1/11. "Growing fontanelle": a serious complication of difficult vacuum extraction.Growing skull fractures in combination with leptomeningeal cysts are well known in childhood. A rare case of a growing fontanelle due to a leptomeningeal cyst is presented. The cyst occurred due to a traumatic delivery with vacuum extraction. Operative repair of the cyst revealed a dural tear at the border of the fontanelle. The imaging findings are discussed.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/11. Ultrasound-guided needle aspiration of cranial epidural hematoma in a neonate: treating a rare complication of vacuum extraction.Epidural hematoma is a rare form of neonatal birth injury accounting for 2% of newborn intracranial hemorrhage. We report the first case of ultrasound-guided needle aspiration of a cranial epidural hematoma in a neonate who also suffered subgaleal and intraparenchymal hemorrhage as a complication of vacuum extraction.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
3/11. Neonatal subgaleal hematoma causing brain compression: report of two cases and review of the literature.OBJECTIVE AND IMPORTANCE: Neonatal subgaleal hematomas (SGHs) are infrequent but underdiagnosed collections of blood beneath the galea, often caused by vacuum delivery. With massive bleeding into the subgaleal space, exsanguination and hypovolemic shock can cause death in 20 to 60% of newborn infants. We report the first two known patients with extracranial cerebral compression caused by SGH. Also, the surgical evacuation of neonatal SGH has not been described previously. CLINICAL PRESENTATION: One patient was a full-term boy who was delivered via vacuum extraction after an uncomplicated pregnancy. Within a few hours, he developed an expanding fluid collection of the scalp and disseminated intravascular coagulation and shock requiring intubation, inotropic support, and blood transfusions. His head circumference grew from 33 cm at birth to 42 cm. He became progressively lethargic and developed posturing movements. Computed tomography of the head revealed a massive SGH causing gross overlapping of the cranial sutures and diffuse cerebral edema. The other patient was a full-term boy delivered via cesarean section after an unsuccessful attempt at vacuum extraction and forceps delivery. The initial head circumference was 34 cm. Within a few hours, he developed an expanding fluid collection of the scalp and became progressively lethargic with posturing. magnetic resonance imaging of the head revealed a massive SGH with cranial compromise and diffuse cerebral edema. INTERVENTION: Both children had radiographic features indicative of elevated intracranial pressure as well as neurological decompensation. The first patient was taken to the operating room, and the hematoma was evacuated through a small scalp incision. Initially, approximately 150 ml of blood was removed, and a Jackson-Pratt drain diverted another 200 ml of blood during the next 2 days. The infant made a good recovery. In the second case, the patient remained too unstable for operative intervention and died. CONCLUSION: Extracranial cerebral compression represents another way by which neonatal SGH may jeopardize the infant's life. Management consists of measures to correct hypovolemic shock and disseminated intravascular coagulation, as well as surgical intervention to control elevated intracranial pressure.- - - - - - - - - - ranking = 0.4keywords = extraction (Clic here for more details about this article) |
4/11. Spiral fracture of the radius: an unusual case of shoulder dystocia-associated morbidity.BACKGROUND: The most common neonatal complications associated with shoulder dystocia include transient brachial plexus palsy, clavicular fracture, and humeral fracture. Fracture of the fetal radius has not been previously reported. CASE: We encountered a shoulder dystocia with the fetal head in the right occiput anterior position that necessitated the McRoberts maneuver, suprapubic pressure, the wood and Rubin maneuvers, and extraction of the posterior fetal arm to effect delivery. The 4610-g infant experienced a spiral fracture of the right (anterior) radius and a fracture of the left (posterior) midhumeral shaft. CONCLUSION: Neonatal radial fracture can result from shoulder dystocia or the maneuvers employed for the alleviation of the shoulder dystocia.- - - - - - - - - - ranking = 0.2keywords = extraction (Clic here for more details about this article) |
5/11. Traumatic neonatal intracranial bleeding and stroke.Ischaemia within the regions supplied by vertebral and posterior cerebral arteries has been described as a complication of birth injury, either by direct trauma or by compression from a herniated temporal uncus. Ischaemia within the territory of the middle cerebral artery has been documented after a stretch injury of the vessel's elastica interna. From a series of seven personal observations on birth trauma and related cerebral stroke, we describe three neonates with the uncal herniation type of occipital stroke and four infants with hypoperfusion of the middle cerebral artery or one of its major branches. In three of the latter a basal convexity subdural haemorrhage probably induced the ischaemia, whereas in the other it was associated with haemorrhagic contusion of the parietal lobe. Experimental work and reports on older children support the idea that vasospasm due to surrounding extravasated blood can be one of the responsible mechanisms. Both forceps delivery and difficult vacuum extraction can be implicated in this supratentorial injury, leading to permanent neurological damage in at least half of the survivors in this series.- - - - - - - - - - ranking = 0.2keywords = extraction (Clic here for more details about this article) |
