Parents are often taken by surprise when their infant is diagnosed with newborn subgaleal hemorrhage.
What Is Newborn Subgaleal Hemorrhage?
A diagnosis of newborn subgaleal hemorrhage is typically given when bleeding occurs in the space between the scalp and the skull. The condition is most often associated with a vacuum extraction birth. In other words, during approximately 10 percent of vaginal deliveries, a vacuum extractor or foceps is used to help pull the baby out of the birth canal. Vacuum extractors are used more often than forceps, and the force of the suction could cause a subgaleal hemorrhage or hematoma.
While the risk of this condition during a delivery is considered rare, its complications could be deadly. In some cases, a newborn subgaleal hemorrhage may be misdiagnosed or overlooked completely, so recognition and quick diagnosis is extremely important. A hematoma of this type could result in the following:
- Intracranial hemorrhage
- Respiratory distress
Because a diagnosis is typically associated with a swelling of the crown of the head, recognition of this condition may not occur for several hours. It may be even as much as two or three days until the swelling is noticed. This is where much of the danger lies with patients experiencing hemorrhagic shock before a problem is noted.
It is recommended that hospitals require that all babies delivered by vacuum extraction be assessed for head size and vital signs during the immediate newborn period.
How can subgaleal hemorrhage be prevented? There are several steps that hospital personnel should take when using a vacuum extractor during a vaginal delivery.
- When using the vacuum extractor, the cup should be applied in the correct place on the newborn's head. This is called the flexion point, and when done correctly, the method will bring the infant's head into the mother's pelvis at the appropriate angle for delivery. While it can be difficult to find the correct area of the head to apply the suction cup, it is imperative that doctors do this.
- The manufacturers of the vacuum extractor should have listed specific guidelines concerning the amount of force and duration of suction. There should also be a limited number of cup pop-offs. It is thought that when a cup pops off the scalp, this could cause blood vessels to tear, creating a hematoma.
- Doctors should also monitor the use of the vacuum extractor closely, recognizing that malfunctions could occur.
- Hospital personnel should also monitor the infant closely for several hours, and even days, after a vacuum extraction delivery.
The treatment for a subgaleal hematoma can vary from close monitoring to pediatric intensive care. Some babies require blood transfusions to maintain their circulation. This is especially important in preventing the baby from going into shock. Pressure wrapping of the head has been used in some cases, but there is no definite proof that this treatment will work. Pressure wrapping often involves attaching a cap to the top of the head and attaching it under the chin. A baby's bilirubin levels should also be monitored as jaundice could occur as well.
The trauma of birth, whether vaginally or through Caesarian section, is well-documented. However, the fragility and delicate nature of an infant's body, including his head tissues, make him that much more vulnerable to injury when outside force through vacuum extraction must be used. The risk increases when the vacuum extractor is not placed properly on the baby's head or the use of the vacuum is prolonged.
In most births, doctors will not know in advance if there will be a necessity for the use of forceps or a vacuum. Be sure and discuss all of these possibilities and risks with your doctor while you are pregnant.