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Background
Preterm birth accounts for 5-10% of all deliveries and preterm premature rupture of membranes (PPROM) accounts for one-third of those preterm deliveries. 1 An important complication of PPROM is fetal non-vertex presentation at delivery.
The proportion of fetus with non-vertex presentation decreases with increasing gestational age (28% at 25-28 weeks gestation; 2% at 37-40 weeks gestation). 2 The most common non-vertex presentation in preterm births is breech position (75%), followed by transverse lie (21%) and other presentations including compound position (4%).
We present a preterm neonate who was born with severe birth trauma after PPROM and transverse lie. The neonate was born after an emergency caesarean section because of fetal distress. At birth, there was extensive swelling and areas of desquamated and necrotic skin of the right lower limb.
Case presentation
A female macrosomic neonate (birth weight 1525 g) was born preterm at 29 weeks gestation in a nulliparous mother whose pregnancy was complicated by threatened preterm labour earlier in pregnancy. The mother had facioscapulohumeral muscular dystrophy. Chorion biopsy did not reveal the same gene defect in the fetus. After PPROM resulting in oligohydramnios at 28 weeks and 3 days, the fetus presented in transverse lie with the fetal back upwards. The cervix was closed during internal examination. Initially, expectant management was instituted until 4 days after admission an emergency caesarean section was performed because of the suspicion of fetal distress because of decelerations on the cardiotocogram. There were no signs of labour at that time.
At delivery, the fetus still presented in transverse lie. The neonate could be delivered in breech position with some difficulty. Apgar scores after 1 and 5 min were 5 and 7, respectively. Because of persistent respiratory distress, the neonate was intubated 20 min after delivery. Owing to a subgaleal bleeding accompanied by hypotension and tachycardia, she received saline, fresh frozen plasma and two blood transfusions in the first few hours after delivery.
At birth, extensive swelling in areas of desquamated and necrotic skin of the right lower limb was noted ( figure 1 ).
Investigations
Full blood count was within the normal range. A blood culture demonstrated an infection with Streptococcus anginosus for which she was treated with penicillin during 10 days. C reactive protein levels increased...