Subgaleal Hematoma Research Articles

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

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

Seizures in a Term Newborn.

Seizures in a Term Newborn.

Vacuum assisted delivery outcomes. Does advanced maternal age matter?

This study evaluated whether advanced maternal age during vacuum-assisted delivery (VAD) leads to a higher rate of adverse maternal and neonatal outcomes. This retrospective cohort study included all nulliparous women who underwent a singleton, VAD in our institution, from 2014 through 2019. The women were grouped according to maternal age ≥ 35 in the study group and < 35 in the control group. Power analysis calculation determined that a sample size of at least 225 women in each group was sufficient to detect significant differences between groups in the rate of third- and fourth-degree perineal tears and umbilical cord pH < 7.15. primary maternal outcomes were third- and fourth-degree perineal tears. primary neonatal outcomes were umbilical cord pH < 7.15. Secondary outcomes were maternal blood loss, Apgar scores, cup detachment, and subgaleal hematoma. Outcomes were compared between the two groups. During the study period, 13,967 nulliparous women delivered in our institution, including 8,810 (63.1%) spontaneous vaginal deliveries, 2,432 (17.4%) instrumental deliveries and 2,725 (19.5%) cesarean sections. The rate of operative vaginal delivery was higher in the advanced maternal age group. Among the vaginal deliveries, 10,116 (90%) were to women < 35, with 2,067 (20.5%) successful vacuum-assisted delivery VAD, and 1,126 (10%) were to women ≥35 years, with 348 (30.9%) successful VAD. There were no significant differences in the rates of third and fourth-grade perineal lacerations or lower cord pH between the study groups. Although there was no difference in the indications for the procedure between the groups, advanced maternal age was associated with a higher head station during the pre-procedure assessment (p=0.002). Vacuum-assisted delivery is not associated with a higher risk for adverse maternal or neonatal outcomes among women with advanced maternal age.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Traumatic brain injury of childhood

Traumatic brain injury of childhood

Neurological neonatal birth injuries caused by vacuum-assisted delivery

Many complications can occur to a new-born during a vacuum-assisted delivery. Vacuum-assisted deliveries are considered to be safe and there seems to be insufficient evidence of long-term neurodevelopmental effects. There has always been a debate among clinicians about the risk of major neonatal injury using vacuum extraction. The major complications presented in this article are: intracranial haemorrhage, subgaleal haemorrhage, seizures, cerebral infarction, hypoxic-ischemic encephalopathy and permanent brachial plexus injury. We included several retrospective studies discussing these major complications. The incidence of vacuum related birth injuries was proven to be higher than the incidence of spontaneous birth injuries; however, the overall incidence was low.

Spontaneous Calvarial Infarction with Epidural Hematoma and Subgaleal Hemorrhage in a Teenager with Sickle Cell SS Disease and Glucose-6-Phosphate Dehydrogenase Deficiency

Introduction:Sequelae of sickle cell disease (SCD) are often the result of vaso-occlusion (VOC) related to the dysmorphic shape of sickled red blood cells (RBC). Bone infarction occurs commonly in patients with sickle cell, most notably in long bones and axial skeleton. Infarct occurs much less frequently in the bones of the skull. Calvarial bone infarct results in MRI findings of T2 hyperintensity in areas of bone marrow edema with associated swelling or hemorrhage. Symptomatic headaches in children with SCD are more likely to be due to severe underlying cerebral pathologies than in those children without SCD. When evaluating a child with SCD presenting with headache, it is important to consider calvarial infarct.Case Description:A 15 year old male with a history of sickle cell disease (type SS) and G6PD deficiency presented with chief complaints of headache and swelling over the left parietal region of the skull for two days with associated left sided visual disturbance. He denied head trauma or seizure-like activity. Upon presentation he was febrile with tachycardia and a normal neurological exam. CT scan of his head was significant for a left subgaleal hemorrhage and bilateral epidural midline and left parietal fluid collections consistent with bone marrow infarcts and associated subacute epidural hematomas, without evidence of brain parenchymal injury or sinus venous thrombosis. A follow up MRI obtained during hospitalization indicated that the left subgaleal hematoma remained stable with breakdown of subgaleal blood products. The patient was treated primarily with supportive care including hydration, packed red blood cell transfusions and pain management. He did not require neurosurgical intervention. His hospital course was complicated by VOC, sickle cell hepatopathy and acute chest syndrome.Discussion:Rarely, cranial VOC has resulted in epidural hematoma. In this case, calvarial infarct with unilateral headache, acute vision loss and acute cranial swelling resulted in subgaleal hemorrhage. This clinically significant finding results from bleeding between the periosteum and scalp galea aponeurosis, which may lead to hypovolemic shock. Calvarial infarcts should be considered on the differential in sickle cell disease patients presenting with a headache as prompt diagnosis can improve morbidity outcomes. DisclosuresNo relevant conflicts of interest to declare.

