Srpski arhiv za celokupno lekarstvo 2013 Volume 141, Issue 7-8, Pages: 528-531
https://doi.org/10.2298/SARH1308528J
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Diagnosis and treatment of rib fracture during spontaneous vaginal delivery
Jovanović Nebojša (Vojnomedicinska akademija, Dispanzer za ginekologiju, Beograd)
Ristovska Nataša (Klinički centar Srbije, Klinika za ginekologiju i akušerstvo, Beograd)
Bogdanović Zorica (Klinički centar Srbije, Klinika za ginekologiju i akušerstvo, Beograd)
Petronijević Miloš (Klinički centar Srbije, Klinika za ginekologiju i akušerstvo, Beograd + Medicinski fakultet, Beograd)
Opalić Jasna (Klinički centar Srbije, Klinika za ginekologiju i akušerstvo, Beograd)
Plećaš Darko (Klinički centar Srbije, Klinika za ginekologiju i akušerstvo, Beograd + Medicinski fakultet, Beograd)
Introduction. Progress of labor in multiparous women usually is not
accompanied with risk of any kind of birth trauma. Case Outline. We report a
very rare case of rib fracture in a neonate during vaginal delivery in the
39/40 week of gestation. The expulsion started spontaneously without any
manipulation from the obstetrician. Live male newborn was delivered 4650 g.
in weight, 55 cm long, with head circumference of 39 cm, Apgar score 9. The
child was immediately examined by the neonatologist. Crepitations were
palpable over the left hemithorax, and auscultatory on the left side
inspiratory cracks. Finding was suspicious for rib fracture on the left side
posteriorly and brachial plexus palsy, while other findings were normal.
Xray finding was inconclusive, but suspicious for fracture of the 4th, 5th,
and 6th left rib posteriorly, without dislocation of bone fragments. There
were no signs of pneumothorax. Dorsal position of the newborn was considered
sufficient, accompanied with analgetics. Xray was scheduled in a week
because formation of the calus would be the only objective sign of previous
rib fracture. On the control Xray fracture lines were clearly visible on the
3rd, 4th, 5th, 6th and 7th rib posteriorly, without dislocation of bone
fragments with initial calus formation. The child was discharged from
hospital in good condition after two weeks, for further outpatient care.
Conclusion. With timely diagnostics of this very rare intrapartal fracture,
adequate treatment, dorsal position and close control of clinical condition
of the newborn, serious and potentially life threatening complications can be
avoided.
Keywords: delivery, macrosomy, rib fracture