Subgaleal Hematoma Research Articles

Subgaleal hemorrhage in neonates: a comprehensive review and summary recommendations.

Subgaleal hemorrhages (SH) involve bleeding in the expansive compartment between the periosteum of the skull and the galea aponeurotica. The potentially rapid accumulation of blood in this space is responsible for the clinical severity, as neonates with SH can present with acute hypovolemia, shock and multiorgan failure. SH is associated with instrumented delivery, especially with use of vacuum extraction. Although infrequent, the incidence of SH has not decreased over the past several decades, despite improvements in obstetrical care. Management of severe SH is complex and requires cardiovascular support, management of co-existent encephalopathy, and most importantly correction of coagulopathy and anemia.

Unilateral Adrenal Hemorrhage Accompanied by Subgaleal Hematoma with Severe Neonatal Anemia — Case Report

Unilateral Adrenal Hemorrhage Accompanied by Subgaleal Hematoma with Severe Neonatal Anemia — Case Report

Circumscribed Thinning of the Calvaria - A Long-Term Sequela After Vacuum Extraction Delivery

Abstract Background Vacuum extraction deliveries are associated with a number of complications like injuries to the skin, subperiosteal, subgaleal and intracranial hemorrhages. Even skull fractures have been described, but data on persistent changes in the bone structure of the skull like thinning of the calvaria is lacking in the literature. Aims We describe a previously unreported long-term sequela of vacuum extraction delivery. Methods We present a series of 8 children, who were referred because of an irregularity of the cranial surface without other symptoms. The investigations revealed a circumscribed thinning of the calvaria in all 8 cases. Detailed history and the specific clinical findings were crucial in the assessment. Various imaging techniques were used to visualize the lesions and rule out some differential diagnoses. Results All children had undergone a vacuum-assisted delivery. All irregularities of the cranial surface were discovered incidentally. Clinical examination revealed a round (6) or linear (1) channel-shaped indentation of the calvaria in 7 cases. The shape and size of the annular thinning of the calvaria matched devices commonly used in vacuum extraction very well. In one patient, a localized protrusion of the calvaria was investigated, but an indentation more posteriorly was detected in the CT scan. CT scan was performed in 6 patients, in 2, parents refused this examination. In the follow-up, no progression or symptoms was observed in any of the patients. Conclusion Such long-term sequelae after vacuum-assisted delivery have not been reported yet and the underlying mechanism is unclear. In children who present with irregularities of the cranium, an accurate history, including the mode of birth, and detailed clinical examination should be performed. Knowledge about the presented pathology may help to avoid extensive investigations, particularly CT scan. The publication of further cases could help to propagate the circumscribed thinning of the calvaria after vacuum extraction as a distinctive clinical entity.

Incidence and predictors of neonatal seizures among neonates admitted in Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia. A prospective follow-up study

IntroductionNeonatal seizures are the most common neurological problem among newborns. To date, scientific studies on the incidence and predictors of neonatal seizures in African countries, including Ethiopia are scarce. Therefore, this study aimed to assess the incidence and predictors of neonatal seizures among neonates admitted to Debre Markos comprehensive Specialized Hospital. MethodsAn institutional-based prospective follow-up study was conducted in Debre Markos comprehensive specialized hospital from February 1, 2022 to January 30, 2023. A systematic random sampling technique was used to select a total of 198 neonates. Data were entered into Epi-Data 4.2 and then exported to STATA version 14.1 for analysis. The Kaplan-Meier survival curve and the log-rank test were computed to explore the descriptive statistics. Variables with a p-value ≤0.2 in bi-variable Cox-regression were selected for multivariable Cox-regression analysis. Finally, a p-value of <0.05 was used to declare the statistical significance of the association with the outcome variable. ResultsThe overall incidence rate of neonatal seizures was 35 per 1000 person-day observations. The mean follow-up time for this study was 123.4 h. The cumulative survival probability of neonates’ at 0 to 24 and 0–72 h was 89.8 % and 81.71 %, respectively. The statistically significant predictors for the incidence of neonatal seizures were perinatal asphyxia (AHR = 10.95; 95%CI: 4.81, 24.93), subgaleal hemorrhage (AHR = 5.17; 95%CI: 2.09, 12.79), and gestational age <37 weeks (AHR = 4.62; 95%CI: 1.62, 13.22). ConclusionsThe incidence rate of neonatal seizures in this study was high. Neonates born with gestational age <37 weeks, having perinatal asphyxia, and having subgaleal hemorrhage were statistical predictors for the incidence of neonatal seizures. Thus, healthcare professionals should give special attention to neonates born with gestational age <37 weeks, prevent perinatal asphyxia and subgaleal hemorrhage.

