Parasagittal intraparenchymal hemorrhage in complicated second stage labour: a report of three cases

Abstract

The increased use and mastery of ceasarian section for deliveries and the refinement of technologies for assisted delivery in the setting of dfficult second stage of labour have made intrapartum deaths more rare and modern obstetrical pracices are rarely accompanied by the classic forceps related intracranial injuries. We document a novel pattern of intracranial injury in three cases of neonatal death following prolonged labor, of which two out of three required vacuum and forceps.All three showed similar bilateral parasagittal intraparenchymal haemorrhages and cerebral edema, in a pattern reminiscent of “gliding contusion, as well as subgaleal haemorrhage of varying amout. Two out of the three cases showed parietal bone fractures and one demonstrated extensive craniolcuniae. We briefly discuss the significance of these findings and implications for future cases.LEARNING OBJECTIVESThis presentation will enable the learner to:1.Explore the current theories leading to neonatal death in prolonged labor2.Summarize the known pathological findings associated with vacuum and forceps3.Discuss the significance of intraparenchymal hematoma in the setting of prolonged delivery