Subgaleal Hematoma

Subgaleal hematoma is a serious complication at birth that can lead to serious consequences to new born infants. Subgaleal hematoma is a bleeding between the skull’s periosteum and the scalp’s tough layer of dense fibrous tissue which covers the upper part of the cranium, the galea aponeurotica. Many risk factors contribute to a higher chance of subgaleal hematoma:

  • First time delivery
  • Excessive infant weight
  • Prolonged labor
  • Cephalopelvic disproportion
  • Infant prematurity

Vacuum Extractions – Major Risk Factor

The major risk factor for subgaleal hematoma is use of vacuum extraction to help deliver the baby. Most cases of subgaleal hematoma (90%) are the result of a vacuum extraction. Vacuum extractions can rupture the emissary veins causing accumulation of blood between the scalp and periosteum. Subgaleal hematoma is highly associated (40%) with the occurrence of head trauma including intracranial hemorrhage or skull fracture.

Vacuum extractions are an alternative to forceps and cesarean section deliveries. With vacuum extractions, a metal or soft cup is placed over the infant’s head and traction is applied. The leverage applied helps pull the infant through the mother’s birth canal.

Vacuum Extractions – Medical Guidelines

Because of concern over potential birth injuries and trauma including subgaleal hematoma, medical guidelines have been created indicating when vacuum extractors are appropriate for use. Situations include prolonged second stage labor, potential infant compromise, maternal disease requiring limited maternal expulsive efforts, and elective outlet delivery. Vacuum extractors should not be used when the presentation of the baby is other than cephalic (for example, breech presentation), the mother is less than 32 weeks gestational, and there exists cephalopelvic disproportion (the baby’s head or body is too large to fit through the mother’s pelvis). A vacuum extraction can only be considered when:

  • the infant’s head is deeply engaged (at least zero station)
  • the mother’s cervix is fully dilated
  • the position and station of the baby’s head is identified with certainty
  • there is adequate maternal analgesia (lack of sensibility to pain while somebody is conscious)
  • facilities are present for neonatal resuscitation
  • the mother’s bladder is empty
  • cephalopelvic disproportion is absent

While vacuum extraction has many benefits as compared to use of forceps (easier to use, less maternal analgesia and trauma) making it a preferred method of vaginal delivery, this method has potential to cause extensive birth injury and trauma including subgaleal hematoma. In order to prevent unnecessary trauma or injury, including subgaleal hematoma, vacuum extraction should be approached as a trial of vaginal delivery. The intention should be to abandon vaginal delivery if the infant is not delivered within limits. For example, progress in the baby’s descent should accompany each traction attempt. The vacuum should be removed and other means used (cesarean section) to deliver the baby if:

  • there is no descent with traction
  • the infant is not delivered after three or four tractions
  • the cup pops off once or twice
  • the total time of the attempt is 15 to 30 minutes

Subgaleal Hematoma – Legal Advice

It is important for health care providers to be aware of medical guidelines so as to not deviate from a relevant standard of care. If providers deviate from these guidelines, they can take actions that may cause unnecessary injury or trauma to an infant at birth including subgaleal hematoma. Subgaleal hematoma can have potentially serious consequences including coagulopathy. If you have given birth to a child and that child has suffered birth injuries or trauma as a result of subgaleal hematoma, you might want to discuss your legal options with an experience legal professional. The attorneys and lawyers at Seeger Weiss LLP have extensive experience seeking compensation for victims of various forms of medical malpractice including birth injuries and trauma from subgaleal hematoma. Please contact Seeger Weiss for a free case evaluation, or call 888-584-0411.

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