Diagnostic imaging features of traumatic subgaleal hematoma in a dog: a case report

Subgaleal hematomas are accumulation of blood between periosteum and galea aponeurosis. A 2-year-old male Chihuahua was presented with a severe head swelling after trauma. Radiography and computed tomography (CT) showed a massive swelling encircling the entire calvarial vault, extending toward the cervical neck and crossing the suture line. It was heterogeneously, mild hyperdense fluid to soft tissue attenuating with contrast enhancement on CT images. On day 4, physical and imaging examination showed resolution of the calvarial swelling. Subgaleal hematoma should be considered as a differential diagnosis when there is a massive soft tissue swelling over the skull on physical and imaging examinations.

Evaluation of overuse of Head Computerized Tomography scan on traumatic brain injury pediatric patients

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality among pediatric patients. Head Computerized Tomography (CT) scan has the undoubtedly benefit of diagnosing TBI lesions but is also associated with increased risk of cancer due to radiation. This study was composed of 190 patients evaluated in the emergency setting of a pediatric Brazilian hospital from January 2019 to December 2021. The results of the study demonstrated an increased amount of CT scans in patients with mild TBI during this period. Besides, we noticed that many of these CT scans showed normal results or clinically insignificant findings such as subgaleal hematomas. Knowing the risks related to radiation exposure at such a young age makes us question the validity of the hospital protocol we are following. Also, we believe that a future solution to this issue would be to implement radiation-free complimentary exams such as Magnetic Resonance Imaging (MRI) to our hospital protocol. Emphasizing the importance of justification of procedures and optimization of radiation doses are also crucial to prevent cancer development in pediatric patients.

Non-Accidental Injury Involving a Neonate

Non-accidental injury (NAI) was brought forward by the investigation and research that was conducted by Ambroise Tardieu, John Caffey and Henry Kempe. Whiplash-shaken infant syndrome and battered child syndrome are the other alternative terms used. NAI is defined as repetitive physical abuse. Marks of injuries such as multiple bruises or abrasions of differing ages and patterns, bite marks, burns and radiological evidence of old bony fractures are valuable indicators in distinguishing nonaccidental from accidental injuries. In addition, birth trauma, bleeding disorders, sepsis, vasculopathy, congenital anomalies, metabolic abnormalities and true accidental injuries must be ruled out beforehand with a meticulous approach when dealing with such deaths. Here, we report a case of a 28-day-old female neonate who was brought in unresponsive by her parents and was pronounced dead at the accident and emergency department. The external examination did not reveal any gross abnormality whereas, the internal examination revealed subgaleal haematoma, subdural and subarachnoid haemorrhage. The microscopic examination revealed retinal haemorrhage. The cause of death was attributed to blunt force trauma to the head. This case is a reminder to all forensic and clinical pathologists that an extremely uncommon manifestation can occur, therefore, a meticulous approach should always be undertaken, before corroborating a cause of death. In conclusion, the findings of the forensic autopsy and histopathology facilitated the investigation and established the cause of death.

Computer-guided cranioplasty using ultra-high molecular weight polyethylene patient-specific implants: a case series

