care cephalopelvic disproportion (CPD) Baby Unit of the BMSH. in the mothers and abnormal pres- All babies with Apgar scores less entation, predominantly breech in than six at one minute and for the fetus. 31.6% of those with se- whom consent was obtained were vere perinatal asphyxia died. recruited consecutively. For out- Conclusion: Prevalence of perina- born babies with no Apgar score tal asphyxia is high.
    [Show full text]
  • Women's Experiences of Birth Trauma and Postpartum Mental Health
    St. Catherine University SOPHIA Master of Social Work Clinical Research Papers School of Social Work 5-2013 Women’s Experiences of Birth Trauma and Postpartum Mental Health Ashley Ashbacher St. Catherine University Follow this and additional works at: https://sophia.stkate.edu/msw_papers Part of the Social Work Commons Recommended Citation Ashbacher, Ashley. (2013). Women’s Experiences of Birth Trauma and Postpartum Mental Health. Retrieved from Sophia, the St. Catherine University repository website: https://sophia.stkate.edu/ msw_papers/147 This Clinical research paper is brought to you for free and open access by the School of Social Work at SOPHIA. It has been accepted for inclusion in Master of Social Work Clinical Research Papers by an authorized administrator of SOPHIA. For more information, please contact [email protected]. Running head: WOMEN’S EXPERIENCES OF BIRTH TRAUMA Women’s Experiences of Birth Trauma and Postpartum Mental Health By Ashley Ashbacher, BSW, LSW MSW Clinical Research Paper Presented to the Faculty of the School of Social Work St. Catherine University and the University of St. Thomas St. Paul, Minnesota in Partial Fulfillment of the Requirements for the Degree of Master of Social Work Committee Members Catherine Marrs Fuchsel, PHD, LICSW Maureen Campion, MS, LP Jess Helle-Morrissey, MA, MSW, LGSW The Clinical Research Project is a graduation requirement for MSW students at St. Catherine University/University of St. Thomas School of Social Work in St. Paul, Minnesota and is conducted within a nine-month time frame to demonstrate facility with basic social research methods. Students must independently conceptualize a research problem, formulate a research design that is approved by a research committee and the university Institutional Review Board, implement the project, and publicly present the findings of the study.
    [Show full text]
  • Perinatal Trauma with and Without Loss Experiences
    1 Perinatal Trauma with and without loss experiences 2 A. Meltem Üstündağ Budak, Gillian Harris & Jacqueline Blissett 3 4 Perinatal trauma with and without loss experiences 5 6 Journal of Reproductive and Infant Psychology, 34:4, 413-425, DOI: 7 10.1080/02646838.2016.1186266 8 9 Accepted 15.3.16 10 11 Word count : 3493 12 13 1 14 Perinatal Trauma with and without loss experiences 15 Objective: The present study explored differences in mental health between women 16 who experienced a trauma which involved a loss of foetal or infant life compared to 17 women whose trauma did not involve a loss (difficult childbirth). Method: The sample 18 consisted of 144 women (Mean age = 31.13) from the UK, US/Canada, Europe, 19 Australia/ New Zealand, who had experienced either stillbirth, neonatal loss, ectopic 20 pregnancy, or traumatic birth with a living infant in the last 4 years. Results: The 21 trauma without loss group reported significantly higher mental health problems than 22 the trauma with loss group (F (1,117) = 4.807 p=.03). This difference was observed in 23 the subtypes of OCD, panic, PTSD and GAD but not for major depression, agoraphobia 24 and social phobia. However, once previous mental health diagnoses were taken into 25 account, differences between trauma groups in terms of mental health scores 26 disappeared, with the exception of PTSD symptoms. Trauma groups also differed in 27 terms of perceived emotional support from significant others. Conclusion: The 28 findings illustrate the need for a change in the focus of support for women’s birth 29 experiences and highlighted previous mental health problems as a risk factor for mental 30 health problems during the perinatal period.
