Subgaleal hemorrhage in a neonate with factor X deficiency following a non-traumatic cesarean section

Abstract

This case report describes a term infant born by a non-traumatic, non-instrumented cesarean section that presented with respiratory failure and severe metabolic acidosis secondary to subgaleal hemorrhage (SGH). Further evaluation revealed a functional factor X deficiency that was initially treated with fresh frozen plasma infusions. This report is significant for the occurrence of a SGH in a non-traumatic delivery and emphasizes the importance of obtaining a coagulopathy evaluation in patients with similar presentations. In addition, this case suggests that the mechanism of injury that causes SGH may occur more frequently than previously thought, but does not become clinically significant in patients without an underlying coagulopathy.

A case for expanding carrier testing to include actionable X‐linked disorders

“…This subgaleal space covers the entire surface of cranium and has the potential to contain a pool in excess of 250 mL of fluid. A term newborn's blood volume is estimated to be approximately 80 mL/kg 4. As such, these conditions are serious and potentially fatal.…”

“…Other recognized risk factors for subgaleal hemorrhage include primiparous mothers, term infants when compared to preterm infants, and infants with underlying coagulopathies. The mortality rate is between 12% and 25% 4. Neonatal subgaleal hemorrhage may be the presenting sign of hemophilia A 6…”

Severe neonatal subgaleal hemorrhage as the first presentation of hemophilia A

“…SGH occurs more commonly in vacuum-and forcepsassisted deliveries, although there are reports of SGH in spontaneous vaginal deliveries associated with macrosomia, fetal distress, prolonged second stage of labor, prematurity, primigravidity, and precipitous delivery [3]. The incidence of SGH drops markedly to 4/10,000 in spontaneous vaginal deliveries and is rarely reported in nontraumatic cesarean sections [1].…”

“…Subgaleal hemorrhage (SGH) is an uncommon, potentially lethal, but often underdiagnosed condition in newborns. The prevalence of subgaleal hemorrhages is 0.04% to 0.15% of all deliveries, with mortality range from 12% to 25% [1,2]. It is caused by the rupture of the emissary veins (connections between the dural sinuses and scalp veins), followed by separation of the epicranial aponeurosis from the underlying periosteum.…”

“…It is caused by the rupture of the emissary veins (connections between the dural sinuses and scalp veins), followed by separation of the epicranial aponeurosis from the underlying periosteum. This can create a compartment in which approximately 250 ml of blood could be accumulated [1]. SGH usually occurs as a complication of instrumental delivery (vacuum extraction or forceps).…”