Subaponeurotic haemorrhage in the 1990s: a 3‐year surveillance

Abstract

A 3-year survey of subaponeurotic haemorrhage (January 1991 to December 1993) in a tertiary referral centre in Hong Kong revealed that the incidence of this life-threatening condition was 6.4 per 1000 ventouse-associated deliveries, which is 60-fold more common than with other modes of childbirth. We highlight a lesser known phenomenon of marked male predominance (male to female ration 8:1). Three of 18 (17%) infants with subaponeurotic haemorrhage died. Severe subaponeurotic haemorrhage with a decrease in venous haematocrit >25% of the baseline value at birth and requiring urgent blood transfusion in the first 12 h, in association with significant birth asphyxia with arterial cord blood pH <7.20 and 1-min Apgar score < or = 3 were the most important risk factors for death. A worrying feature was the silent presentation of occult subaponeurotic haemorrhage in two of the fatal cases. Frequent monitoring of haematocrit, early and rapid restoration of blood volume and prompt commencement of cardiac inotropes are the keys to the management of this condition, which should be suspected in all ill newborn infants subjected to the ventouse applicator.

Sagittal synostosis and ossified scalp hematoma: cause or consequence?

“…Mortality rates between 2.7 and 25% have been reported. 3,4,6,9,15,16 There is a single case report of a school-aged child with intractable epilepsy, frequent falls, and a calcified subgaleal hematoma, 19 but ossification of a subgaleal hematoma has not been described in infancy.…”

“…1,2,4,14,15 Subgaleal hematomas are associated with vacuum-assisted delivery in 50-96% of cases. 1,3,4,9,15,16 Rupture of small vessels passing from the pericranium through the subgaleal space to the overlying scalp is the source of some hemorrhage, but in more severe cases there may be laceration of the dural venous sinuses from extreme deformation of the skull by the extractor. Hemorrhage into the subgaleal space is not constrained by sutural borders, and hemodynamic instability, acidosis, and coagulopathy can be seen.…”

A « caput succedaneum » and a pallor following birth asphyxia in the term newborn...

“…Malgré la publication des premiers cas, il y a plusieurs décennies [2,5], son diagnostic n'est pas habituellement envisagé en phase initiale, car c'est une affection rare dont l'incidence varie, selon les séries, entre 0,2 à 1,6 pour 1 000 naissances [2,6,8]. Sa méconnaissance peut être source de retard thérapeutique et de morbidité ou de mortalité accrue.…”

“…De même, la pâleur constatée ne doit pas être rattachée uniquement à une acidose postanoxique, en cas de mauvaise adaptation postnatale initiale (cas n o 2) qui n'est pas exceptionnelle en cas d'HSG. Le rôle prépondérant d'une extraction instrumentale par ventouse ou forceps après un travail prolongé, une circulaire serrée du cordon, une macrosomie, une primiparité, une souffrance foetale aiguë, a d'ailleurs été largement souligné [6,10]. Ces éléments anamnestiques constituent autant d'arguments supplémen-taires pour ce diagnostic.…”

“…Ces éléments anamnestiques constituent autant d'arguments supplémen-taires pour ce diagnostic. Pour être complet, une prédomi-nance masculine [6,8,10] et une plus grande susceptibilité, chez les sujets de race noire, ont été décrites [5]. La découverte d'une pathologie constitutionnelle de la coagulation (patient n o 1) est connue mais rare [11,12].…”