Head injuries after instrumental vaginal deliveries

The types, mechanisms and clinical manifestations of head injuries (extracranial, cranial and intracranial) after instrumental delivery are described along with current evidence of their prevention and management.

Asymptomatic subdural hematomas can occur in up to 6.1% of uncomplicated vaginal deliveries. Maternal nulliparity, incorrect placement of vacuum extraction cup and failed vacuum extraction are predisposing factors to subgaleal hemorrhage. Injuries associated with the vacuum devices may be minimized if the recommended limits for a safe traction force are not exceeded. There is no difference in the incidence of scalp trauma between vacuum deliveries by a rigid plastic cup (Omnicup) and the standard, silastic cup. The use of a metal cup may increase the occurrence of head injuries. Protective covers over forceps reduce the rates of neonatal facial abrasions and skin bruises. There is no difference in the incidence of cephalhematoma comparing a sequential operative vaginal delivery and a caesarean section following a failed vacuum delivery.

Instrumental vaginal deliveries carry substantial risks. Only practitioners who are adequately trained or are under supervision should undertake instrumental delivery. The mode of intervention needs to be individualized after consideration of the operator's skills and experience and the clinical circumstances.