6/11. Tentorial hemorrhage associated with vacuum extraction.The clinical and radiologic descriptions of three neonates with tentorial hemorrhage after vacuum extraction are reported. All patients were full term, with Apgar scores of 8 or more; one patient experienced fetal distress during delivery. Within 36 hours after birth, the neonates had multiple generalized seizures; computed tomography or magnetic resonance imaging outlined distinctive tentorial hemorrhages with extension over the superior surface of the cerebellum or inferior surface of the occipital lobe. One patient had diffuse hypoxic-ischemic injury, and another had bilateral temporal lobe infarcts. Treatment included medical control of seizures and intracranial hypertension; one patient had surgical evacuation of bilateral subdural hematomas. Follow-up from 1 to 5 years showed significant developmental delays in two patients. These cases demonstrate that the forces generated on the fetal cranium by vacuum extraction are similar to those produced by forceps and result in tentorial laceration, venous rupture, and subdural hemorrhage. Because these hemorrhages may be associated with significant ischemic injury, serial radiologic evaluation is recommended for the detection of persistent structural abnormalities.- - - - - - - - - - ranking = 1.2keywords = extraction (Clic here for more details about this article) |
7/11. Thoracic spinal cord (T3-T4) transection in a breech-presenting, cesarean-section-delivered preterm infant.Thoracic spinal cord transection below the origin of the brachial plexus is a rare event among breech-presenting infants delivered by cesarean section. A case of a thoracic (T3-T4) spinal cord injury with paravertebral hemorrhage mimicking catastrophic intracranial bleeding is presented to illustrate the value of careful application of traction or any longitudinal stretching forces during fetal head extraction.- - - - - - - - - - ranking = 0.2keywords = extraction (Clic here for more details about this article) |
8/11. MR of neurologically symptomatic newborns after vacuum extraction delivery.We present the MR findings in three neurologically symptomatic newborns after vacuum extraction delivery. The lesions included subdural hematomas, one tentorial hematoma, and one intracerebellar hemorrhage. One patient had hydrocephalus that required shunting. We propose that the visualized abnormalities are probably the result of vertical stress leading to laceration of bridging veins, venous sinuses, and/or venous hemorrhagic infarctions.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
9/11. A randomized comparison of vacuum extraction delivery with a rigid and a pliable cup.OBJECTIVE: To compare the effectiveness and complications of obstetric vacuum extraction with a rigid and a pliable cup, with a focus on neonatal retinal hemorrhage. methods: One hundred women requiring assisted delivery who met predefined criteria for vacuum extraction were randomly assigned to be delivered by the classic rigid Malmstrom cup or the pliable Silastic cup. RESULTS: Because of the faster induction of vacuum, delivery occurred more rapidly with the pliable cup, but the pliable cup detached significantly more often than the rigid cup. The overall failure rate was not significantly different between the cups. There were no significant differences between the groups with regard to Apgar scores, umbilical artery pH, birth canal trauma, or maternal blood loss, but scalp injury occurred less frequently with the soft than with the rigid cup. retinal hemorrhage in the newborns showed a similar incidence of about 50%, and neonatal neurologic examination showed no significant differences between the groups. CONCLUSION: In comparison with the rigid cup, the advantage of the pliable cup is limited to a smaller incidence of neonatal scalp injury.- - - - - - - - - - ranking = 1.2keywords = extraction (Clic here for more details about this article) |
10/11. Skull fracture caused by vacuum extraction.BACKGROUND: The vacuum extractor is being increasingly advocated as the instrument of first choice for assisted vaginal delivery. It is widely believed that the vacuum cup will dislodge before causing serious fetal trauma. CASE: Rotational delivery of a term infant was effected using a vacuum extractor. A 6-cm Malmstrom metal cup with a paramedian application was in place for 12 minutes. The vacuum pressure developed was 0.8 kg/cm2. Four traction efforts with contractions were required to deliver the fetal head. A neonatal skull x-ray the following day showed a comminuted parietal bone fracture at the vacuum cup application site. Management was conservative, and the infant's neurologic behavior remained normal. CONCLUSION: The vacuum extractor exerts considerable traction force. Fetal skull fracture can result, and its true incidence may be higher than expected, considering that few neonates with normal neurologic behavior undergo skull x-ray.- - - - - - - - - - ranking = 0.8keywords = extraction (Clic here for more details about this article) |
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