Clinical case of combined diabetes insipidus and cerebral salt-wasting syndrome in a patient with craniocerebral and spinal injury

Introduction. Cerebral salt-wasting syndrome and diabetes insipidus are serious complications of craniocerebral injury and spinal cord injuries. Each of the syndromes in some cases causes a life-threatening condition. This determines the importance of timely diagnosis and emergency intensive care measures. In the literature, there are only single descriptions of combinations of these symptoms in one patient.Clinical case report. A victim with craniocerebral injury and cervical spinal cord injury underwent, according to emergency indications, emptying and drainage of a tense subgaleal hematoma of the fronto-parieto-occipital region, spinal cord decompression, and stabilization of the spine. Postoperative follow-up and intensive care: on the 1st day the rate of diuresis was 2.5 mL/kg/h, blood glucose level – 14.18 mmol/L, and sodium level – 148–158 mmol/L. The patient was diagnosed with diabetes insipidus, and a therapy with desmopressin at a dose of 0.6 mg/day, restoration of fluid volume with hypotonic solutions, and correction of hyperglycemia was started. On the 4th day blood sodium level was 133 mmol/L, and blood glucose level – 8.67 mmol/L. On the 5th day, hyponatremia of 126–115 mmol/L was noted with a diuresis rate of 4 mL/kg/h and glicemya level of 7.86 mmol/L. The development of cerebral salt-wasting syndrome was diagnosed, and the infusion of hydrocortisone 400 mg/day and of 10% NaCl solution was started. On the 6th day glucose level returned to normal. On the 9th day of follow-up, an increase in the volume of diuresis was again observed, and desmopressin therapy was continued. Stable normalization of water-electrolyte balance, urine output, and glucose levels were observed on the 16th day of follow-up.Conclusion. Monitoring of fluid balance and electrolyte composition of blood serum, and adequate replacement therapy were the conditions for successful treatment of a rare combination of diabetes insipidus and cerebral salt-wasting syndrome in patients with concomitant craniocerebral and spinal cord injuries.

Rapid Disappearance of Acute Unilateral Epidural Hematoma Due to Compression of Contralateral Subdural Hematoma.

A 54-year-old man presented with unconsciousness for 2 hours after head trauma. Brain CT revealed vanished epidural hematoma and expanded subdural hematoma compared with brain CT performed 1 hour before (Figure). An operation plan to evacuate the left subdural hematoma and then the right subgaleal hematoma was made.1 However, respiratory and cardiac arrest occurred, accompanied by lasting hypotension, and blood test revealed acute disorders of coagulation and decreased platelets contraindicating surgery. He received conservative treatment and died 36 hours after trauma. Although rare, acute epidural hematoma total shifts into subgaleal hematoma could occur because of rapidly increased intracranial pressure in patients with coagulation disturbance.

Vacuum Drains versus Passive Drains versus No Drains in Decompressive Craniectomies–A Randomized Controlled Trial on Subgaleal Drain Complication Rates (VADER Trial)

