Neonatal subgaleal hemorrhage [a fatal complication of vacuum extraction delivery]

ABSTRACT

Neonatal subgaleal hemorrhage is a rare but potentially lethal complication of instrumental delivery, particularly vacuum extraction. It is often underreported and underdiagnosed. The prevalence of subgaleal hemorrhages varies from 0.04 to 0.15% of all deliveries. We describe two cases of severe subgaleal hemorrhage [SGH] and review the key elements of identification and treatment. The first case was a female neonate with birth weight 2220gr that was born by vacuum assisted vaginal delivery. At birth, the infant was pale, flaccid with no respiratory effort. She was grossly pale with poor perfusion, lethargic, decreased muscle tone, anemia, and hypovolemic shock. On her head a large fluctuant swelling was seen. She died at 20[th] hours of age. The second case was a full term male neonate that was born with cesarean section after an unsuccessful 2 to 3 time vacuum extraction. At birth the infant was limp, cyanotic with weak respiratory effort. After 7[th] hours, a severe fluctuant swelling was found on his head with head circumference of 38.5 cm and ecchymosis around his orbits. He developed anemia and seizure. After successful treatment, he was released from hospital. Increased awareness of SGH should lead to earlier identification, referral and treatment with resultant improved outcomes: