Subgaleal hematoma causing hypovolemic shock during delivery after failed vacuum extraction: a case report

Subgaleal hematomas are potentially lethal intracranial bleedings, occurring most commonly in the neonate after difficult vacuum extraction. We report a case of hypovolemic shock occurring at birth after failed extraction and subgaleal bleeding. Subgaleal hematomas may form because of preexisting risk factors (e.g., coagulopathy), but vacuum extraction itself predisposes an infant toward subgaleal bleeding. Although the frequency of these bleedings has decreased with introduction of silicone extraction cups, the risk of subgaleal bleeding after vacuum extraction continues to be increased for primiparous women; severe dystocia, occiput lateral or posterior head presentations; and repeated, forceful, or prolonged use of vacuum suction. The presence of ballotable cranial fluid collections and signs of volume loss in a neonate raise the possibility of subgaleal bleeding. Treatment, if the subgaleal hematoma is symptomatic, requires restoration of blood volume and control of bleeding, inasmuch as these hematomas can be fatal if not treated. Prevention may require limitation of the frequency and duration of vacuum assistance in high-risk infants.