"Subgaleal hemorrhage"

Prevention, detection, and management of subgaleal haemorrhage in the newborn Prevention, detection, and management of subgaleal haemorrhage in the newborn (C-Obs 28) Page 1 of 14 Clinical Guidance Statement Prevention, detection, and management of subgaleal haemorrhage in the newborn This statement has been developed and reviewed by the Women’s Health Committee and approved by the RANZCOG Board . This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The document has been prepared having regard to general circumstances. First endorsed by RANZCOG: July 2009 Current: November 2021 Review due: November 2026 Objectives: To provide advice on the prevention, detection and management of subgaleal haemorrhage in the newborn. Target audience: All health

Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction. Subgaleal hemorrhage (SGH) is a life-threatening neonatal condition that is strongly associated with vacuum assisted delivery (VAD). The factors associated with the development of SGH following VAD are not well-established. We aimed to evaluate the factors associated with the development of SGH following

Encephalopathy in neonates with subgaleal hemorrhage is a key predictor of outcome. Subgaleal hemorrhage (SGH) is reported to be associated with severe hemodynamic instability, coagulopathy, and even mortality. The importance of the presence or absence of neonatal encephalopathy in predicting SGH outcomes has not been explored. The aim of this study was to determine the relationship of clinical

, RR 2.48, 95% CI 1.59 to 3.87)22 Lower Higher *Flatus incontinence/altered continence (1 study, n=130, RR 1.77, 95% CI 1.19 to 2.62)22 Lower Higher Levator avulsion (7 studies; n=977, OR 4.45, 95% CI 3.09 to 6.42)23 Lower Higher Subgaleal haemorrhage (SGH) Rate per 1000 instrumental births 3 to 7.6/100024 1.6/100025 *Other maternal outcomes22: blood loss, pain on day four, caesarean section (CS Available from: www.health.qld.gov.au/qcg © State of Queensland (Queensland Health) 2020 Page 5 of 6 Post-intervention care Aspect Consideration Baby care • Perform neonatal surveillance according to risk for SGH [refer to RANZCOG statement on Subgaleal haemorrhage in the newborn32] o Use Neonatal Early Warning Tool (NEWT) or similar to record observations33 • Collect paired cord blood gas samples

. • There was little to no difference found in length of second stage (MD -8.60 minutes, 95% CI -24.15 minutes to 6.95 minutes). • There was little to no difference found in rates of spontaneous vaginal birth (RR 1.07 95% CI 0.95-1.20). • There was little to no difference found in neonatal outcomes of NICU admission, five-minute Apgar score, or subgaleal haemorrhage between the manual rotation and sham groups

different than placebo. • There was no evidence comparing different mechanical methods with each other, with membrane sweeping or with expectant management in the outpatient setting. • For all comparisons, there was insufficient evidence on time from admission to vaginal birth, perinatal mortality, fetal/neonatal intracranial or subgaleal hemorrhage, hypoxic-ischemic encephalopathy, and maternal

with a soft cup OR 1.65, 95% CI 1.19-2.29), but are associated with more scalp injuries (24% versus 13% OR 0.45, 95 % CI 0.15-0.60). 6 To minimise the risk of subgaleal haemorrhage, shearing forces on the scalp should be minimised (eg. avoid ‘rocking’). Cup placement should be: i. Placed evenly across the sagittal suture, rather than being applied to one or other parietal bone to avoid asynclitism , as the rapid decompression may result in vessel damage and predispose to subgaleal haemorrhage. The acceptable number of detachments will depend on whether detachment was due to equipment failure, or to poor application and/or excessive traction. Up to three detachments would generally be considered acceptable, but re-application of the cup on each occasion should only be considered where there has been

, subgaleal hemorrhage, intracranial hemorrhage, facial nerve injury, and brachial plexus injury (BPI). χ2 and multivariable Poisson regression analyses were used to assess the association between hospital OVD volume and outcomes. Among 306 818 OVDs (mean [SD] birthing parent's age, 28.5 [6.2] years; 155 157 patients with public insurance [50.6%]), hospitals with low OVD volume had an increased proportion of obstetric anal sphincter injury compared with hospitals with medium and high volumes (12.16% [7444 patients] vs 11.07% [10 709 patients] vs 9.45% [14 064 patients]). Hospitals with low volume also had a higher proportion of adverse neonatal outcomes, including shoulder dystocia (3.84% [2351 patients] vs 3.50% [3386 patients] vs 2.80% [4160 patients]), subgaleal hemorrhage (0.27% [165 patients] vs 0.18