Subgaleal drains are generally deemed necessary for cranial surgeries including decompressive craniectomies (DCs) to avoid excessive postoperative subgaleal hematoma (SGH) formation. Many surgeries have moved away from routine prophylactic drainage but the role of subgaleal drainage in cranial surgeries has not been addressed. This was a randomized controlled trial at 2 centers. A total of 78 patients requiring DC were randomized in a 1:1:1 ratio into 3 groups: vacuum drains (VD), passive drains (PD), and no drains (ND). Complications studied were need for surgical revision, SGH amount, new remote hematomas, postcraniectomy hydrocephalus (PCH), functional outcomes, and mortality. Only 1 VD patient required surgical revision to evacuate SGH. There was no difference in SGH thickness and volume among the 3 drain types (P= 0.171 and P=0.320, respectively). Rate of new remote hematoma and PCH was not significantly different (P= 0.647 and P=0.083, respectively), but the ND group did not have any patient with PCH. In the subgroup analysis of 49 patients with traumatic brain injury, the SGH amount of the PD and ND group was significantly higher than that of the VD group. However, these higher amounts did not translate as a significant risk factor for poor functional outcome or mortality. VD may have better functional outcome and mortality. In terms of complication rates, VD, PD, and ND may be used safely in DC. A higher amount of SGH was not associated with poorer outcomes. Further studies are needed to clarify the advantage of VD regarding functional outcome and mortality, and if ND reduces PCH rates.

Adverse outcomes in vacuum-assisted delivery after detachment of non-metal cup: a retrospective cohort study.

To evaluate neonatal and maternal outcomes associated with detachment of non-metal vacuum cup during delivery and to identify risk factors for these detachments. This retrospective cohort study included women with singleton pregnancy, who underwent vacuum-assisted vaginal delivery with a non-metal vacuum cup in a single academic institution, January 2014-August 2019. Failed vacuum deliveries were excluded. Primary outcomes were defined as subgaleal hematoma (SGH) and cord blood pH < 7.15. Secondary outcome included other neonatal complications and adverse maternal outcomes. Outcomes were compared between vacuum-assisted deliveries with and without cup detachment during the procedure. A total of 3246 women had successful VAD and met the inclusion criteria. During the procedure, the cup detached at least once in 665 (20.5%) deliveries and did not detach in 2581 (79.5%). The cup detachment group experienced higher rates of SGH (8.9% vs. 3.5%, p = 0.001) and cord blood pH < 7.15 (9.8% vs. 7.1%, p = 0.03). There were also more neonatal intensive care unit admissions (NICU) (4.4% vs. 2.7%, p = 0.03) and more fetuses with occiput posterior position (70.8% vs. 79.4%, p = 0.001), the vacuum duration was slightly longer (6 ± 3.7 vs. 5 ± 2.9min) and more neonates had birth weights > 3700g (14.1% vs, 10.3%, p = 0.006). Interestingly, there were more males in that group (60.6 vs. 54.6, p = 0.005). All these factors remained significant after controlling for potential confounders. Vacuum cup detachment has several predictive characteristics and is associated with adverse neonatal outcomes that should be incorporated into decisions made during the procedure.

Patients with early-stage cervical cancer have an increased risk of preterm birth in a population-based cohort study

