scary case last night

chillchick · Feb 28, 2010

How long did this occur before you left? What I mean is: Did it look like a skull fracture or was it a skull fracture?

Esp. if there were decels, they may have gotten rather "rough" in trying to get the baby out which can cause some seriously nasty-looking marks/protrusions/etc. on the baby.

Just curious what kind of diagnostic studies they did bc I had an infant whose shoulder they thought was broken (and it certainly looked like it was) that healed in less than a week in the NICU.

If it is an actual skull fracture, supposing no complications, I would imagine it would be largely dependent on the location but in any case it should still be okay since their heads are "designed for" trauma to a certain extent.

I hope all goes well. xo

babyktchr, BSN, RN · Feb 28, 2010

You did not tell us what kind of decels you were having. If the baby had moderate variability and accels, despite the decels, this baby was not in metabolic acidemia. The moderate variability alone tells you that the baby had a decent oxygen status, and add the accels and it is even better. If your decels were early, that would be head compression and given what you said about the size of the mom's pelvis and the difficult time getting the baby out, I am guessing that is what you saw. Getting the baby out once it is wedged down there can certainly take some time. Someone is usually under the sterile drape with gloves on pushing on the baby from the lady parts to help release it.

Based on the information you gave (i would also like to know what your baseline was, a decel from 120 to 80 is not horrible)...you didn't have a bad strip....you had a baby telling you that it was having some issues (if the decels were truly early). More than likely your baby's issues were more from birth trauma and the length of time it took to get it out than something that happened before. Just my opinion though.

klone, MSN, RN · Feb 28, 2010

Last night we had a pt with a not so great tracing. Long decels down to 80 or something. But overall it wasn't terrible - I think she had moderate variability and accels.

If baby had moderate variability and accels, then baby was probably doing okay. Were these early, variable or late decels?

adpiRN · Mar 1, 2010

I would call them prolonged. They were probably between 2 and 10 minutes. Resolved with mom in hands and knees position. Could be baby rolling on cord or getting crushed in the pelvis.

Update on the baby is "multiple skull fractures", had a craniotomy, and they remove a hematoma. Not good.... They said baby should be "fine", but I think that means it will survive, not predicting brain damage, because it's too soon to tell.

It seems unclear how this happened, but the nurses seem to be leaning towards trauma in surgery. The baby had malpresentation (OP and something else) and combined with a narrow pelvis on mom, the baby really got wedged in there I guess.

McBx3 · Mar 2, 2010

Is there any chance the infant could have osteogenesis imperfecta?

(Sorry if I am way off the mark It was the first thing that popped in my head when I read about the multiple skull fractures...)

EricJRN, MSN, RN · Mar 2, 2010

Is there any chance the infant could have osteogenesis imperfecta?
(Sorry if I am way off the mark It was the first thing that popped in my head when I read about the multiple skull fractures...)

Good thinking, but it seems very unlikely here. There are several types of OI with varying presentations, but it would be unusual to see skull fractures as the only manifestation of OI.

Some of the other signs that might make us think of that diagnosis would include low birth weight, blue sclerae, a small chest, bowed extremities and evidence of intrauterine limb fractures.

McBx3 · Mar 3, 2010

Thanks Eric :) I was pretty sure it was a long shot, because I wasn't sure of the other S/S... always welcome a learning opportunity though!