Neonatal Subgaleal Hemorrhage “A fatal complication of vacuum extraction delivery”

Objective: Neonatal subgaleal hemorrhage is a rare but potentially lethal complication of instrumentaldelivery, particularly vacuum extraction. It is often underreported and underdiagnosed. Theprevalence of subgaleal hemorrhages varies from 0.04 to 0.15% of all deliveries. We describe twocases of severe subgaleal hemorrhage (SGH) and review the key elements of identification andtreatment.Case report: The first case was a female neonate with birth weight 2220gr that was born by vacuumassisted vaginal delivery. At birth, the infant was pale, flaccid with no respiratory effort. She wasgrossly pale with poor perfusion, lethargic, decreased muscle tone, anemia, and hypovolemic shock.On her head a large fluctuant swelling was seen. She died at 20th hours of age. The second case was a full term male neonate that was born with cesarean section after an unsuccessful 2 to 3 time vacuumextraction. At birth the infant was limp, cyanotic with weak respiratory effort. After 7th hours, asevere fluctuant swelling was found on his head with head circumference of 38.5 cm and ecchymosisaround his orbits. He developed anemia and seizure. After successful treatment, he was released fromhospital.Conclusion: Increased awareness of SGH should lead to earlier identification, referral and treatment,with resultant improved outcomes.