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Figure 4.38. This mother had a history of a difficult previous abortion. With diis pregnancy she had a spontaneous rupture of the uterus. On laparotomy a large perforation was noted in the uterus through which the infant's lower extremities presented. Note the compression edema and ecchymoses of the left leg and die gangrene of the right foot.

Figure 4.38. This mother had a history of a difficult previous abortion. With diis pregnancy she had a spontaneous rupture of the uterus. On laparotomy a large perforation was noted in the uterus through which the infant's lower extremities presented. Note the compression edema and ecchymoses of the left leg and die gangrene of the right foot.

Figure 4.39. A close-up view of the gangrene of the right foot in the same infant.

Figure 4.40. Subcapsular hematoma of the liver is generally a pathologic finding. It occurs most commonly with breech delivery especially in premature infants. Occasionally, if bleeding persists, the capsule of the liver ruptures and there is massive hemorrhage into the peritoneal cavity. This usually occurs on the third or fourth day of life. The same may occur in the course of mismanaged artificial cardiopulmonary resuscitation. Rupture of the spleen is very rare and is more common with a transverse lie.

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Figure 4.40. Subcapsular hematoma of the liver is generally a pathologic finding. It occurs most commonly with breech delivery especially in premature infants. Occasionally, if bleeding persists, the capsule of the liver ruptures and there is massive hemorrhage into the peritoneal cavity. This usually occurs on the third or fourth day of life. The same may occur in the course of mismanaged artificial cardiopulmonary resuscitation. Rupture of the spleen is very rare and is more common with a transverse lie.

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Figure 4.41. Transverse lie widi a shoulder presentation. Note the marked swelling and ecchymoses of the right shoulder and upper extremity.

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Figure 4.42. Compound presentation of the right arm, hand and vertex. Note the depression in the skull.

Figure 4.41. Transverse lie widi a shoulder presentation. Note the marked swelling and ecchymoses of the right shoulder and upper extremity.

Figure 4.43. The same infant with the arm and hand placed in its in utero position. Note the marked edema of the right forearm and hand compared to that of the left arm and hand. This occurred as the result of the compound presentation.

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Figure 4.44. In this infant the membranes ruptured 10 days prior to delivery which was by cesarean birth for chorioamnionitis. There was difficulty in delivering the right arm which presented at the elbow. The hand is normal; therefore this was not due to an amniotic band.

Figure 4.45. Intrauterine skull fracture (congenital molding of the skull) which occurs in cases of infants with poor mineralization of the skull where the mother has a prominent sacral promontory and has a prolonged labor or delivers precipitously. It results in a greenstick or depressed fracture of the skull.

Figure 4.46. Radiograph of die skull of die infant shown in Figure 4-45 showing a depressed fracture in a poorly mineralized skull after a spontaneous vertex delivery. In these infants die fracture may improve spontaneously but there is a question as to whether treatment should be passive or surgical lifting of die fracture is indicated.

Figure 4.46. Radiograph of die skull of die infant shown in Figure 4-45 showing a depressed fracture in a poorly mineralized skull after a spontaneous vertex delivery. In these infants die fracture may improve spontaneously but there is a question as to whether treatment should be passive or surgical lifting of die fracture is indicated.

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