, region, level of obstetric care and institutional OVD volume. We conducted a cohort study of all singleton, term deliveries in Canada between April 2013 and March 2019, excluding Quebec. Our main outcome measures were maternal trauma (e.g., obstetric anal sphincter injury, high vaginal lacerations) and neonatal trauma (e.g., subgaleal hemorrhage, brachial plexus injury). We calculated adjusted

bilateral involvement. Clinical symptoms include abdominal mass, poor feeding, vomiting, prolonged jaundice, and anemia. Subgaleal hemorrhage (SGH) is one of the most clinically remarkable and potentially hazardous postnatal cranial injuries. An early-term Iranian male neonate who was born through spontaneous vaginal delivery and experienced shoulder dystocia was diagnosed with bilateral NAH leading

cesarean delivery and a perinatal composite (death, respiratory support, 5-minute Apgar score 3 or less, hypoxic ischemic encephalopathy, seizure, sepsis, meconium aspiration syndrome, birth trauma, intracranial or subgaleal hemorrhage, or hypotension requiring vasopressor support). Other outcomes included a maternal composite (blood transfusion, surgical intervention for postpartum hemorrhage

hours of ageþ Central cyanosis• Petechiae new/unrelated to birth• Pallor, haemangiomaHead and neckþ Enlarged/bulging/sunken fontanelle• Macro/microcephalyþ Subgaleal haemorrhage• Caput, cephalhaematoma• Fused sutures• Facial palsy/asymmetry on crying• Hazy, dull cornea; congenital cataract• Absent red eye reflex• Pupils unequal/dilated/constricted• Purulent conjunctivitis/yellow scleraþ Nasal

/unrelated to birth• Pallor, haemangiomaHead and neckþ Enlarged/bulging/sunken fontanelle• Macro/microcephalyþ Subgaleal haemorrhage• Caput, cephalhaematoma• Fused sutures• Facial palsy/asymmetry on crying• Hazy, dull cornea; congenital cataract• Absent red eye reflex• Pupils unequal/dilated/constricted• Purulent conjunctivitis/yellow scleraþ Nasal obstruction• Dacryocyst; cleft lip/palate• Unresponsive percentile) þ Subgaleal haemorrhage • Caput/cephalhaematoma (consider potential for developing jaundice) • Fused sutures Queensland Clinical Guideline: Newborn baby assessment (routine) Refer to online version, destroy printed copies after use Page 15 of 25 Table 7. Newborn baby examination continued Aspect Clinical assessment Indications for further investigation þ Urgent follow-up Face20,24

/unrelated to birth• Pallor, haemangiomaHead and neckþ Enlarged/bulging/sunken fontanelle• Macro/microcephalyþ Subgaleal haemorrhage• Caput, cephalhaematoma• Fused sutures• Facial palsy/asymmetry on crying• Hazy, dull cornea; congenital cataract• Absent red eye reflex• Pupils unequal/dilated/constricted• Purulent conjunctivitis/yellow scleraþ Nasal obstruction• Dacryocyst; cleft lip/palate• Unresponsive percentile) þ Subgaleal haemorrhage • Caput/cephalhaematoma (consider potential for developing jaundice) • Fused sutures Queensland Clinical Guideline: Newborn baby assessment (routine) Refer to online version, destroy printed copies after use Page 15 of 25 Table 7. Newborn baby examination continued Aspect Clinical assessment Indications for further investigation þ Urgent follow-up Face20,24

DD, Roshan A, Canela CD, et al; Shoulder DystociaRaines DA, Krawiec C, Jain S; Cephalohematoma.Swanson AE, Veldman A, Wallace EM, et al; Subgaleal hemorrhage: risk factors and outcomes. Acta Obstet Gynecol Scand. 2012 Feb91(2):260-3. doi: 10.1111/j.1600-0412.2011.01300.x. Epub 2011 Dec 16.Assisted Vaginal Birth; Royal College of Obstetricians and Gynaecologists (Green-top Guideline No. 26). April 2020Wetzel EA, Kingma PS; Subgaleal hemorrhage in a neonate with factor X deficiency following a non-traumatic cesarean section. J Perinatol. 2012 Apr32(4):304-5. doi: 10.1038/jp.2011.122.Chang HY, Peng CC, Kao HA, et al; Neonatal subgaleal hemorrhage: clinical presentation, treatment, and predictors of poor prognosis. Pediatr Int. 2007 Dec49(6):903-7.Jacob K, Hoerter JE; Caput Succedaneum.Luo TD, Levy ML

in the neonatal period.Extravasated bloodSignificant areas of bruising, such as severe cephalohematoma, subgaleal hemorrhage or peripheral ecchymoses from birth trauma, can result in an increased bilirubin load in the serum as the blood collection resolves. Internal areas of hemorrhage, such as pulmonary or intraventricular bleeds, can also be a significant occult source of serum bilirubin.Enzyme inductionAs