<h3>Objectives:</h3> Cancer therapy can impact not only fertility but also the course of a subsequent pregnancy. Over 40% of women with cervical cancer will be diagnosed prior to age 45 and many will have not completed childbearing. Those with early-stage disease are eligible for fertility-sparing surgery (FSS), which is increasingly utilized. We sought to evaluate obstetric outcomes among cervical cancer patients in a population-based cohort. <h3>Methods:</h3> This is a population based retrospective study of women age 18-45 years with a history of (FIGO 2009) stage IA1-IB1 cervical cancer reported to the California Cancer Registry (CCR) for the years 2000-2012. CCR data were linked to the 2000-2015 California Office of Statewide Health Planning and Development (OSPHD) birth and discharge datasets to establish a linked database with both oncologic characteristics and obstetric outcomes. Exposure status was defined as cervical cancer patients who conceived at least 3 months after fertility-sparing surgery (FSS) and delivered after 23 weeks gestational age (GA). The primary outcome was preterm birth, and only the first pregnancy following cancer diagnosis was considered. Secondary outcomes included growth restriction, fetal demise, neonatal morbidity (any of the following: need for respiratory support within 72 hours of life, hypoxic-ischemic encephalopathy, seizure, sepsis/pneumonia, meconium aspiration syndrome, birth trauma, and intracranial or subgaleal hemorrhage), and severe maternal morbidity (SMM) as defined by the CDC. Propensity score was used to match similar women in 2 groups in a 1:2 ratio (when possible) of cases to controls: group 1: women who conceived at least 1 year prior to their cervical cancer diagnosis; group 2: healthy controls. Wald statistics and logistic regression were used to evaluate outcomes. <h3>Results:</h3> Of the 4087 patients who were 18-45 years at time of cervical cancer diagnosis, 40.9% (n=1671) had a recorded pregnancy. Of those, 113 conceived following FSS and were primarily non-Hispanic White (52.2%) followed by Hispanic (31.9%) with a median age of 32 years (29-36). The majority had squamous cell carcinoma histology (62.8%), and of those with known type of surgery (97.3%), 90.9% had a LEEP or conization and 9.1% had a trachelectomy. Prematurity rates prior to 32 and 37 weeks were 5.3% and 26.5% respectively, and the live birth rate was 99.1%. Propensity score matching yielded 213 group 1 controls and 226 group 2 controls. Cervical cancer was associated with higher odds of preterm birth before 32 weeks compared to healthy controls (OR 4.17 95% CI 1.023-16.99), but not compared to control group 1, and higher odds of preterm birth before 37 weeks compared to both control groups (OR 2.39, 95% CI 1.34-4.25; OR 3.94, 95% CI 2.10^-7.38, control 1, 2 respectively). There were no differences between the groups in rates of: growth restriction (5th or 10th percentile), fetal demise, and delivery via cesarean section. Neonatal morbidity was more common among the cervical cancer cohort compared to both control groups (OR 2.69, 95% CI 1.29-5.64; OR 2.3, 95% CI 1.15-4.72, control 1,2 respectively). <h3>Conclusions:</h3> In a population-based cohort, patients who conceived at least 3 months following surgery for early-stage cervical cancer had a high live birth rate, but higher odds of preterm delivery and consequent neonatal morbidity compared to matched controls who had a pregnancy prior to their diagnosis as well as healthy controls.

Raccoon eyes in a newborn

Introduction: Periorbital ecchymoses or “raccoon eyes” in the neonate/infant may be due to basal skull fractures or neuroblastoma. Case Report: A term male baby born by vacuum-assisted delivery developed a medium size subgaleal hematoma on the first day of life (DOL). On the third DOL, bilateral periorbital ecchymosis (raccoon eyes) developed. The cerebral ultrasound, hematologic and coagulation studies were normal. The raccoon eyes were interpreted as an extension of the subgaleal hematoma to the orbital ridges. At DOL 38, he was thriving and the raccoon eyes were resolved. Discussion: “Raccoon eyes” may result from a subgaleal hematoma without fracture caused by birth trauma.

Maternal and Neonatal Complications Resulting From Vacuum-Assisted and Normal Vaginal Deliveries.

BackgroundOperative vaginal delivery is a procedure that is performed using forceps or vacuum to extract an infant from the birth canal. It has many indications, one of which is prolonged second stage of labor. Although rare, vacuum extraction (VE) can lead to various neonatal and maternal complications. The objective of this study was to compare the rates of different neonatal and maternal complications between vacuum-assisted deliveries and spontaneous vaginal deliveries.MethodsThis is a retrospective cohort study that was conducted in King Abdulaziz Medical City, Jeddah (KAMC-J), Saudi Arabia. The data were collected from the Labor and Delivery Unit at KAMC-J. A total of 745 samples was included (586 delivered spontaneously and 157 delivered by VE). Analysis was performed using the Statistical Package for Social Sciences (SPSS) Version 27.0.ResultsThe median age was 30 years (IQR=36-34). Of all deliveries, vacuum was used in 21.1%. Perineal tear was the most frequent maternal complication (20.9%), while caput succedaneum was the commonest neonatal complication (11.8%). Post-partum hemorrhage was significantly higher among vacuum deliveries (RR=18.8; 95% CI: 5.5-64.15), as well as cephalohematoma (RR=28.9; 95% CI: 8.79-95.04) and caput succedaneum (RR=18.6; 95% CI: 10.99-31.49). The first-minute Apgar score was lower with VE (p < 0.001), and higher perineal tear degrees were reported with VE (p < 0.001).ConclusionThe rates of maternal and neonatal complications were significantly higher among vacuum-assisted deliveries. The most serious neonatal complication was subgaleal hematoma, which is considered life-threatening. Further research is recommended to investigate subgaleal hematoma risk factors.