    [Show full text]
  • AWHONN Compendium of Postpartum Care
    AWHONN Compendium of Postpartum Care THIRD EDITION AWHONN Compendium of Postpartum Care Third Edition Editors: Patricia D. Suplee, PhD, RNC-OB Jill Janke, PhD, WHNP, RN This Compendium was developed by AWHONN as an informational resource for nursing practice. The Compendium does not define a standard of care, nor is it intended to dictate an exclusive course of management. It presents general methods and techniques of practice that AWHONN believes to be currently and widely viewed as acceptable, based on current research and recognized authorities. Proper care of individual patients may depend on many individual factors to be considered in clinical practice, as well as professional judgment in the techniques described herein. Variations and innovations that are consistent with law and that demonstrably improve the quality of patient care should be encouraged. AWHONN believes the drug classifications and product selection set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check information available in other published sources for each drug for potential changes in indications, dosages, warnings, and precautions. This is particularly important when a recommended agent is a new product or drug or an infrequently employed drug. In addition, appropriate medication use may depend on unique factors such as individuals’ health status, other medication use, and other factors that the professional must consider in clinical practice. The information presented here is not designed to define standards of practice for employment, licensure, discipline, legal, or other purposes.
    [Show full text]
  • Newborn Exam and Gestational Age Assessment
    An Introduction to the Nursery Photgraph: Anne Geddes Newborn Nursery Faculty: Division of General Pediatrics Created by: Maria Kelly MD Pertinent Maternal History Everyone involved in the care of the infant should have knowledge of the relevant maternal history Pre-partum Antenatal Perinatal Maternal History Family History Inherited diseases (cystic fibrosis, sickle cell disease, metabolic disease, polycystic kidneys, hemophilia, and history of perinatal death) Maternal History Age, blood type, chronic diseases, diabetes, hypertension, renal disease, cardiac disease, bleeding disorders, infertility, recent infections/exposures, rubella status, GBS status, and STD’s Maternal History Sexually transmitted diseases (STD’s) HIV Syphilis (RPR or VDRL) Hepatitis B (HepBsAg) Gonorrhea (GC DNA) Chlamydia (Cz DNA) Group B Streptococcus “GBS” Group B Strep (streptococcus agalactiae) Rectal/vaginal swab results at 35-37 weeks gestation **all maternal results must be verified/confirmed by visualizing a lab report** Maternal History Previous pregnancies Abortions, fetal demise, neonatal death, premature births, postdate births, malformations, respiratory distress syndrome, jaundice, apnea Drug history Medications, drugs of abuse, ETOH, tobacco usage during pregnancy Maternal History Current Pregnancy Gestational age, quickening, FHT, results of fetal testing, pre-eclampsia, bleeding, trauma, infection, surgery, polyhydramnios, oligohydramnios, glucocorticoids, labor suppressants, antibiotics Important factors during labor…… Onset of labor: spontaneous vs. induced Rupture of membranes Placental exam Presentation Analgesia Labor and Delivery: Maternal fever Anesthesia Important Factors Fetal monitoring Apgar scores Resuscitation Method of delivery Duration of labor Sample Note: A/P A: Term infant, DOL #1, with sepsis risk factors and breastfeeding concerns. Plan: ID: GBS + mother, but adequate treatment. No other risk factors and infant clinically well.
    [Show full text]
  • The Swelling in Caput Succedaneum Crosses Suture Lines Because It Is Above the Cranium in the Subcutaneous Tissue
    HEAD TO FOOT EXAMINATION DR JP,ASST. PROF.ICH,GOVT MEDICAL COLLEGE KOTTAYAM 1.CRANIUM Is the size of head normal.?(measure ofc).is the skull shape abnormal( LOOK FROM ABOVE)? Are there any swellings on scalp(newborn)? Are the sutures normal? Are the fontanels open or closed? Is the Hair pattern normal? Is there a low hairline? Is there any bossing of skull? Is the skull unusually soft? Is it transluminant? Are there signs of ict? LISTEN FOR A BRUIT newborn . The swelling in caput succedaneum crosses suture lines because it is above the cranium in the subcutaneous tissue. Caputs, unlike cephalohematomas, tend to have pitting edema. Cephalohematomas are boggy and do not extend across suture lines because they are limited by the boundaries of the periosteum. There is no discoloration of the scalp with a cephalohematoma unless there is an overlying caput or bruising in the subcutaneous tissue. Subgaleal hematomas are considered fluctuant masses that cross suture lines, may be associated with a fluid wave or ecchymoses behind the ear; and may extend to other areas of the scalp. Infants with subgaleal hemorrhages must be observed in an intensive care nursery for progressive enlargement because the bleeding may be massive and associated with severe anemia and neonatal mortality. The ecchymoses that may be associated with caput succedaneum and the bleeding seen with cephalohematomas and subgaleal hematomas may contribute to neonatal jaundice infants . When assessing the head shape, it is best to look at the top of the head from above. Measure head circumference to see whether macrocephaly>2sd or microcephaly>3sd is present in addition to abnormal head shape.
    [Show full text]