Neonatal Subgaleal Hemorrhage and Its Relationship to Delivery by Vacuum Extraction

Abstract

Subgaleal hemorrhage is a rare condition of the neonate often associated with instrumental delivery. It is a potentially fatal condition that is often underreported and underdiagnosed. The vacuum extractor is being advocated as the instrument of first choice for assisted vaginal delivery, but appears to be associated with an increased incidence of subgaleal hemorrhage. It is widely believed that the vacuum cup will dislodge before causing serious fetal trauma. Because of the ease of application, vacuum extractors could be used potentially in circumstances in which forceps would not be attempted, allowing an operator of average experience to perform rotational deliveries. The worrisome increase in the incidence of subgaleal hemorrhage associated with vacuum extraction leads to the issuance of warnings from governmental authorities in Canada and the United States. This review discusses the anatomy of this lesion, etiology, clinical presentation, management, and possible prevention.

Operative Vaginal Delivery: A Cause of Birth Injury or Is It?

“…Hypovolemic shock, disseminated intravascular coagulation, and multiorgan failure can develop in this setting and lead to neonatal death in up to 25% of cases. [11][12][13] The mechanism of injury for a subgaleal hemorrhage is thought to be the vacuum traction pulling the scalp away from a stationary bony calvarium thus avulsing open the subgaleal space causing the bridging vessels to tear and bleed into the subgaleal space. 7 Continued bleeding would occur until tamponade occurs from pressure.…”

Maternal and neonatal morbidity in relation to the instrument used for mid‐cavity rotational operative vaginal delivery: a prospective cohort study

“…6,7 There are few studies investigating the morbidity related to rotational vacuum extraction or manual rotation. [8][9][10] In these case studies morbidity has been reported in comparison with the morbidity associated with a non-rotational operative vaginal delivery or a spontaneous vaginal birth.…”

A Case Report of Death Claimed Due To Oral Polio Vaccine (OPV)

“…Subgaleal haemorrhage although rare, is associated with significant morbidity and mortality. Uchil et al in 2003 reported incidence of subgaleal haemorrhage in 0.4/1000 cases of spontaneous vaginal births and 5.9/1000 cases of vacuum births [4]. On careful examination of medical records at the time of delivery, we found that proper surveillance methods were adapted from the RANZCOG Recommendations [7] & there was no reported abnormality regarding -heart rate, respiratory rate, colour (pallor) and activity.…”

“…Subgaleal haemorrhage is most serious complication of instrumental delivery, although rare, is associated with significant morbidity and mortality [3]. As it is not limited by suture line, the newborn can therefore lose up to 80% of their blood volume within the subaponeurotic space resulting in hypovolemic shock, acute anaemia, coagulopathy and death [4] but volume of subgaleal bleed was much less in this case. Thirdly we focussed on biochemical examination of fluid found at the tracheo-bronchial region.…”