Outcomes of the First Pregnancy After Fertility-Sparing Surgery for Early-Stage Ovarian Cancer.

To evaluate the outcomes of the first pregnancy after fertility-sparing surgery in patients treated for early-stage ovarian cancer. We performed a retrospective study of women aged 18-45 years with a history of stage IA or IC ovarian cancer reported to the California Cancer Registry for the years 2000-2012. These data were linked to the 2000-2012 California Office of Statewide Health Planning and Development birth and discharge data sets to ascertain oncologic characteristics and obstetric outcomes. We included in the case group ovarian cancer patients who conceived at least 3 months after fertility-sparing surgery. The primary outcome was preterm birth, and only the first pregnancy after cancer diagnosis was considered. Secondary outcomes included small-for-gestational-age (SGA) neonates, neonatal morbidity (respiratory support within 72 hours after birth, hypoxic-ischemic encephalopathy, seizures, infection, meconium aspiration syndrome, birth trauma, and intracranial or subgaleal hemorrhage), and severe maternal morbidity as defined by the Centers for Disease Control and Prevention. Propensity scores were used to match women in a 1:2 ratio for the case group and the control group. Wald statistics and logistic regressions were used to evaluate outcomes. A total of 153 patients who conceived after fertility-sparing surgery were matched to 306 women in a control group. Histologic types included epithelial (55%), germ-cell (37%), and sex-cord stromal (7%). Treatment for ovarian cancer was not associated with preterm birth before 37 weeks of gestation (13.7% vs 11.4%; odds ratio [OR] 1.23, 95% CI 0.69-2.20), SGA neonates (birth weight less than the 10th percentile: 11.8% vs 12.7%; OR 0.91, 95% CI 0.50-1.66), severe maternal morbidity (2.6% vs 1.3%; OR 2.03, 95% CI 0.50-8.25), or neonatal morbidity (both 5.9% OR 1.00, 95% CI 0.44-2.28). Patients who conceived at least 3 months after surgery for early-stage ovarian cancer did not have an increased risk of adverse obstetric outcomes.

Scalp Swelling and Headache in a 12-year-old Boy

1. Kathryn Westphal, MD* 2. Respicius Bakalemwa, MD† 3. Elizabeth Groothuis, MD, MPH* 1. *Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 2. †Department of Pediatrics, Bugando Medical Centre, Mwanza, Tanzania A 12-year-old boy with sickle cell disease (SCD) is admitted to a hospital in Mwanza, Tanzania, with acute onset of periorbital and scalp swelling. Associated symptoms include fever, headache, difficulty breathing, and back pain. Because resources in sub-Saharan Africa are limited, access to comprehensive care for patients with SCD is variable. The general principles of management focus on early diagnosis, parental education, prevention of infection with vaccinations and prophylactic medications, prompt treatment of infection and pain, the use of hydroxyurea for stroke prevention, and blood transfusions for life-threatening anemia. This patient has a known diagnosis of SCD but has infrequent pain episodes and no previous transfusions. He is not receiving hydroxyurea or prophylaxis against bacterial infections or malaria. He has no history of stroke and no known head trauma. On presentation he is afebrile and his heart rate is 120 beats/min, respiratory rate is 40 breaths/min, and blood pressure is 105/75 mm Hg. His oxygen saturation is 92% in room air. Physical examination is significant for pallor, periorbital edema, scalp edema, dyspnea without adventitious lung sounds, and splenomegaly with diffuse abdominal tenderness. His scalp edema is fluctuant and extends posteriorly from the periorbital region, encompassing the entire scalp. Swelling is most prominent in the frontal and parietal areas. The overlying skin is nonerythematous and nontender but is warm to the touch. His neurologic examination has no focal findings, although generally he appears tired. Initial laboratory results demonstrate a white blood cell count of 84,000/μL (84×109/L) with a lymphocytic predominance (57%), a hemoglobin level of …

Point-of-care Ultrasound to Distinguish Subgaleal and Cephalohematoma: Case Report.

