A subgaleal hemorrhage is a type of brain bleed in newborns. Brain bleeds and hemorrhages may not be visible but they present a serious danger to the baby. Serious bleeding inside the head can put the baby at risk of serious injury, encephalopathy, or death.
Bleeding in the skull can be caused by trauma, including head trauma during delivery. These types of injuries can increase with the use of extraction devices, like vacuums or forceps. When a doctor improperly delivers the child, causing serious injury, the doctor should be held responsible for their actions. A medical malpractice lawsuit can help the family recover damages to cover the costs of care, medical bills, and emotional damages.
What is a Subgaleal Hemorrhage in Newborns?
A subgaleal hemorrhage is bleeding in the skull between the periosteum layer and the scalp. Subgaleal hematoma (SGH) is a serious complication where blood accumulates in the skull. A hematoma can pose a risk to the infant by putting pressure on the sensitive brain tissue, causing damage to brain cells.
Too much blood in the skull can also take away blood from supplying oxygen to the brain and other vital organs. Subgaleal hemorrhage can lead to hypovolemia. Up to a quarter of babies who require neonatal intensive care for subgaleal hemorrhage die from the condition. There may also be a higher rate of disability associated with severe SGH which causes cerebral injury.
The consequences of skull hemorrhages can be severe. It may cause brain damage, developmental delays, seizures, physical disabilities, cerebral palsy, and other medical problems. Early recognition of a hemorrhage and proper treatment are vital in reducing the extent of damage done and reducing the likelihood of permanent injury.
Bleeding inside the head is categorized by where the bleeding occurs. Some of the bleeding injuries involve traumatic head injuries for infants include:
- Cerebral hemorrhage (bleeding within the brain)
- Intracranial hemorrhage (bleeding inside the skull)
- Epidural hemorrhage (bleeding in the dura mater)
- Subgaleal hemorrhage (bleeding between the epicranial aponeurosis and the periosteum)
- Subdural hemorrhage (bleeding between the dura mater and the arachnoid membrane)
- Subarachnoid hemorrhage (bleeding in the space between the arachnoid membrane and the pia mater)
- Caput succedaneum (bleeding between the skin and the epicranial aponeurosis
Dangers of Extraction Devices in Delivery
A common cause of subgaleal hematoma and other bleeding in the skull is extraction devices during delivery. Extraction devices include a vacuum extractor and obstetrical forceps. The vacuum extractor, or “ventouse,” is used to aid in delivery of the baby. The vacuum or forceps can be used in a difficult delivery, including when:
- The mother is no longer able to help push,
- Secondary stages of labor have gone on for an extended period,
- There are signs of fetal distress, or
- Maternal illness where bearing down could risk the mother’s health.
About 5% of newborns in the US are born with an assisted delivery, or 1 in 20 babies. Health organizations prefer the use of vacuum extractors over forceps for safety reasons. However, any assistive device could pose a risk of traumatic head injury to the child. When a vacuum extractor is used improperly, it can cause head injuries to the child, including subgaleal hemorrhage.
Causes of Neonatal Subgaleal Hemorrhage
Most cases of neonatal subgaleal hemorrhage occur with assisted devices during delivery. According to the Journal of Pediatrics and Child Health, the “association between vacuum extraction and SGH is well described.”
In 1998, the FDA issued a public health advisory because of the 500% increase in reported morbidity and mortality from subgaleal hemorrhage after vacuum extraction deliveries. Canada issued a similar advisory the following year.
Signs and Symptoms of Subgaleal Hemorrhage
The physical signs of possible hematoma or hemorrhage in the skull include swelling on the head. A mass may develop over the scalp with superficial bruising. The swelling may begin within 12 to 72 hours after delivery. In severe cases, swelling may begin immediately after delivery.
A baby with SGH may present with hemorrhagic shock. Hemorrhagic shock is a type of hypovolemic shock. In neonatal subgaleal hemorrhage, shock may be caused by a drop in fluid volume that impairs the body’s ability to pump blood through the circulatory system.
Blood tests may show hyperbilirubinemia caused by reabsorption of blood. When bilirubin, a substance in the blood, builds up to very high levels it can then spread into a baby’s brain tissues, leading to kernicterus and permanent brain damage. Blood tests may also show lower levels of hemoglobin and hematocrit.
Subgaleal Hemorrhage Treatment and Outcome
Early diagnosis and treatment can be key to recovery. If SGH is immediately identified and treated, the child has a good chance of recovery with no long-term complications. However, the more extensive the injury and the longer the hemorrhage continues before treatment can increase the risk of serious brain injury or death.
Treatment involves close monitoring of the baby, looking for signs of hemorrhagic shock, jaundice, and hyperbilirubinemia. If the baby’s fluid volume is too low, fluids may be administered. In some cases, blood transfusion and phototherapy may be required.
Subgaleal Hemorrhage and Signs of Medical Malpractice
Subgaleal hemorrhage may be caused by medical malpractice. If a doctor improperly uses a vacuum extractor on a baby, it may cause head trauma and bleeding in the scalp. In some cases, when a doctor made a mistake, they may try and avoid responsibility, which could delay treatment and could make the problem worse.
In some deliveries, the use of a vacuum extractor may be the wrong way to deliver the baby. Contraindications for vacuum extraction include:
- Fetal prematurity (<34 weeks of gestation)
- Fetal scalp trauma
- Unengaged head
- Incomplete dilation
- Active bleeding
- Suspected macrosomia
- Cephalopelvic disproportion
- Breech or other nonvertex presentations
Using a vacuum suction device during delivery when medical standards are against such devices may be a deviation from the standard of care. If the doctor breaches the standard of care which causes injury to the baby or mother, the doctor may be liable for damages. A medical malpractice lawsuit will allow the injury victims to recover medical costs, pain and suffering, and other costs associated with a medical injury.
Philadelphia Birth Injury Attorneys
At Gilman & Bedigian, we will use our experience, knowledge, and dedication to investigate birth injuries caused by medical malpractice. Our aggressive Philadelphia trial lawyers have helped Pennsylvania families recover millions of dollars in compensation for birth injury negligence. Contact us online or call our law office at (800) 529-6162 for a free consultation.