Extracranial hemorrhage in babies admitted to neonatal units over a 10-year period

Abstract

Abstract
Background: Extracranial hemorrhage is one of the complications of instrumental delivery associated with increased
risk of mortality. Absence of published data in Ethiopia on this issue was the motivation for this study.
Objective: The objective of this study is to review extracranial hemorrhage cases (cephalhematoma and subgaleal
hemorrhage) and outcomes of treatment.
Methods: A retrospective record review of extracranial hemorrhage case series admitted to the neonatal unit between
January 1993 and December 2002 was undertaken. Antepartum and intrapartum history, neonatal problems developed
due to extracranial hemorrhage, progress evaluated by clinical, laboratory and anthropometric indicators and the final
outcomes were analyzed.
Results: A total of 701 cases of extracranial hemorrhage were registered during the study period. Of which, 76.6%
were subgaleal hemorrhage and 24.4% were cephalhematoma with 74 and 15 deaths, respectively. Instrumental
delivery or attempts alone accounted for 71.5 % of subgaleal hemorrhage cases. In contrast, more cases of
cephalhematoma were found in spontaneous vertex delivery, breech delivery, health center and home deliveries. The
severity of blood loss in subgaleal hemorrhage was marked by causing 81.9% cases of of severe anemia, of which 106
being found in hemorrhagic shock and 87.9% above 90th percentile head circumferences.
Conclusion: Although instrumental delivery or attempt was dominant on the occurrence of subgaleal hemorrhage,
there was no mode of delivery safe for extracranial hemorrhage. Cephalhematoma was not always benign as reported
in literature. Hemorrhagic shock was the commonest cause of death in both subgaleal hemorrhage and
cephalhematoma. The choice and application of instrumental delivery are areas of further investigation.
[Ethiop.J.Health Dev. 2004;18(3):190-198]