IntroductionCephalohematomas generally do not pose a significant risk to the patient and resolve spontaneously. Conversely, a subgaleal hematoma is a rare but more serious condition. While it may be challenging to make this diagnostic distinction based on a physical examination alone, the findings that differentiate these two conditions can be appreciated on point-of-care ultrasound (POCUS). We describe two pediatric patient cases where POCUS was used to distinguish between a subgaleal hematoma and a cephalohematoma.Case ReportsWe describe one case of a 14-month-old male brought to the pediatric emergency department (PED) with concern for head injury. A POCUS examination revealed a large fluid collection that did not cross the sagittal suture. Thus, the hematoma was more consistent with a cephalohematoma and less compatible with a subgaleal hematoma. Given these findings, further emergent imaging was deferred in the PED and the patient was kept for observation. In the second case an 8-week-old male presented with suspected swelling over the right parietal region. A POCUS examination was performed, which demonstrated an extensive, simple fluid collection that extended across the suture line, making it more concerning for a subgaleal hematoma. Given the heightened suspicion for a subgaleal hematoma, the patient was admitted for further imaging and evaluation.ConclusionPoint-of-care ultrasound can be used to help differentiate between a subgaleal hematoma and a cephalohematoma to risk-stratify patients and determine the need for further imaging.

Perinatal outcome after vacuum assisted delivery with digital feedback on traction force; a randomised controlled study

BackgroundLow and mid station vacuum assisted deliveries (VAD) are delicate manual procedures that entail a high degree of subjectivity from the operator and are associated with adverse neonatal outcome. Little has been done to improve the procedure, including the technical development, traction force and the possibility of objective documentation. We aimed to explore if a digital handle with instant haptic feedback on traction force would reduce the neonatal risk during low or mid station VAD.MethodsA two centre, randomised superiority trial at Karolinska University Hospital, Sweden, 2016–2018. Cases were randomised bedside to either a conventional or a digital handle attached to a Bird metal cup (50 mm, 80 kPa). The digital handle measured applied force including an instant notification by vibration when high levels of traction force were predicted according to a predefined algorithm. Primary outcome was a composite of hypoxic ischaemic encephalopathy, intracranial haemorrhage, seizures, death and/or subgaleal hematoma. Three hundred eighty low and mid VAD in each group were estimated to decrease primary outcome from six to 2 %.ResultsAfter 2 years, an interim analyse was undertaken. Meeting the inclusion criteria, 567 vacuum extractions were randomized to the use of a digital handle (n = 296) or a conventional handle (n = 271). Primary outcome did not differ between the two groups: (2.7% digital handle vs 2.6% conventional handle). The incidence of primary outcome differed significantly between the two delivery wards (4% vs 0.9%, p < 0.05). A recalculation of power revealed that 800 cases would be needed in each group to show a decrease in primary outcome from three to 1 %. This was not feasible, and the study therefore closed.ConclusionsThe incidence of primary outcome was lower than estimated and the study was underpowered. However, the difference between the two delivery wards might reflect varying degree of experience of the technical equipment. An objective documentation of the extraction procedure is an attractive alternative in respect to safety and clinical training. To demonstrate improved safety, a multicentre study is required to reach an adequate cohort. This was beyond the scope of the study.Trial registrationClinicalTrials.gov NCT03071783, March 1, 2017, retrospectively registered.

ИСПОЛЬЗОВАНИЕ МЕТОДА NPWT В ЛЕЧЕНИИ ОБШИРНОЙ НАГНОИВШЕЙСЯ ПОДШЛЕМНОЙ ГЕМАТОМЫ У ВЗРОСЛОГО

Negative pressure wound therapy (NPWT) has been proven to be one of the most effective techniques in the treatment of severely infected wounds of various origins and localizations. At the same time, the prospects for its application are constantly expanding. This clinical observation demonstrates the use of NPWT in the treatment of an adult patient hospitalized in severe condition with a picture of extensive post-traumatic infected subgaleal hematoma. The development of a generalized suppurative purulent process was contributed both by the patient’s late request for medical help (18&lt;sup&gt;th&lt;/sup&gt; day after the injury) and, as a consequence, the lack of primary surgical treatment of the scalp soft tissue injury, as well as the anatomical features of this area. The magnetic resonance tomography as instrumental examination methods played a significant role in the diagnosis of complications in addition to clinical data. Medical tactics was based on the surgical treatment of the infected focus, the application of antibacterial therapy, taking into consideration the isolated microbial flora (Streptococcus pyogenes). To eliminate severe inflammatory changes in the tissues and to reduce the size of the vast subaponeurotic cavity, NPWT technique was applied, which made it possible in short time to prepare a postoperative wound for surgical closure. The early secondary suturing at the final stage of treatment allowed obtaining a good result.

