Main description:

Retinal haemorrhage occurring during birth is a common feature in the newborn. There is no basic funduscopic or morphologic difference between this perinatal type of haemorrhage and that in the adult. The difference is that perinatal haemorrhage resorbs rapidly, within a few days, and no functional defects of retinal vessels are known. The fIrst observation of perinatal haemorrhage took place nearly 100 years ago. Many observations have been published in short papers; what was still lacking was a systematic pathogenic classifIcation of the different types of haemorrhage, a compari son of the perinatal type of other types of retinal haemorrhage, a comparison to other perinatal ocular haemorrhages, a detailed histologic description and a multi-faceted correlation of haemorrhage to aetiologic factors. The author has based his comprehensive evaluation on the observation of more than 400 newborn infants, the reexamination of several cases with macular haemor rhage, the histologic work-up of serial sections and the review of extensive literature. It is a remarkable fact that a physiologic process, birth, is related to this type of vessel rupture, which is present during a short period of postnatal life. In its complex analysis of these facts and conditions this book is particularly valuable.

Contents:

I. The First Observation.- A. Koenigstein or von Jaeger?.- B. Ely.- C. Summary.- II. Material and Methods.- A. Ophthalmoscopy.- B. Fundus Photography.- C. Histology.- D. Clinical Follow-Up.- E. Summary.- III. Morphology.- A. Intraretinal Haemorrhages.- 1. Flame-Shaped Haemorrhages of the Nerve Fibre Layer.- a) Histology.- b) Spread of Haemorrhages.- c) Source of Haemorrhages.- 2. Granular Haemorrhages of the Internal Granular Layer.- a) Histology.- b) Spread of Haemorrhages.- c) Source of Haemorrhages.- 3. Hemispheric Submembranacious Haemorrhages.- a) Ophthalmoscopy.- b) Histology.- 4. Discussion.- B. Extraretinal Haemorrhages.- 1. Subretinal Haemorrhages.- 2. Subhyaloid Haemorrhages.- 3. Hyaloid (Vitreous) Haemorrhages.- 4. Discussion.- C. White Fibrin Thrombi of Vessel Ruptures and Fibrin Emboli in Retinal Vessels.- D. Summary.- IV. Location.- A. Clinical Reports.- B. Histology.- C. Macular Haemorrhage.- D. Bilaterality.- E. Summary.- V. Clinical Course.- A. Onset.- B. Resorption.- C. Postnatal Extension.- D. Summary.- VI. Numerical Data.- A. Quantitative Evaluation.- 1. Literature.- 2. Numerical Classification Applied Here.- B. Incidence.- 1. Histology.- 2. Clinical Observations.- 3. Summary.- VII. Aetiology.- A. Types of Delivery.- 1. Spontaneous Delivery from Occipital Presentation.- a) General Data.- b) Number and Location.- c) Left or Right Occipital Presentation.- 2. Forceps Delivery.- a) Forceps Injuries.- b) Retinal Haemorrhages After Forceps Delivery.- 3. Vacuum Extraction.- 4. Caesarian Section.- 5. Breech Presentation.- 6. Other Types.- 7. Duration of Labour.- a) Total Duration.- b) First Stage.- c) Second Stage.- d) Rupture of Foetal Membranes.- 8. Drugs Administered During Labour.- a) Pituitary Preparations.- b) Anaesthetics.- 9. Summary.- B. Maternal Factors.- 1. Parity.- 2. Age of Mother.- 3. Other Maternal Factors.- 4. Summary.- C. Infantile Factors.- 1. Sex Distribution.- 2. Weight and Size of the Newborn.- 3. Cranial Circumference.- 4. Period of Gestation; Immaturity.- 5. Asphyxia.- 6. Other Infantile Factors.- 7. Summary.- D. Haemorrhagic Disease of the Newborn: Attempted Treatment.- 1. Haemorrhagic Diathesis.- 2. Prothrombin Time and Vitamin K.- 3. Capillary Resistance and Vitamin Prophylaxis.- 4. Fibrinolysis and Fibrinolysis Inhibitors.- 5. Summary.- E. Comparable Retinal Haemorrhages of Other Origin.- 1. Retinal Venous Occlusion.- 2. Intracranial Haemorrhage and Elevation of Cerebrospinal Fluid Pressure.- 3. Trauma.- 4. Summary.- F. Correlation with Other Perinatal Haemorrhages.- 1. Cephalhaematoma.- 2. Conjunctival Haemorrhages.- 3. Choroidal Haemorrhages.- 4. Summary.- G. Aetiology and Pathogenesis.- 1. Literature.- a) Elevation of Intracranial Pressure.- b) Vascular Factors.- c) Anoxia.- d) Haemorrhagic Diathesis.- e) Anatomic Conditions.- 2. Discussion.- VIII. Significance.- A. Evaluation of Different Types of Delivery.- B. Retinal and Intracranial Haemorrhages.- 1. Pathoanatomy.- 2. Clinical Examinations.- 3. Discussion.- 4. Summary.- C. Retinal Haemorrhages and Amblyopia.- 1. Pathoanatomy.- 2. Clinical Investigations.- a) Original Observations.- b) Literature.- 3. Discussion.- 4. Summary.- IX. Conclusion.- X. Appendix.- A. Plates.- B. The First Description.- C. Bibliographic Notes.