IntroductionCranioplasty is the surgical correction of a cranial defect. Three-dimensional software designs have allowed patient-specific single-step cranial reconstruction for neuroprotection and cosmesis. Ultra-high molecular weight polyethylene for partial or total bone replacement has been recently introduced as a promising material for cranioplasty. The objectives of this study are to evaluate the complications and esthetic results concerning the use of ultra-high molecular weight polyethylene patient-specific implants in craniectomy patients.MethodsWe report a series of nine patients with cranial defects from a previous craniectomy, or patients eligible for simultaneous craniectomy and cranioplasty via computer designed ultra-high molecular weight polyethylene patient-specific implants. We have analyzed the complications and cosmetic outcomes over a course of six months.ResultsNone of the cases developed infection, extra/subdural hematoma, cerebrospinal fluid leak, or implant failure. Three cases had postoperative sequalae: The first patient had mild postoperative seroma which subsided after medical therapy and compression, the second showed wound breakdown due to tumor metastasis and recurrence but did not necessitate implant removal, while the third sequela was a subgaleal hematoma which was aspirated, and the patient healed uneventfully afterward. Esthetic results were highly satisfactory in 75% of the patients (good patient acceptance without touch-ups).ConclusionUltra-high molecular weight polyethylene is in all respects suitable for primary and secondary cranioplasty, combined with computer-aided manufacturing–computer-aided design techniques, excellent esthetic and functional results were achieved. However, proper preoperative planning is important, and we recommend further prospective studies with larger number of patients followed up for longer periods for better assessment.

Differential diagnosis of bulging scalp: beyond cephalohematoma and subgaleal hematoma

A 30-day-old infant was brought to the pediatric emergency room with a bulge in the scalp in the parieto-occipital region, mobile and without associated phlogistic signs. He had no history of fever or any other complaints. The mother reported that the bulge appeared at 20 days of life and showed progressive growth. There was no history of trauma. The boy was born at term by cesarean delivery due to cephalopelvic disproportion.&#x0D; For initial evaluation, skull X-ray and cerebral ultrasound were performed (Figure 1). A magnetic resonance imaging and tomography of the brain were also performed (Figure 1). &#x0D; Faced with the diagnostic challenge, neurosurgery proceeded with drainage of the collection and biopsy of the galea. No malignant cells were found and the biopsy only found an inflammatory change. Given these findings, the diagnosis of delayed subaponeurotic fluid collection (DSFD) was made. There was no recurrence of the collection and the patient had a good evolution.&#x0D; DSFD are a rare condition, which occurs spontaneously between the 4th and 18th week of life, and makes the differential diagnosis with cephalohematoma, caput succedeneum and subgaleal hematoma [1]. Its pathophysiology is not fully elucidated; however, most reports share a similar history of prolonged or instrumented delivery [1,2]. Patients are otherwise healthy and with no history of trauma [2].&#x0D; The management of DSFD is conservative and the natural history is spontaneous resolution within 1 to 2 months [1,2].

Severe neonatal birth injury: Observational study of associations with operative, cesarean, and spontaneous vaginal delivery.

To determine the association of successful and unsuccessful operative vaginal delivery attempts with risk of severe neonatal birth injury. We conducted a population-based observational study of 1 080 503 births between 2006 and 2019 in Quebec, Canada. The main exposure was operative vaginal delivery with forceps or vacuum, elective or emergency cesarean with or without an operative vaginal attempt, and spontaneous delivery. The outcome was severe birth injury, including intracranial hemorrhage, brain and spinal damage, Erb's paralysis and other brachial plexus injuries, epicranial subaponeurotic hemorrhage, skull and long bone fractures, and liver, spleen, and other neonatal body injuries. We determined the association of delivery mode with risk of severe birth injury using adjusted risk ratios (RR) and 95% confidence intervals (CI). A total of 8194 infants (0.8%) had severe birth injuries. Compared with spontaneous delivery, vacuum (RR 2.98, 95% CI 2.80-3.16) and forceps (RR 3.35, 95% CI 3.07-3.66) were both associated with risk of severe injury. Forceps was associated with intracranial hemorrhage (RR 16.4, 95% CI 10.1-26.6) and brain and spinal damage (RR 13.5, 95% CI 5.72-32.0), while vacuum was associated with epicranial subaponeurotic hemorrhage (RR 27.5, 95% CI 20.8-36.4) and skull fractures (RR 2.04, 95% CI 1.86-2.25). Emergency cesarean after an unsuccessful operative attempt was associated with intracranial and epicranial subaponeurotic hemorrhage, but elective and other emergency cesareans were not associated with severe injury. Operative vaginal delivery and unsuccessful operative attempts that result in an emergency cesarean are associated with elevated risks of severe birth injury.

