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

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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 infants 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 patients 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.

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作者简介

E. Shestak

Yekaterinburg Clinical Perinatal Center; Ural State Medical University, Ministry of Health of Russia

编辑信件的主要联系方式.
Email: shestakev@yandex.ru

D. Svetlakova

Yekaterinburg Clinical Perinatal Center

Email: shestakev@yandex.ru

K. Desyatnik

Yekaterinburg Clinical Perinatal Center

Email: shestakev@yandex.ru

参考

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1. JATS XML
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2. Fig. 1. Partograms of Patient M. (the data have been provided by K.A. Desyatnik)

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3. Fig. 2. Location of the fetal head in relation to the spinal plane (Sp) (source: UpToDate.com)

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4. Fig. 3. Cardiotocography at the time of operative vacuum extraction of the fetus (the data have been provided by K.A. Desyatnik)

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5. Fig. 4. Plain radiography of the skull in frontal and lateral projections; there are multiple defects in the cortical layer of the parietal bone; obvious soft tissue edema up to 20 mm (the data have been provided by E.V. Shestak)

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6. Fig. 5. Ultrasonography of soft tissues of the head: а – aponeurosis; б – blood accumulation; в – parietal bone (the data have been provided by O.I. Fedotova)

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7. Fig. 6. Subgaleal hematoma in the baby on the first day of life; a 2.5-cm head circumference increase since birth (the data have been provided by E.V. Shestak)

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