Subgaleal hemorrhage: risk factors and outcomes

Subgaleal hemorrhage in the newborn is a serious adverse event that is often unrecognized and under‐appreciated. This retrospective case series aimed to determine perinatal factors associated with subgaleal hemorrhage and subsequent neonatal outcomes. Obstetric and neonatal details of 21 infants with subgaleal hemorrhage over a 10‐year period were collected. The mother was primiparous in 95% cases, 48% had a prolonged second stage (>120 minutes) and 43% had prolonged rupture of membranes (>12 hours). Thirteen infants (62%) were born by instrumental vaginal delivery. Ten infants (48%) required resuscitation at delivery. The severity of subgaleal hemorrhage was mild in four infants (19%), moderate in 10 (48%) and severe in seven (33%). Hypovolemic shock developed in 10 infants (48%), encephalopathy in 13 (62%) and coagulopathy was present in five infants (24%). There were three (14%) deaths. Long‐term outcomes were good in the surviving infants.

[1]  J. Kuint,et al.  Rescue recombinant activated factor VII for neonatal subgaleal hemorrhage. , 2009, The Israel Medical Association journal : IMAJ.

[2]  R. Tubbs,et al.  Contribution of surgical evacuation of a large subgaleal hematoma to the resolution of severe conjugated hyperbilirubinemia in a neonate. Case report. , 2007, Journal of neurosurgery.

[3]  C. Hünseler,et al.  Recombinant activated factor seven in acute life-threatening bleeding in neonates: report on three cases and review of literature , 2006, Journal of Perinatology.

[4]  D. Damron.  Forceps compared with vacuum: rates of neonatal and maternal morbidity. , 2006, Obstetrics and gynecology.

[5]  N. Boo,et al.  Risk factors associated with subaponeurotic haemorrhage in full‐term infants exposed to vacuum extraction , 2005, BJOG : an international journal of obstetrics and gynaecology.

[6]  H. Ba’aqeel,et al.  Failed individual and sequential instrumental vaginal delivery: contributing risk factors and maternal–neonatal complications , 2003, Acta obstetricia et gynecologica Scandinavica.

[7]  M. Levy,et al.  Neonatal Subgaleal Hematoma Causing Brain Compression: Report of Two Cases and Review of the Literature , 2003, Neurosurgery.

[8]  D. J. Davis,et al.  Neonatal subgaleal hemorrhage: diagnosis and management. , 2001, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[9]  J. Kurinczuk,et al.  Neonatal subgaleal haematoma: Associated risk factors, complications and outcome , 1996, Journal of paediatrics and child health.

[10]  P. Govaert,et al.  Vacuum extraction, bone injury and neonatal subgaleal bleeding , 1992, European Journal of Pediatrics.

[11]  W. Plauché.  Subgaleal hematoma. A complication of instrumental delivery. , 1980, JAMA.

[12]  Harvey B. Sarnat,et al.  NEONATAL ENCEPHALOPATHY FOLLOWING FETAL DISTRESS , 1977 .

[13]  H. Sarnat,et al.  Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. , 1976, Archives of neurology.