Welcome to the 1st series on 'Clinical Pictures in Obstetrics and Neonatology' of the Perinatal Society of Malaysia.
These pictures are meant only for educational purposes and is not to be reproduced in whatever form for commercial interest.

It is hoped that readers will be enlightened and encouraged in their quest for better knowledge and understanding of some interesting conditions in the practice of perinatal medicine and nursing.

CASE 1
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A baby boy was delivered by SVD in a private clinic with a birth weight of 3.5 kg .
There was no antepartum or intrapartum problems.
On day 4 of life mum noted that the baby was vomiting after every feed.
Vomitus was yellowish occasionally.
The vomiting became worse and associated subsequently with abdominal distension.
Baby was then admitted to the hospital.

He developed respiratory complications and was intubated and ventilated.
Q 1. What investigations would you do to determine the diagnosis?
Answer :
Q 2. What does this X'Ray show?
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Answer :
Q 3. List 3 causes of gut perforation?
Answer :
Answer

 

CASE 2
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The mother of this baby came to labour room in 2nd stage of labour.
She did not receive any antenatal checkup.
A baby girl with a birth weight of 1.5 kg was delivered vaginally.
She had apgar scores of 4 at 1 min and 6 at 5min.
The baby had respiratory distress in labour room and was immediately ventilated.
She was also noted to be oedematous but by Day 2 the oedema had subsided

This is the baby on day 2 of life

Q 1. What is the obvious abnormality seen that will clinch the diagnosis?
Answer :
Q 2. What one investigation would you do to confirm the diagnosis?
Answer :
Q 3. What is the treatment?
Answer :
Q 4. Could this problem be prevented with good antenatal checks?
Answer :
Answer

 

CASE 3
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This little boy came to the emergency ward on day 9 of life with a history of mild cough and lethargy .
On examination he was afebrile with a respiratory rate of 65 per min. Examination of the heart, lungs and abdomen was otherwise normal.
However he was noted to have a rash over the face and abdomen.
He was delivered by SVD with a birth weight of 3kg. Mum had chicken-pox and he was admitted to the neonatal ward and observed for 1 week.
Q 1. If mum had chicken-pox 3 days before delivery what should have been given for the baby?
Answer :
Q 2. How long should the baby have been observed before discharge?
Answer :
Q 3. What is the diagnosis and treatment of this baby now?
Answer :
Answer

 

CASE 4
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Q 1. What is the lesion at the back of this baby's head?
Answer :
Q 2. Name 1 syndrome associated with this lesion
Answer :
Q 3. What is the other obvious feature associated with this syndrome?
Answer :
Answer

 

CASE 5

The mother of this child did not realise that she was pregnant until the gestation was 3 months .
She was a 32 year old lady who worked in a karaoke pub.
The baby was delivered by SVD and had an apgar score of 5 at 1min and 6 at 5min.
However he was noted to be dysmorphic and at about 2 weeks of life he developed seizures
Q 1. List the 3 abnormal features seen in this baby (See picture below)
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Answer :
Q 2. What is the diagnosis ?
Answer :
Answer

 

CASE 6
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This newborn baby was picked up at routine examination to have short neck.

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Q 1. What is the diagnosis ?
Answer :
Q 2. What is the abnormality?
Answer :
Q 3. What other abnormalities are often associated?
Answer :
Answer

 

CASE 7
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This baby was delivered SVD with a good apgar score.
Mother was found antenatally to be VDRL positive but TPHA was not checked and she was not treated for syphilis
Baby weighed 3kg and on routine examination was found to have an incomplete Moro's response.
There was also poverty of movement of the right arm.

Q 1. What is the abnormality seen ?
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Answer :
Q 2. What is the diagnosis?
Answer :
Q 3. What are the bony changes you may expect to find on Xray of the right upper limb?
Answer :
Answer

 



 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CASE 1
Enlarge Image
Click to enlarge
A baby boy was delivered by SVD in a private clinic with a birth weight of 3.5 kg .
There was no antepartum or intrapartum problems.
On day 4 of life mum noted that the baby was vomiting after every feed.
Vomitus was yellowish occasionally.
The vomiting became worse and associated subsequently with abdominal distension.
Baby was then admitted to the hospital.