The role of sonographic head circumference in the occurrence of subgaleal hemorrhage following vacuum delivery

Objective Subgaleal hemorrhage (SGH) is a severe neonatal morbidity that is associated with vacuum-assisted delivery (VAD). Large sonographic head circumference (sHC) was previously associated with complicated VAD. Nevertheless, the association of large sHC with SGH formation following VAD is underreported. We aim to evaluate the role of sonographic head circumference (sHC) with SGH formation following attempted VAD. Methods A retrospective case-control study. Cases comprised singleton pregnancies for whom attempted VAD resulted in SGH with an sHC measured within 2 weeks from delivery. Controls were VAD deliveries which not resulted in SGH, with an sHC measured within 2 weeks from delivery. We matched controls in a 1:1 ratio by gestational age, parity and year of delivery. Results Overall, 118 women were included in the SGH study group and were matched to 118 controls. Baseline maternal and fetal characteristics were similar between the groups except for higher neonatal birth weight in the SGH group (median 3422 vs. 3195 grams, p = .001). sHC did not vary between groups (median 336 mm in SGH groups vs. 333, p = .08). Rate of sHC >90th and >95th percentile did not significantly differ between the groups (13.6% vs. 8.5%, 6.8% vs. 3.4%, p = .21, p = .37, for SGH vs. controls, respectively). In multivariate regression analysis, sHC was not found to be independently associated with SGH – aOR (95% CI) 1.004 (0.97–1.03). Receiver operating characteristic curves of sHC for SGH formation underlined an area under the curve of 0.58 (95% CI) (0.51–0.65). Conclusions sHC is not associated with SGH formation following VAD

385 Head injuries related to birth trauma during vacuum extraction in low birth-weight neonates

To evaluate the impact of vacuum extraction on neonatal head injuries related to birth trauma, among new-borns with low birth weight (BW) (<2,500 g) using a non-metal vacuum cup. Retrospective cohort study of 3335 women with a singleton pregnancy, ≥34 gestational weeks delivered by a vacuum extraction, between 2014 and 2019. The current study compared head injuries related to birth trauma, and rates of other neonatal complications of 207 (6.2%) neonates with a BW < 2,500 g to 3128 (93.8%) neonates with higher BW, divided into three subgroups (2,500-2,999g, 3,000-3,499g, ≥3,500g) The lowest rates of subgaleal hematomas occurred in neonates with low BW < 2,500g (0.5%) and increased with every additional 500 g of neonatal weight (3.2%, 4.4% and 7.6% in 2,500-2,999g, 3,000-3,499g, ≥3,500g groups respectively, p=0.001). Cephalohematomas were also significantly lower among low BW neonates (0.5% in <2,500gs BW) and increased with every additional 500 g to BW (2.6%, 3.3% and 3.8% in 2,500-2,999g, 3,000-3,499g, ≥3,500g groups respectively, p=0.026). Primary Composite Neonatal Outcome – including head injuries related to birth trauma, fractures of humerus or clavicle and erb's palsy- increased with increasing weight as well (1% among neonates weighing < 2,500g, versus 6.2%, 8.2% and 13.6% in 2,500-2,999g, 3,000-3,499g, ≥3,500g groups respectively, p=0.000). Logistic regression found increasing neonatal weight as a risk factor for subgaleal hematoma and cephalohematoma during vacuum assisted vaginal deliveries. NICU hospitalization rates were highest among neonates weighing <2,500 g (10.1%) compared to the other groups (2.7%, 1.7% and 3.3% in 2,500-2,999g, 3,000-3,499g, ≥3,500g respectively, p=0.000). Vacuum extraction of neonates weighing <2500 g at 34 weeks and beyond seems to be a safe mode of delivery when indicated, with lower rates of head injuries related to birth trauma compared to neonates with higher birth weights.View Large Image Figure ViewerDownload Hi-res image Download (PPT)