| An evaluation of the possible etiologic factors in hyperextension of the fetal head in breech presentation and a discussion of management are presented. Our seven cases plus a review of the literature led to the conclusion that hyperextension of the aftercoming head is a dangerous malpresentation that should not be underestimated. For this reason, we strongly suggest an x-ray of all breech presentations in early labor, not only to evaluate pelvic adequacy but also to determine the attitude of the head. In persistent hyperextension, cesarean section is the management of choice. ( info) |
12/99. Persistent hyperextension of the neck in breech ("star-gazing fetus") and in transverse lie ("flying-fetus"): indication for cesarean section. All pregnancies with a breech or transverse lie should be examined roentgenologically, at least after the onset of labor, and those in whom hyperextension of the neck persists should be sectioned to avoid the real danger of injury to the cervical cord incurred in vaginal delivery. The radiologist should not assume a seriously deformed fetus just from the hyperextension; most of these fetuses are otherwise normal. ( info) |
13/99. Long bone fractures in extreme low birth weight infants at birth: obstetrical considerations. BACKGROUND: cesarean section is a common delivery route for breech fetuses < 1000 gm to prevent trauma. However, abdominal and vaginal delivery maneuvers are similar. cesarean section avoids the risk of head entrapment but long bone trauma can still occur. CASES: We identified three neonates with femoral fractures during a one year period. All mothers were in active labor. All were premature newborns less than 32 weeks gestation, in breech presentation and delivered by a low vertical cesarean section. review of all cesarean sections done due to mal presentation (n = 26) during that time showed 11 classic and 15 lower segment vertical incisions (both vertical and transverse). CONCLUSIONS: The interest to reduce maternal morbidity may prompt physicians to perform a low segment vertical incision for delivery of a preterm breech. This decision may increase the chances of trauma by providing less area for the required obstetric maneuvers. ( info) |
14/99. Hyperextension of the fetal head in breech presentation: radiological evaluation and significance. Damage of the cervical cord is not rare in breech delivery with hyperextension of the fetal head. Among 57 cases from the literature and one of ours in which the angle of extension could be measured on X-ray films, 20 had an extension angle greater than 90 degrees. Of these, 11 were delivered vaginally and included 8 cases of damage to the cervical cord. It is recommended that elective Caesarean section be performed when the angle of extension exceeds 90 degrees. ( info) |
15/99. Ultrasound assessment of biometric trends in a case of thanatophoric dysplasia. We present a case of thanatophoric dysplasia diagnosed at the 21st week of gestation. Serial ultrasound was performed throughout pregnancy. The scans showed a distinctive pattern of development of the fetal long bones. Up to week 25, the fetal long bones appeared to grow steadily but slower compared to normal measurements (4-5 SD below the mean); then, between weeks 26 and 30, long bone growth was further and more severely hampered, until it almost stopped altogether approaching term, with measurements 9-12 SD below the mean at week 38. ( info) |
16/99. Classic metaphyseal lesion following external cephalic version and cesarean section. We report a case of an otherwise healthy neonate diagnosed at birth with a classic metaphyseal lesion of the proximal tibia following external cephalic version for frank breech presentation and a subsequent urgent cesarean section. Although the classic metaphyseal lesion is considered highly specific for infant abuse, this case demonstrates the importance of obtaining a history of obstetric trauma for neonates presenting to the imaging department for suspected non-accidental injury. ( info) |
17/99. Fetal spinal-cord injury secondary to hyperextension of the neck: no effect of caesarean section. A 24-month-old Japanese girl is reported who had upper spinal-cord injury secondary to fetal hyperextension of the neck in breech presentation. She was first noted to be in this position 10 days before the expected date of birth and was delivered by caesarean section. ( info) |
18/99. Iniencephaly. Iniencephaly is a rare congenital anomaly which is a type of neural tube defect. Babies with iniencephaly are almost always still born but exceptionally live born cases are reported. This article reports a case of a live born iniencephalic baby who died about 15 minutes after birth. ( info) |
| We report the management of a fetus with breech presentation and double nuchal cord in a mother desiring external cephalic version (ECV). The patient was a 26-year-old woman, gravida 1, para 0, with an unremarkable prenatal course, who was found to have a breech presentation at 34 weeks 1 day. She consented for external cephalic version (ECV) and upon evaluation at 36 weeks 2 days, the fetus was found to have double nuchal coils of the umbilical cord. ECV was not attempted. Subsequent fetal surveillance consisted of fetal movement counts, non-stress tests and Doppler ultrasound of the umbilical artery. At 38 weeks 1 day, ultrasound revealed absence of the nuchal coils. ECV was attempted and was successful. The fetus maintained the cephalic presentation and the patient delivered uneventfully. This case report illustrates the value of follow-up ultrasound in a patient who desires an ECV and for whom such a procedure was declined due to the presence of double nuchal coils. Cesarean delivery was successfully avoided. ( info) |
20/99. Traumatic cervical syringomyelia related to birth injury. A rare case of cervical syringomyelia related to breech delivery is reported. The initial diagnosis was bilateral brachial plexus palsy due to birth injury, which was revealed by magnetic resonance imaging (MRI) to be traumatic syringomyelia. The usefulness of MRI in the early diagnosis of cervical cord birth injury, especially in differentiating between brachial plexus palsy due to birth injury and spinal cord trauma due to birth injury in infancy, is emphasized. ( info) |