Diastasis coronal suture fracture with frontoparietal (vertex) epidural hematoma in adult

Introduction: Vertex epidural hematoma (VEDH) is an uncommon presentation of extra-axial hematomas and comprises 1-8% of all extradural hematomas. It can represent a surgical dilemma regarding when and how to operate, particularly considering the potential implication of the superior sagittal sinus (SSS). It is estimated that up to 85%-95% of EDHs are associated with skull fractures. Nonetheless, diastasis of cranial sutures in adults has scarce scientific reports, let alone with associated epidural hematoma. Cases: We reported a 42-year-old male patient who came with a main complaint of a lacerated wound on his head due to an accident when he repaired the truck tire. His GCS score was 15 without any neurological deficit. A Head CT scan revealed a hyperdense biconvex lesion on the frontoparietal (vertex), frontal sinus depressed fracture and diastasis fracture of the coronal suture. Craniotomy evacuated EDH and craniectomy elevated depressed fracture with cranialization of frontal sinus were performed. Postoperative there is no surgery complication. Discussion: Vertex epidural hematoma (VEDH) frequently causes a diagnostic dilemma, both clinically and radiographically. Clinically, VEDH are often indicated by elevated intracranial pressure (a headache which is usually severe and unrelenting, nausea, visual impairment, and vomiting). Those resulted from compression of the venous outflow at the SSS and subsequently decreased absorption and outflow of cerebrospinal fluid (CSF), which may not contribute to the establishment of a specific diagnosis. Vertex fractures are present in most cases with a linear fracture line crosses (usually horizontally) the sagittal suture overlying the hematoma or diastasis of the coronal and/or sagittal suture, with or without significant external sub-galeal hematomas, indicating a vertex impact. Conclusion: Vertex epidural hematoma is a rare case. In this case, the patient had GCS score 15 without any neurological deficit. The prompt decision to surgery is vital for good outcomes for the patient with VEDH.

The Association Between the Number of Vacuum Pop-Offs and Adverse Neonatal Outcomes

ABSTRACT Vacuum-assisted vaginal delivery (VAVD) is used to expedite vaginal delivery in cases of an arrest of descent, maternal exhaustion, or concern for fetal well-being. In 2015, the rate of VAVD was greater than the use of forceps in the United States (2.58% vs 0.56%). Several studies have examined various characteristics of vacuum devices, such as cup shape and material, number of pulls, and number of pop-ups, which is defined as the spontaneous dislodgment of the cup from the fetal scalp. Vacuum manufacturers, such as Kiwi and Mityvac, recommend abandoning VAVD as an intervention after 2 or 3 pop-offs; however, the American College of Obstetricians and Gynecologists acknowledges that there are not enough data to recommend guidelines on how many pop-offs should be allowed before discontinuing. Some studies have demonstrated an increased risk of adverse neonatal outcomes with any number of pop-offs versus no pop-offs, whereas other studies have shown no independent association between the number of pop-offs and neonatal head injury. In addition, compared with an increase in the number of pop-offs, a large multicenter study found that increased duration of VAVD has a stronger association with adverse outcomes. The aim of this study was to examine the association between the number of pop-offs and adverse neonatal outcomes. This was a retrospective cohort study conducted at a single tertiary care institution from October 1, 2005, to June 1, 2014. Data were collected from electronic medical records. Included were adult women with singleton pregnancies who delivered via VAVD or a trial of VAVD followed by cesarean delivery. Excluded were those who underwent sequential trials of both vacuum and forceps. Institutional policy recommended converting to cesarean delivery after &gt;3 pop-offs, but the decision was left to the discretion of the physician. The primary outcome was a composite of severe adverse neonatal outcome, including brachial plexus injury, intracranial hemorrhage, convulsions, and central nervous system (CNS) depression. Other outcomes of study were scalp/facial lacerations, intracranial hemorrhage, seizures, CNS depression, and admission to the neonatal intensive care unit (NICU). A total of 1730 women were included in the analysis. Of these, 74.7% had no pop-offs, 13.9% had 1 pop-off, 7.4% had 2 pop-offs, and approximately 4% had ≥3 pop-offs. Approximately 94% delivered via VAVD. As the number of pop-offs increased, the number of scalp/facial lacerations, intracranial hemorrhage, subgaleal hemorrhage, convulsions, CNS depression, and NICU admissions significantly increased. However, there was no association with the composite outcome, as well as severe perinatal laceration, shoulder dystocia, brachial plexus injury, and cephalohematoma. Adjusting for confounders, having any number of pop-offs increased the likelihood of scalp/facial lacerations, intracranial hemorrhage, convulsions, CNS depression, and NICU admission. However, there was not a dose-dependent association in the odds of adverse outcomes as the number of pop-offs increased. Compared with having no pop-offs, having any number of pop-offs was associated with an increase in adverse neonatal outcomes. In addition, the rates of intracranial hemorrhage and subgaleal hemorrhage were increased with greater numbers of pop-offs.

