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Figure 4.21. Fetus born in a caul with a nuchal cord. Cord around the neck once is present in about 20% of deliveries and, in about 2% of deliveries, there is a cord around the neck twice. This common finding generally does not cause problems unless the cord constricts the neck tightly. (Klima, T.)
Figure 4.22. Facial suffusion due to a nuchal cord.

Figure 4.23. Cord around the neck interfering with circulation. Note the petechiae of the face and head and the subconjunctival hemorrhages. Petechiae are also seen in infants in whom there is abnormal delay following delivery of the head and neck before the trunk and shoulders are delivered. In subconjunctival hemorrhage a linear or lunar hemorrhage is often seen to the side of the iris. Petechiae and subconjunctival hemorrhages do not have the same ominous significance as those on the trunk or limbs and usually fade in the first few days of life.

Figure 4.23. Cord around the neck interfering with circulation. Note the petechiae of the face and head and the subconjunctival hemorrhages. Petechiae are also seen in infants in whom there is abnormal delay following delivery of the head and neck before the trunk and shoulders are delivered. In subconjunctival hemorrhage a linear or lunar hemorrhage is often seen to the side of the iris. Petechiae and subconjunctival hemorrhages do not have the same ominous significance as those on the trunk or limbs and usually fade in the first few days of life.

4.24

Figure 4.24. Marked suffusion and bruising of the face as a result of a face presentation. This could be - . , considered the equivalent of a caput with the face as the presenting part. There is deep blue discoloration and swelling of the face and there may be considerable disfiguration of the face which is of short duration.

Figure 4.25. Face presentation in a premature infant of 34 weeks gestation. Note the very marked ecchymotic appearance of the face.

Figure 4.26. Face/brow presentation. Note the marked edema and ecchymoses over the face and brow, particularly the left eye.

4.27

Figure 4.27. A brow presentation with hyperextension of the head. This is die classic "militaristic attitude" with head back and chin out. Opisthotonos is excluded by lack of arching of the back. As this is the baby's "position-of-comfort" in utero, during the first few days post-natally the infant will be unhappy if an attempt is made to flex the head. After several days the infant will adopt a normal posture.

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