Subgaleal hemorrhage from birth trauma: from the first stage of labor to the baby’s discharge: a clinical case at the intersection of specialties

DOI: https://doi.org/10.29296/25877305-2022-08-04
Issue: 
8
Year: 
2022

E. Shestak(1, 2), D. Svetlakova(1), K. Desyatnik(1)
1-Yekaterinburg Clinical Perinatal Center
2-Ural State Medical University, Ministry of Health of Russia, Yekaterinburg

Neonatal subgaleal hemorrhage (SH) is a common complication of vacuum extraction delivery. The baby’s condition after SH can progressively worsen up to death in 22% of cases. The basis for SH is a large blood accumulation volume in the subgaleal space, resulting in hemorrhagic shock and coagulopathy. The paper describes a clinical case of female patient M. who has undergone operative vaginal vacuum extraction done to deliver a baby, if clinically indicated. It analyzes the labor activity of Patient M., by providing a rationale for obstetric care tactics. The paper depicts the further worsening severity of neonatal infant’s condition in the presence of progressive bleeding into the subgaleal space, as well as neonatologists’ treatment policy, with a detailed description of instrumental and laboratory data up to the moment the patient’s discharge from hospital. An analysis of the clinical case showed that medical personnel alertness regarding the detection of SH after vacuum extraction delivery was a predetermining factor in the prognosis of the baby’s health and life. A particularly important step is to make a correct differential diagnosis of conditions similar to SH. Intensive infusion-transfusion therapy is in the first place while providing assistance and stabilizing the baby’s condition, since ongoing bleeding and hemorrhagic shock are the main causes of mortality in SH.

Keywords: 
obstetrics and gynecology
neonalogy
vacuum extraction
neonatal infant
subgaleal hematoma
birth trauma
coagulopathy