Spontaneous Subgaleal Hemorrhage in a Child with Autism

Objective Women have continued to bear a heavy burden of cardiovascular disease morbidity and mortality with hypertension as the flagship. This is partly because as the modifiable cardiovascular disease risk factors are falling in rate, gender specific risk factors have persisted. One of them is age at first pregnancy and delivery. Methods In order to contribute to this discourse, we secondarily analysed data generated in a previous field study on risk factors for cardiovascular diseases in free living adults in Plateau State, Nigeria. The women were divided into four groups and we looked at blood pressure at the time of study from the perspective of age at first pregnancy. Reults It was found that those who had their first pregnancy in the late teenage years had the lowest mean arterial blood pressure many years down the line; better than those who started child bearing earlier and those who started later. There was also significant within and between group differences in the blood pressures (p = 0.000). Conclusion To stem the tide of female hypertension later in life, child bearing should not start in the early teenage years nor be unnecessarily delayed. Sociocultural conditions that promote early teenage marriage and pregnancy should be discouraged.

Precision of vacuum cup placement and its association with subgaleal hemorrhage and associated morbidity in term neonates.

To evaluate whether the precision of vacuum cup placement is associated with failed vacuum extraction(VE), neonatal subgaleal hemorrhage(SGH) and other VE-related birth trauma. All women with singleton term cephalic fetuses with attempted VE were recruited over a period of 30months. Neonates were examined immediately after birth and the position of the chignon documented to decide whether the cup position was flexing median or suboptimal. Vigilant neonatal surveillance was performed to look for VE-related trauma, including subgaleal/subdural hemorrhages, skull fractures, scalp lacerations. CT scans of the brain were ordered liberally as clinically indicated. The VE rate was 5.89% in the study period. There were 17(4.9%) failures among 345 attempted VEs. Thirty babies suffered from subgaleal/subdural hemorrhages, skull fractures, scalp lacerations or a combination of these, giving an incidence of VE-related birth trauma of 8.7%. Suboptimal cup positions occurred in 31.6%. Logistic regression analysis showed that failed VE was associated with a non-occipital anterior fetal head position (OR 3.5, 95% CI 1.22-10.2), suboptimal vacuum cup placement (OR 4.13, 95% CI 1.38-12.2) and a longer duration of traction (OR 8.79, 95% CI 2.13-36.2); while, VE-related birth trauma was associated with failed VE (OR 3.93, 95% CI 1.08-14.3) and more pulls (OR 4.07, 95% CI 1.98-8.36). Suboptimal vacuum cup positions were related to failed VE but not to SGH and other vacuum-related birth trauma. While optimal flexed median cup positions should be most desirable mechanically to effect delivery, such a position does not guarantee prevention of SGH.

Vacuum-assisted delivery outcomes: is advanced maternal age a factor?

This study evaluated age-related maternal outcomes of vacuum-assisted vaginal deliveries (VAD). This retrospective cohort study included all nulliparous women with singleton VAD in one academic institution. Study group parturients were maternal age ≥ 35years and controls < 35. Power analysis revealed that 225 women/group would be sufficient to detect a difference in the rate of third- and fourth-degree perineal tears (primary maternal outcome) and umbilical cord pH < 7.15 (primary neonatal outcome). Secondary outcomes were maternal blood loss, Apgar scores, cup detachment, and subgaleal hematoma. Outcomes were compared between groups. From 2014 to 2019, 13,967 nulliparas delivered at our institution. Overall, 8810 (63.1%) underwent normal vaginal delivery, 2432 (17.4%) instrumental, and 2725 (19.5%) cesarean. Among 11,242 vaginal deliveries, 10,116 (90%) involved women < 35, including 2067 (20.5%) successful VAD vs. 1126 (10%) women ≥ 35years with 348 (30.9%) successful VAD (p < 0.001). Rates of third- and fourth-degree perineal lacerations were 6 (1.7%) with advanced maternal age and 57 (2.8%) among controls (p = 0.259). Cord pH < 7.15 was similar: 23 (6.6%) study group and 156 (7.5%) controls (p = 0.739). Advanced maternal age and VAD are not associated with higher risk for adverse outcomes. Older, nulliparous women are more likely to undergo vacuum delivery than younger parturients.

