Hematoma Injuries in Childbirth

Hematoma refers to the collection of blood outside of a blood vessel which occurs when there is damage to the wall of a blood vessel, artery, vein or capillary allowing the blood to leak into the tissues. Hematoma is one of the injuries that can happen in a trauma at birth and most often it occurs in the baby’s head. In most cases, the head is the first to come out of the birth canal and thus is susceptible to injuries because it receives a lot of pressure especially in a prolonged and difficult delivery. Two of the most common types of hematoma that happen during childbirth are Cephalohematoma and Subdural Hematoma.

Cephalohematoma

A Cephalohematoma is one of the most common cranial injuries that an infant may suffer especially during a forceps-assisted delivery or vacuum extraction. It can also result from a prolonged labor. It is characterized by the swelling of an infant's scalp as a result of hemorrhaging or a collection of blood between the infant’s skull—most often the parietal or occipital bone and the periosteum, a tough thin tissue that surrounds the bone. Although it is most common in the parietal and occipital regions, it can also happen in other locations. The swelling will appear as a squishy or slightly hardened and reddish lump on the baby’s head.

Cephalohematoma usually requires no special treatment and resolves on its own over a few weeks to three months. However, if the cephalohematoma is severe, the baby may develop jaundice, anemia or hypotension. To determine the extent of the hematoma, the infant may be made to undergo a head CT scan. The procedure could also rule out skull fractures as a Cephalohematoma can also be indicative of a linear skull fracture.

Cephalohematoma is most often caused by a prolonged second stage of labor or ventouse-assisted delivery. In most cases, no medical intervention such as draining is required because the swelling will eventually go down as the blood is slowly re-absorbed from the periphery to the center. Although, severe cephalohematoma may take longer to resolve as it can become infected and require surgical drainage. Also, the swelling will harden and will appear as a depressed skull fracture.

Subdural Hematoma

Subdural Hematoma, on the other hand, is a collection of blood in the space between the outer and middle layers of the covering of the brain as a result of torn and bleeding veins which may have been caused by a traumatic birthing process.

Most of the infants suffering from subdural hematoma are those who have a history of traumatic or instrumental delivery. The condition commonly develops after a craniocerebral trauma often in association with linear skull fractures.

An infant suffering from subdural hematoma will have swollen or bulging fontanelles or "soft spots" in the skull, focal seizures, generalized tonic-clonic seizures, increased sleepiness, irritability, vomiting, restlessness, stupor, shock with pallor and papillary dilatation.

The severity of a subdural hematoma will depend on its size. Those smaller in size may not pose a threat because the blood may be absorbed over a few weeks. Large subdural hematomas, however, are of utmost concern because it can lead to death. In this case, the bleeding may have stopped but the hematoma is continuing to grow. A hematoma that continues to grow will increase the pressure inside the skull and compress the brain which can result to damage or even death. When this happens, a surgery needs to be conducted to drain the blood and relieve the pressure.