Neonatal Subgaleal Hemorrhage due to mathernal ITP with Vacuum-assisted Delivery.a rare case report

Back ground and Aim: A rare, but serious and, at times, fatal complication of vacuum extraction delivery is subgaleal (subaponeurotic) hemorrhage (SGH). Hemorrhage in subaponeurotic space of the scalp occurs gradually and may progress to massive hemorrhage and disseminated intravascular coagulation hypovolemic shock and death. Subgaleal hemorrhage is most often associated with vacuum extraction and forceps delivery (90%). but Subgaleal hemorrhage may also occur with other rare presentation including sever thrombocytopenia, neonatal coagulopathy, or with other risk factors.Patient Report: With this case report, we describe a rare case of Subgaleal hemorrhage due to mathernal ITP and sever thrombocytopenia and with vaccum Instrument delivery .we review causes, risk factors, clinical features, differential diagnosis and treatment of SGH one neonate that born with female sex, term, Wight 3800gr, cesarean section after an unsuccessful 2 to 3 time vacuum extraction, ,low Apgar and neonate transfer to NICU because of tachypnea, pallor and a fluctuant swelling on his head and low Apgar. After 6 Th hours, a severe fluctuant swelling was increased on his head with head circumference of 39cm and ecchymosis around his orbits. ). hemoglobin value was 11.2 gr/dl and decreased to 9 gr/dl after 10 hours latter in lab data PT ,PTT, PLT, BT,CT, renal function test were normal but plt count was 44000. In mathernal past medical history plt count was low and mother received IVIG for ITP deasise. The diagnosis was made subgaleal hemorrhage. The infant received a total of 20 ml/kg of packed red blood cell and intravenous Immunoglobulin (IVIG). After successful treatment, the baby fully recoveredCONCLUSION: SGH may be associated with serious complications and death. The condition must be recognized promptly and monitored closely. Early recognition, careful monitoring, prompt and aggressive administration of blood products to avoid hypovolemic shock, and treatment of any Associated coagulopathy are the keys to improving outcome.

کلیدواژه ها:

Subgaleal hemorrhage ، neonate ، thrombocytopenia