Prevalence of Birth Injury and Its Determinants Factors in West Iran in 2020 - 2021

Background: Birth injuries occur during the birth process. The progress made in birth care and prenatal diagnosis has reduced the prevalence of birth injuries around the globe. Objectives: This study aimed to determine the prevalence of birth injuries and their determining factors in Hamadan Fatemieh Hospital, 2020 - 2021. Methods: In this case- control study, all live births between 2020 and 2021 were examined on the first day of birth. In the case of detecting any birth injury, the cases were categorized by injury type and were recorded on a pre-designed form along with the risk factors. An equal number of neonates with no birth injuries were also examined for the same risk factors. Independent test and chi-square test was used to assess in two groups. The results were analyzed using SPSS version 16. Results: During the study, 66 birth injuries were recorded among 5,592 births (incidence rate 11.8 per 1,000 live births). Proportion incidence of birth injuries were caput succedaneum (28.8%), cephalohematoma (22.7%), ecchymosis (9.1%), subgaleal hemorrhage (7.6%), hypoxic-ischemic encephalopathy (7.6%), Erb’s palsy (6.1%), abrasion and subconjunctival hemorrhage (3%), and laceration and humerus fracture and clavicle fracture (1.5%). Control group was included 65 neonates without any types of birth injury whom matched with cases in gestational age and weight. According to findings of two groups, these factors lower gestational age, lower Apgar, delivery method (vaginal), and responsible person for delivery significantly related with incidence of birth injuries (P-value &lt; 0.05). Conclusions: The most prevalent birth injury in Fatemieh Hamadan Medical Training Center was soft tissue injuries, that course training should be provided for health workers.

To Learn, Try Teaching

To Learn, Try Teaching

Head Injuries Related to Birth Trauma in Low Birthweight Neonates During Vacuum Extraction.

Introduction Preterm delivery (gestational age <34w) is a relative contraindication to vacuum extraction. Current data do not differentiate clearly between preterm delivery and low birthweight. We aimed to evaluate the impact of non-metal vacuum cup extraction on neonatal head injuries related to birth trauma in newborns with low birthweights (<2500g). Materials and Methods A retrospective cohort of 3377 singleton pregnancies delivered by vacuum extraction from 2014 to 2019. All were gestational age ≥34w. We compared 206 (6.1%) neonates with low birthweights <2500g to 3171 (93.9%) neonates with higher birthweights, divided into 3 subgroups (2500-2999g, 3000-3499g, and ≥3500g). A primary composite outcome of neonatal head injuries related to birth trauma was defined. Results The lowest rates of subgaleal hematoma occurred in neonates <2500g (0.5%); the rate increased with every additional 500g of neonatal birthweight (3.5%, 4.4% and 8.0% in the 2500-2999g, 3000-3499g, and ≥3500g groups, respectively; p=0.001). Fewer cephalohematomas occurred in low birthweight neonates (0.5% in <2500g), although the percentage increased with every additional 500g of birthweight (2.6%, 3.3% and 3.7% in the 2500-2999g, 3000-3499g, and ≥3500g groups, respectively, p=0.020). Logistic regression found increasing birthweight to be a significant risk factor for head injuries during vacuum extraction, with adjusted odds ratios of 8.12, 10.88, and 13.5 for 2500-2999g, 3000-3499g, and ≥3500g, respectively (p=0.016). NICU hospitalization rates were highest for neonates weighing <2500g (10.2%) compared to the other groups (3.1%, 1.7% and 3.3% in 2500-2999g, 3000-3499g, ≥3500 respectively, p<0.001). Conclusions Vacuum extraction of neonates weighing <2500g at 34w and beyond seems to be a safe mode of delivery when indicated, with lower rates of head injury related to birth trauma, compared to neonates with higher birthweights.

