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Upper cervical spinal cord injury in neonates: the use of magnetic resonance imaging.

Neonatal upper cervical spinal cord injury is associated with rotational forceps delivery and presents with quadriparesis and diaphragmatic paralysis. The underlying pathology determines neurologic outcome but is difficult to assess clinically or with simple radiographic techniques. We report 4 cases in which early magnetic resonance imaging demonstrated the extent and severity of the injury and guided management.

Cervical Vertebrae↗

Neonatal and prospective follow-up study of infants delivered by vacuum extraction (VE).

Forty infants delivered by vacuum extraction have been studied in the neonatal period--neurological examination, neonatal CSF-examinations, skull X-ray examination, transillumination and sonoencephalography --and at 14 months of age--developmental and behavioural evaluation, neurological examination, skull X-ray examination, sonoencephalography and electroencephalography. Two infants died in the neonatal period but in both cases a life-threatening situation of the fetus required immediate delivery. CSF cytological signs of haemorrhage were observed in 42% of the 26 infants who had a successful lumbar tap, compared to 10% found in normal deliveries. The result of the neonatal neurological study did not differ from that in a control group. The result of the skull X-ray examination and sonoencephalography were also within normal limits. In the follow-up study behavioural problems were found in 25%, but otherwise very few abnormalities were found. The deviatiosn found do not for the present indicate any later signs of brain lesions. It is concluded that this prospective study has shown that VE-delivery in fullterm babies seem to imply no risk fo serious cerebral sequelae. Further follow-up studies at a later age in order to evaluate the incidence of so-called minimal brain damage in VE-delivered children are required.

Adult↗

Forceps delivery after two previous Caesarean sections.

Caesarean section is one of the most frequently performed surgical procedures in current obstetric practice. There are several reasons for this upward tendency, including well developed hemotherapy, anesthesia, antibiotic treatment and skilled doctors. Despite such risks as uterine rupture, necessity of blood transfusion or the possibility of the necessity of ending the delivery by means of surgery, it is possible, in justified cases, to attempt spontaneous labor. A decision jointly made by the patient and her doctor, based on careful consideration of benefits and risks, as well as positive attitude on the woman's part may lead to positive outcome of labor. Taking the above factors into account we have decided to present a study of a difficult, operational labor after two Caesarean sections.

Adult↗

Fatal forceps.

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Birth Injuries↗