Hematomas and Intracranial Hemorrhages

Nationwide Cerebral Palsy Resource Network

In the hands of an experienced obstetrician, more aggressive measures may be used to facilitate a quick, painless and injury-free birth. These may include the need to pull or twist a child (whether during a cesarean section or vaginal delivery) and even, if necessary, to use vacuum extractors and forceps to hasten a vaginal birth.  When these devices are used improperly, or if a child is handled with excessive force during a vaginal or cesarean delivery, it can cause serious and sometimes permanent birth injuries.

If your child sustained a hematoma or other head injury due to improper birthing practices, please call Stern Law, PLLC at (800)462-5772 to review the details of your case for free with an experienced birth injury attorney.

What is a hematoma?

A hematoma is an injury to a baby’s head that causes the blood vessels to tear and bleed. The actual “hematoma” refers to the collection of blood that occurs unnaturally in the head after sustaining some form of trauma. While not every hematoma is life threatening, the following are a list of the most serious types:

  • Caput Succedaneum – This refers to swelling of the soft tissues on a baby’s head and scalp. The condition is often caused by pressure exerted on a baby’s head during a head-first vaginal delivery;
  • Subgaleal hematoma – This refers to swelling that occurs between a baby’s skull bones and scalp which is often caused by pressure asserted on his or her head during delivery. Swelling may extend around the baby’s eyes, ears and depending upon the severity of the case, completely cover the baby’s head;
  • Cephalhematoma – This refers to bleeding that occurs between a baby’s skull and periosteum (a membrane that lines the surface of all bones in the body except at the joints) that can lead to this serious type of hematoma.  This condition may occur secondarily to skull fractures and typically arises when pressure is asserted on a baby’s head during delivery, perhaps through the use of forceps or vacuum extraction;
  • Sternocleidomastoid hematoma – This occurs when a baby’s head is twisted to one side during delivery, which leads to tightness in and the potential shortening of the sternocleidomastoid muscles (the muscles that are present between a baby’s breastbone and collarbone that connects them to the portion of the skull behind his or her ear). If left untreated, or in the most severe of cases, a child could be left with limited to no movement in his or her neck and also suffer from craniofacial abnormalities.

Timely diagnosis and treatment of a hematoma is critical to reducing the damaged caused by this type of injury.

What are intracranial hemorrhages?

Intracranial hemorrhaging, or bleeding within the brain, can occur as a result of pressure asserted on a baby’s head during labor and delivery.  There are number of different types of hemorrhages that can develop, such as:

  • Subaponeurotic hemorrhages – Although generally rare, this condition occurs when pressure is asserted on the head in such a way as to cause blood vessels to break and cause bleeding in the aponeurosis of the skull (a layer of flat, connective tissue that anchors a muscle to the various parts that it moves);
  • Subarachnoid hemorrhages – These occur below the innermost membrane that cover the brain and are the most common of all intracranial hemorrhages. This type of hemorrhaging can put excessive pressure on the surface of the brain and may lead to seizures and high levels of bilirubin in the blood should a child not be treated immediately;
  • Subdural hemorrhages – This results from tearing of the faix cerebri, tentorium or bridging veins within the skill. These can occur during a difficult delivery due to pressure asserted on the intracranial vessels;
  • Intraventricular hemorrhages – This can occur in the fluid filled spaces of the brain, known as the ventricles. This type of hemorrhage typically affects premature babies whose brains are not fully developed;
  • Intraparenchymal hemorrhages – This refers to bleeding that occurs in the brain tissue itself, and like intraventricular hemorrhages, typically affect prematurely born children.

Symptoms of a hematoma or intracranial hemorrhaging

  • Brain infection;
  • Jaundice;
  • Anemia;
  • Brain damage, including developmental delay, seizure disorders, paralysis, mental retardation and Cerebral Palsy;
  • Hypotension;
  • Brain death;
  • Labored breathing;
  • Sluggishness;
  • Convulsions;
  • One-sided weakness or paralysis;
  • Headache;
  • Poor feeding;
  • Hypoxia-ischemia;
  • Variations in blood pressure;
  • The presence of germinal matrix, a mass of embryonic cells in the brain;
  • Hematologic disorders such as a vitamin K deficiency, hemophilia, disseminated intravascular coagulation;
  • Brain compression;
  • Loss of consciousness;
  • Craniofacial abnormalities;
  • Nerve damage;
  • The development of blood clots;
  • Death.

What are the risk factors and causes of hematomas and intracranial hemorrhaging?

  • The use of excessive force applied during delivery;
  • Vaginal obstruction of a child during birth;
  • Twisting a child’s head or neck to free him or her from the delivery canal or during a cesarean section;
  • Macrosomia (excessive infant weight);
  • Cephalopelvic disproportion (a child with an extremely large head compared to the rest of his or her body);
  • Inexperienced doctors and medical staff;
  • A prolonged labor;
  • Oxygen deprivation;
  • Fetal prematurity;
  • Maternal obesity.

Competent medical professionals should be aware of risk factors like these and be able to minimize or prevent a hematoma or intracranial bleeding.

Unfortunately, not every birth goes the way you would expect. Stern Law, PLLC has over three decades of experience representing birth injury victims in cases involving multiple forms of head trauma. For a free consultation, please call (800)462-5772.