Parents are often taken by surprise when their infant is diagnosed with newborn subgaleal hemorrhage. This is a rare but serious bleeding condition that requires medical attention.
What Is Subgaleal Hemorrhage in Newborns?
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 forceps 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.
Risks of Subgaleal Hemorrhage
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:
- Anemia
- Intracranial hemorrhage
- Respiratory distress
- Seizures
- Shock
- Death
Diagnosing Subgaleal Hemorrhage
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.
Preventing Subgaleal Hemorrhage in Newborns
How can subgaleal hemorrhage be prevented? Prevention is in the hands of your labor and delivery team. There are several steps that hospital personnel should take when using a vacuum extractor during a vaginal delivery.
Apply Vacuum Extractor in the Correct Position
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.
Manufacturers Need to List Guidelines
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.
Monitor Vacuum Extraction and Newborn Infant Closely
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.
Treating Your Baby's Subgaleal Hemorrhage
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.
Protecting Your Baby After the Trauma of Birth
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.
What can Parents Do?
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. If your baby was delivered by vacuum, talk with your doctor and nurses about your baby's post-delivery care, including care of your baby once you bring him home.