References: 
  1. Pressler J.L. Classification of major newborn birth injuries. J Perinat Neonatal Nurs. 2008; 22 (1): 60–7. DOI: 10.1097/01.JPN.0000311876.38452.fd
  2. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)-WHO Version for 2019-covid-expanded, Chapter XVI, Certain conditions originating in the perinatal period (P00-P96). URL: https://icd.who.int/browse10/2019/en#/P10-P15
  3. Verma G.L., Spalding J.J., Wilkinson M.D. et al. Instruments for assisted vaginal birth. Cochrane Database Syst Rev. 2021; 9 (9): CD005455. DOI: 10.1002/14651858.CD005455.pub3
  4. Plauché W.C. Subgaleal hematoma. A complication of instrumental delivery. JAMA. 1980; 244 (14): 1597–8.
  5. Levin G., Elchalal U., Yagel S. et al. Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction. Acta Obstet Gynecol Scand. 2019; 98 (11): 1464. DOI: 10.1111/aogs.13678
  6. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)-WHO Version for 2019-covid-expanded, Chapter XVI, Certain conditions originating in the perinatal period (P00-P96). URL: https://icd.who.int/browse10/2019/en#/P00-P04
  7. Uchil D., Arulkumaran S. Neonatal subgaleal hemorrhage and its relationship to delivery by vacuum extraction. Obstet Gynecol Surv. 2003; 58 (10): 687–93. DOI: 10.1097/01.OGX.0000086420.13848.89
  8. Kilani R.A., Wetmore J. Neonatal subgaleal hematoma: presentation and outcome--radiological findings and factors associated with mortality. Am J Perinatol. 2006; 23 (1): 41–8. DOI: 10.1055/s-2005-923438
  9. Gebremariam A. Subgaleal haemorrhage: risk factors and neurological and developmental outcome in survivors. Ann Trop Paediatr. 1999; 19 (1): 45–50. DOI: 10.1080/02724939992626
  10. Chadwick L.M., Pemberton P.J., Kurinczuk J.J. Neonatal subgaleal haematoma: associated risk factors, complications and outcome. J Paediatr Child Health. 1996; 32 (3): 228–32. DOI: 10.1111/j.1440-1754.1996.tb01559.x
  11. Ayres-de-Campos D., Spong C.Y., Chandraharan E. FIGO consensus guidelines on intrapartum fetal monitoring: Cardiotocography. Int J Gynaecol Obstet. 2015; 131 (1): 13–24. DOI: 10.1016/j.ijgo.2015.06.020
  12. National Institute for Health and Care Excellence (NICE) 2019 surveillance of intrapartum care for healthy women and babies (NICE guideline CG190).
  13. World Health Organization. WHO recommendations: Intrapartum care for a positive childbirth experience. Geneva, 2018; 212 p. DOI: 10.1111/1471-0528.15237
  14. Caughey A.B., Cahill A.G., Guise J.-M. et al. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014; 210 (3): 179–93. DOI: 10.1016/j.ajog.2014.01.026
  15. Morel M.I., Anyaegbunam A.M., Mikhail M.S. et al. Oxytocin augmentation in arrest disorders in the presence of thick meconium: influence on neonatal outcome. Gynecol Obstet Invest. 1994; 37 (1): 21–4. DOI: 10.1159/000292514
  16. Vacca A. Handbook of Vacuum Delivery in Obstetric Practice, 3rd Ed., 2009.
  17. Davis D.J. Neonatal subgaleal hemorrhage: diagnosis and management. CMAJ. 2001; 164 (10): 1452–3.
  18. Health Protection Branch. The use of vacuum assisted delivery devices and fetal subgaleal haemorrhage. Medical device alert 110. Ottawa: Health Canada, 1999. Available: www.hc-sc.gc.ca/english/search.htm
  19. Florentino-Pineda I., Ezhuthachan S.G., Sineni L.G. et al. Subgaleal hemorrhage in the newborn infant associated with silicone elastomer vacuum extractor. J Perinatol. 1994; 14 (2): 95–100.
  20. Wetzel E.A., Kingma P.S. Subgaleal hemorrhage in a neonate with factor X deficiency following a non-traumatic cesarean section. J Perinatol. 2012; 32 (4): 304–5. DOI: 10.1038/jp.2011.122
  21. Chaturvedi A., Chaturvedi A., Stanescu A.L. et al. Mechanical birth-related trauma to the neonate: An imaging perspective. Insights Imaging. 2018; 9 (1): 103–18. DOI: 10.1007/s13244-017-0586-x
  22. Ilagan N.B., Weyhing B.T., Liang K.C. et al. Radiological case of the month. Neonatal subgaleal hemorrhage. Arch Pediatr Adolesc Med. 1994; 148 (1): 65–6. DOI: 10.1001/archpedi.1994.02170010067015
  23. Nicholson L. Caput succedaneum and cephalohematoma: the cs that leave bumps on the head. Neonatal Netw. 2007; 26 (5): 277–81. DOI: 10.1891/0730-0832.26.5.277
  24. Reid J. Neonatal subgaleal hemorrhage. Neonatal Netw. 2007; 26 (4): 219–27. DOI: 10.1891/0730-0832.26.4.219
  25. Rabelo N.N., Matushita H., Cardeal D.D. Traumatic brain lesions in newborns. Arq Neuropsiquiatr. 2017; 75 (3): 180–8. DOI: 10.1590/0004-282X20170016
  26. Akangire G., Carter B. Birth Injuries in Neonates. Pediatr Rev. 2016; 37 (11): 451–62. DOI: 10.1542/pir.2015-0125
  27. Eliachar E., Bret A.J., Bardiaux M. et al. H’ematome sous-cutan’e cr anien du nouveau-n’e [Cranial subcutaneous hematoma in the newborn]. Arch Fr Pediatr. 1963; 20: 1105–11.
  28. Vacca A. Birth by vacuum extraction: neonatal outcome. J Paediatr Child Health. 1996; 32 (3): 204–6. DOI: 10.1111/j.1440-1754.1996.tb01553.x
  29. Pape K.E., Wigglesworth S. Birth trauma. Haemorrhage, ischaemia and the perinatal brain. Clin Develop Med. 1979; 69 (70): 62–5.
  30. Colditz M.J., Lai M.M., Cartwright D.W. et al. Subgaleal haemorrhage in the newborn: A call for early diagnosis and aggressive management. J Paediatr Child Health. 2015; 51 (2): 140–6. DOI: 10.1111/jpc.12698
  31. Swanson A.E., Veldman A., Wallace E.M. et al. Subgaleal hemorrhage: risk factors and outcomes. Acta Obstet Gynecol Scand. 2012; 91 (2): 260–3. DOI: 10.1111/j.1600-0412.2011.01300.x