What is a Subgaleal Hemorrhage Birth Injury?


Laura Schaefer

New parents do everything possible to protect their newborn. Likewise, they expect their healthcare workers to provide excellent care during labor and delivery. Unfortunately, unexpected malpractices during a difficult delivery can cause a subgaleal hemorrhage to occur. Another name for this injury is a newborn brain bleed.

A subgaleal hemorrhage is blood that forms between your newborn’s skull and the skin on their scalp. Although rare, this type of injury occurs in nearly 0.6% of vacuum-assisted deliveries.

Sometimes after a newborn brain bleeds, hospitals tell parents there was nothing that could have prevented the injury. You may have been told doctors and nurses performed the best standard of care. This may not be true.

IMPORTANT: Birth injuries such as a subgaleal hemorrhage exact a physical and emotional toll on your new family. If this is something your family is dealing with, it may be helpful to talk to a birth injury lawyer.

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What Causes a Subgaleal Hemorrhage in Newborns?

Subgaleal hemorrhages form as trauma to a newborn’s head during labor and delivery. This leads to rupture of the emissary veins. These are the connections between the dural sinuses and the scalp veins.

Pulling or compressing of a baby’s head during delivery often causes this form of trauma to form. The use of vacuum extractors or forceps during delivery highly correlates with this type of birth injury.

Your healthcare provider may have decided to use tools to assist the delivery because:

  • The baby’s head or body was too large to fit through the mother’s pelvis
  • Your baby wasn’t progressing down the birth canal safely
  • Labor failed to progress after more than 20 hours
  • Labor progressed unexpectedly quickly

When vacuum extractors or other assistive tools like forceps are used improperly, a subgaleal hemorrhage birth injury is more likely to occur.

How Deadly Are Subgaleal Hemorrhages?

According to the Cleveland Clinic, subgaleal hemorrhage can be life-threatening because your baby can lose 20-40% of their blood volume as the hemorrhage forms in their skull. An estimated 10-25% of babies born with a subgaleal hemorrhage pass away from their condition. (Deborah J. Davis CMAJ, May 2001, 164 (10) 1452-1453;)

Risk Factors of a Subgaleal Hemorrhage

Some of the most prominent risk factors for subgaleal hemorrhage in newborns are:

  • First-time pregnancies
  • Prolonged second stage of labor
  • Premature birth
  • Cephalopelvic disproportion, a mismatch between the size of the baby’s head and the size of the mother’s pelvis
  • Macrosomia, a baby weighing more than 8 lbs, 13 ounces

Subgaleal hematomas can occur during all methods of birth delivery, but more physical forms of delivery like vacuum extraction raise the chances of birth injury.

Symptoms of a Newborn Subgaleal Hemorrhage

Symptoms of a subgaleal hematoma appear in newborns directly after birth. These include:

  • Bruising on the skin
  • Fast heart rate
  • Low blood pressure
  • Pale skin tone
  • Reduced levels of hemoglobin and hematocrit in their blood
  • Swelling on the baby’s head that has a liquid-like movement (swelling) due to internal bleeding

How Common are Subgaleal Hemorrhages?

Subgaleal hemorrhages are rare. They occur about 4 times out of every 10,000 vaginal deliveries when tools are not used. When tools such as a vacuum extractor are used, there are 60 cases out of 10,000 deliveries.

Diagnosing a Newborn for Subgaleal Hemorrhages

Healthcare providers examine babies for physical symptoms of the condition after delivery, particularly if tools were used during labor. If they suspect a subgaleal hemorrhage has occurred, the healthcare provider will order an imaging test of the newborn’s head.

This could be an ultrasound, CT scan, MRI, or an X-ray to examine the hemorrhage beneath their skin.

Treating a Subgaleal Hematoma

Newborns diagnosed with subgaleal hematomas must be treated immediately to prevent further damage.

  1. First, they’ll receive blood and plasma transfusions in the newborn intensive care unit. This is done to restore blood volume in the baby’s body.
  2. Next, the baby’s healthcare provider will monitor their blood levels to verify their hemoglobin and hematocrit counts. The NICU healthcare provider will also regularly measure the child’s head circumference to check for swelling.
  3. If fluid transfusion treatment isn’t helping, emergency surgery on the baby’s subgaleal area will be performed to stop internal bleeding.

The steps to treat a subgaleal hematoma are long and involve a great deal of precision to execute. If a healthcare professional exhibits negligence during this process, they may endanger you and your baby’s safety.

Preventing a Newborn Subgaleal Hemorrhage

Regular prenatal ultrasounds can help prevent this type of birth injury. In the weeks leading up to labor and delivery, a woman’s healthcare provider will examine their child’s position. He or she will evaluate whether a vaginal delivery is the safest option.

If it’s not, your doctor may issue a C-Section. However, not all subgaleal hemorrhages can be prevented in this way.

What Happens if the Condition is not Treated?

If your baby’s subgaleal hemorrhage is not treated, they may experience severe encephalopathy, profound hypotension, and renal failure.

Sadly, approximately one in four infants who require neonatal intensive care for this condition die. However, if your baby receives treatment in a timely manner, the condition usually resolves within two to three weeks after birth.

It is important to recognize the long-term effects of an improperly treated subgaleal hemorrhage. These include:

  • Elevated bilirubin levels
  • Cerebral palsy
  • Developmental delays
  • Hydrocephalus
  • Intellectual disabilities
  • Permanent brain damage
  • Seizure disorders

Find a Birth Injury Attorney to Represent You

If you are looking for more information on subgaleal hemorrhage malpractice cases and want to consult with a birth injury lawyer, contact LegalASAP. Our network of experienced birth injury law firms can advise you on the next steps for your case.

During your first meeting with a birth injury lawyer, be sure to ask how many medical malpractice cases – specifically birth injuries – like your own they typically handle in a year.

This lawyer and their team of professionals should be familiar with reviewing medical records and diagnostic tests. They should also understand the use of birthing tools and electronic fetal monitoring devices.

Take our free evaluation today to see if you qualify.

Laura Schaefer

Laura Schaefer is the author of The Teashop Girls, The Secret Ingredient, and Littler Women: A Modern Retelling. She is also an active co-author or ghostwriter of several nonfiction books on personal and business development. Laura currently lives in Windermere, Florida with her husband and daughter and works with clients all over the world. Visit her online at lauraschaeferwriter.com and linkedin.com.