Vacuum extraction outcomes in primiparas delivered with an induction of labor

Induction of labor (IOL) has become a common practice in the western world although it might prolong labors and potentially increase interventions. Vacuum extraction (VE) might result in obstetrical complications due to birth trauma. We aimed to evaluate the impact of an IOL on outcomes of primiparas delivered by VE. A retrospective cohort including primiparas with a singleton pregnancy ≥34w delivered by VE. We estimated delivery complications among deliveries that started with an IOL, compared to deliveries with a spontaneous onset of labor (SO). Included 2,975 deliveries, 1,048 (35.2%) with IOL and 1,927 (64.8%) with a SO. Comparing the basic characteristics between the groups: The rates of pre-gestational and gestational DM were higher in the IOL group (13.5% vs 8.2%, p< 0.001). Obesity rates (BMI >30kg/m2) were similar. Gestational age (GA) at delivery did not have a clinically significant difference (39.6 ± 1.4 in the IOL, 39.2± 1.3 in the SO, p< 0.001). Comparing labor characteristics: Epidural analgesia was more common in IOL (97.9% vs 90.7%, p< 0.001). Neonatal birthweight (BW) was higher in IOL (3210.7g ± 438.7 vs 3155.5 ± 417.3, p=0.001) and also the rates of BW ≥3700g (13.5% vs 8.4% p< 0.001). 2nd stage arrest (SSA) as the indication for VE was relatively common in the IOL group (29.8% vs 23%, p< 0.001), and rates of subgaleal hematomas (SGH) were higher (7.6% vs 4.4%, p< 0.001). Other maternal and neonatal complications: 3rd-4th degree perineal lacerations, blood loss, shoulder dystocia, clavicular fractures, Apgar scores, cord pH< 7.1 and NICU admission were comparable. Logistic regression found IOL as a risk factor for both SSA (aOR 1.3, 95%CI 1.1-1.5) and SGH (aOR 1.6, CI 1.2-2.2) when adjusting for the confounders of maternal age and BMI, GA, DM, epidural and neonatal BW. VE performed in deliveries that were induced were more likely to be performed due to SSA and complicated by increased rates of SGH which might be related to the VE indication. These outcomes can be incorporated into clinical decisions regarding IOL and mode of deliveryView Large Image Figure ViewerDownload Hi-res image Download (PPT)

Prevalence and Patterns of Neonatal Birth Trauma in Ethiopia: Systematic Review and Meta-Analysis.

Introduction. Neonatal death is still alarming in low-income countries including Ethiopia, accounts 30 death per 1000 alive births. Birth trauma is the second most common contributing factors for the death. Nevertheless, there is no aggregate evidence on the prevalence and patterns of neonatal birth trauma in Ethiopia. Therefore, this study aimed to assess the pooled prevalence and patterns of neonatal birth trauma in Ethiopia. Methods. Searching databases including PubMed, MEDLINE, Popline, SCOPUS, Web of Science, EMBASE, CINHAL (EBSCO), Google, Google Scholar, and lists of references were used to search literatures in Ethiopia. STATA version 14 was used for analysis, and the odds ratios of the outcome variable were determined using the random-effects model. Heterogeneity among the studies was assessed by computing values for I2 and P-values. Also, sensitivity analysis and funnel plot were done to assess the stability of pooled values to outliers and publication bias. Results. A total of 6 studies with a sample size of 3663 were included in this study. The overall prevalence of neonatal birth trauma was 15% (95% CI: 13-16). Subgaleal hemorrhage (39%), cephalohematoma (27%), and caput succedaneum (24%) were the most common neonatal birth trauma in Ethiopia. Meta-analyses and sensitivity analyses showed the stability of the pooled odds ratios, and the funnel plots did not show publication bias. Conclusion. This systematic review and meta-analysis revealed a high prevalence of neonatal birth trauma in Ethiopia. Moreover, most of the neonatal birth injuries were severe and life-threatening that need medical attention to safe the neonates and its life long complications.