He developed respiratory complications and was intubated and ventilated.
Q 1. What investigations would you do to determine the diagnosis?
Your Answer :
Answer : Infection screen (ie Blood culture, Urine Culture, Chest X'ray, Full Blood Count) Abdominal X'ray
Q 2. What does this X'Ray show?
Enlarge Image
Your Answer :
Answer : Football sign suggestive of gut perforation
Q 3. List 3 causes of gut perforation?
Your Answer :
Answer : 1. Necrotising enterocolitis
2. Intestinal obstruction
3. Spontaneous perforation
Back to Questions | Next Case

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CASE 2
Enlarge Image
Click to enlarge
The mother of this baby came to labour room in 2nd stage of labour.
She did not receive any antenatal checkup.
A baby girl with a birth weight of 1.5 kg was delivered vaginally.
She had apgar scores of 4 at 1 min and 6 at 5min.
The baby had respiratory distress in labour room and was immediately ventilated.
She was also noted to be oedematous but by Day 2 the oedema had subsided

This is the baby on day 2 of life

Q 1. What is the obvious abnormality seen that will clinch the diagnosis?
Your Answer :
Answer : Dry and peeling skin over hands and feet
Q 2. What one investigation would you do to confirm the diagnosis?
Your Answer :
Answer : Blood VDRL test
Q 3. What is the treatment?
Your Answer :
Answer : Supportive treatment and treatment with antibiotics ie penicillin for baby
Treatment for parents
Q 4. Could this be problem be prevented with good antenatal checks?
Your Answer :
Answer : Yes, antenatal screening would have been done and mother treated before infection could be transmitted to the baby
 Back to Questions | Next Case

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CASE 3
Enlarge Image
Click to enlarge

This little boy came to the emergency ward on day 9 of life with a history of mild cough and lethargy .
On examination he was afebrile with a respiratory rate of 65 per min. Examination of the heart, lungs and abdomen was otherwise normal.
However he was noted to have a rash over the face and abdomen.
He was delivered by SVD with a birth weight of 3kg. Mum had chicken-pox and he was admitted to the neonatal ward and observed for 1 week.
Q 1. If mum had chicken-pox 3 days before delivery what should have been given for the baby?
Your Answer :
Answer : Varicella-zoster immune globulin
Q 2. How long should the baby have been observed before discharge?
Your Answer :
Answer : Baby must be separated from the mother as long as she has lesions that are still wet.
Q 3. What is the diagnosis and treatment of this baby now?
Your Answer :
Answer : Diagnosis is Neonatal Chicken-pox
Treatment is with acyclovir and treatment of complications
 Back to Questions | Next Case

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CASE 4
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Q 1. What is the lesion at the back of this baby's head?
Your Answer :
Answer : Posterior encephalocele
Q 2. Name 1 syndrome associated with this lesion
Your Answer :
Answer : Meckel Gruber syndrome
Q 3. What is the other obvious feature associated with this syndrome?
Your Answer :
Answer : Polydactly
 Back to Questions | Next Case

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CASE 5

The mother of this child did not realise that she was pregnant until the gestation was 3 months .
She was a 32 year old lady who worked in a karaoke pub.
The baby was delivered by SVD and had an apgar score of 5 at 1min and 6 at 5min.
However he was noted to be dysmorphic and at about 2 weeks of life he developed seizures
Q 1. List the 3 abnormal features seen in this baby (See picture below)
Enlarge Image
Your Answer :
Answer : 1. Microcephaly
2. Thin upper lip
3. Smooth philtrum
4. Small palpebral fissures
Q 2. .What is the diagnosis ?
Your Answer :
Answer : Fetal alcohol syndrome
 Back to Questions | Next Case

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CASE 6
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This newborn baby was picked up at routine examination to have short neck.

Enlarge Image Enlarge Image
Q 1. What is the diagnosis ?
Your Answer :
Answer : Klippel-Feil syndrome
Q 2. What is the abnormality?
Your Answer :
Answer : Congenital fusion of at least 2 cervical veterbrae
Q 3. What other abnormalities are often associated?
Your Answer :
Answer : Genitourinary abnormalities
 Back to Questions | Next Case

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CASE 7
Enlarge Image
Click to enlarge

This baby was delivered SVD with a good apgar score.
Mother was found antenatally to be VDRL positive but TPHA was not checked and she was not treated for syphilis
Baby weighed 3kg and on routine examination was found to have an incomplete Moro's response.
There was also poverty of movement of the right arm.

Q 1. What is the abnormality seen ?
Enlarge Image
Your Answer :
Answer : Swelling of the right elbow and upper arm
Q 2. What is the diagnosis?
Your Answer :
Answer : Pseudoparalysis secondary to congenital syphilis
Q 3. What are the bony changes you may expect to find on Xray of the right upper limb?
Your Answer :
Answer : 1. Periostitis
2. Osteochondritis
3. Osteitis
4. Fracture
 Back to Questions 


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