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Faulty fetal packing: a case series and literature review
Sakura M Noda1,2, Jeffrey Otjen3,4, Ajay S Koti3,4
1University of Washington Medical Center, Seattle, WA, USA. sakuran@uw.edu.
Insights
Faulty fetal packing causes non-traumatic skull depressions in newborns, often mistaken for fractures. These resolve with observation, highlighting the need for accurate diagnosis.
Area of Science:
- Neonatal care
- Pediatric radiology
- Obstetrics
Background:
- Faulty fetal packing is an under-recognized nontraumatic condition.
- It is frequently misdiagnosed as a depressed skull fracture.
Purpose of the Study:
- To describe institutional cases of faulty fetal packing.
- To analyze their features, management, and outcomes.
- To compare findings with existing literature.
Main Methods:
- Retrospective study of a radiology database (2014-2022).
- Inclusion of cases of faulty fetal packing from a quaternary children's hospital.
- Recording of clinical, imaging, management, and outcome data.
Main Results:
- Five cases of faulty fetal packing were identified in neonates born at 37-41 weeks gestation.
- Parietal skull depressions were observed, with no associated traumatic findings on imaging.
- All patients were managed conservatively with observation, showing significant improvement within 2-4 months.
Conclusions:
- Skull depressions from faulty fetal packing should be considered in the differential diagnosis of depressed skull fractures.
- This condition typically resolves with conservative management.
- Accurate diagnosis is crucial to avoid unnecessary interventions.
Background:
Faulty fetal packing is an under-recognized nontraumatic entity often confused with depressed skull fracture.
Objective:
To describe cases of faulty fetal packing at our institution and their common features, management, and outcomes compared to existing literature.
Materials And Methods:
Institutional review board approval was obtained for this retrospective study. A retrospective search through a radiology database at a quaternary freestanding children's hospital from 2014-2022 was performed for cases of faulty fetal packing. Clinical characteristics, imaging findings, management, and outcome were recorded.
Results:
Five cases of faulty fetal packing were identified. These neonates were born at 37-41 weeks, one by vaginal delivery and four by Cesarean section, all after long labor or difficult extraction. Parietal skull depressions were noted at birth or by 16 days after birth, and no associated traumatic findings were identified on imaging. The depressions were initially diagnosed as fractures. All patients were managed by observation, and depressions significantly improved by 2-4 months in four cases; one case was lost to follow-up after 16 days. No adverse outcomes were reported.
Conclusion:
Skull depressions seen in faulty fetal packing should be considered in the differential diagnosis of depressed skull fracture. They typically resolve with conservative management.
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