Epidural Hematoma (EDH) and Birth Trauma
An epidural hematoma/hemorrhage (EDH), also known as an extradural hematoma/hemorrhage, is a rare but dangerous result of birth trauma. It is a type of intracranial hemorrhage, characterized by bleeding between the infant’s dura (a tough outer membrane that covers the brain) and skull. Note: 1) An EDH can also occur between the spinal cord dura and the spine, but here we’ll focus on those that occur within the skull (1).
Risk factors and causes of epidural hematoma
Epidural hematomas can generally be attributed to some type of traumatic head injury. In adults and adolescents, EDH generally results from motor vehicle accidents, falls, and assaults (2). In young children, EDH can be caused by lower velocity impact, even a fall of less than five feet. EDH can also stem from child abuse. EDH in neonates is associated with birth trauma (3). In particular, EDH in neonates most often occurs with operative deliveries (use of forceps or vacuum extractors) (4).
Other causes of birth trauma, which increase the risk of intracranial hemorrhages, include the following:
- Excessive uterine contractions (often the result of Pitocin or Cytotec misuse)
- Abnormal fetal presentation
- Macrosomia (abnormally large baby)
- Cephalopelvic disproportion (the fetus’s head is too big to safely fit through the mother’s pelvis)
Signs of epidural hematoma
In neonates, an epidural hematoma is often asymptomatic. However, there are many possible signs and associated conditions to watch for, including the following (3, 4, 5, 6) :
- Neonatal seizures
- Hypotonia (low muscle tone)
- Bulging fontanelle
- Coma/altered level of consciousness
- Changes to vital signs
- Pupillary changes
- Irritability or lethargy
- Scalp hematoma
- Subgaleal hematoma
- Hemorrhagic shock
- Low Apgar score
- Respiratory distress
- Apnea or bradycardia
- Split sutures
Diagnosis of epidural hematoma
An epidural hematoma is typically diagnosed via CT or MRI of the head. This may help to differentiate it from subdural hemorrhage, which may manifest similarly (4). Ultrasound may also show signs of EDH, but ultrasound imaging can be less precise, and a CT or MRI can reveal more details.
Because EDH may be asymptomatic, the decision to do brain imaging should be based not only on physical findings and clinical manifestations, but also on risk factors (i.e. if the delivery was complicated or involved the use of forceps or vacuum extractors) (7).
It is important that clinicians diagnose EDH prior to neurological deterioration, because this allows time for surgical intervention, which can be lifesaving/prevent permanent damage (5).
Management of epidural hematoma
In some cases, EDH has been successfully managed with supportive therapy. However, there are many circumstances under which emergency surgery is needed. This may involve craniotomy and evacuation of the hematoma.
If a baby with an EDH is managed nonoperatively (which should only occur if the EDH is small and they are showing no neurological symptoms), the following precautions must be taken (5):
- Close observation by medical personnel with relevant experience (the baby should be carefully monitored for at least 24 hours)
- 24-hour access to emergency CT scans and a fully-equipped operating room
- Repeat CT scans or MRIs to make sure that the EDH is not expanding
There is still some controversy over how to manage patients who are stable and asymptomatic. More research into this topic is needed.
Epidural hematoma, birth trauma, and medical malpractice
Epidural hematoma and other types of birth trauma are sometimes caused by medical malpractice (for example, inappropriate usage of birth-assisting tools or labor-enhancing drugs). It is also malpractice if medical professionals fail to respond to emergencies during the birthing process (such as cephalopelvic disproportion), or if they fail to intervene after birth trauma has occurred (e.g., by providing needed emergency surgery).
If you believe that your child or loved one was permanently harmed by birth trauma, the attorneys at Reiter & Walsh ABC Law Centers may be able to help. We have many verdicts and settlements that attest to our success, and you pay nothing unless we win your case.
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- Epidural Hematoma. (2018, May 24). Retrieved October 25, 2018, from https://emedicine.medscape.com/article/1137065-overview
- (n.d.). Retrieved October 25, 2018, from https://www.uptodate.com/contents/intracranial-epidural-hematoma-in-adults?search=epidural%20hematoma&source=search_result&selectedTitle=1~116&usage_type=default&display_rank=1
- (n.d.). Retrieved October 25, 2018, from https://www.uptodate.com/contents/intracranial-epidural-hematoma-in-children-epidemiology-anatomy-and-pathophysiology
- (n.d.). Retrieved October 25, 2018, from https://www.uptodate.com/contents/neonatal-birth-injuries#H17
- (n.d.). Retrieved October 25, 2018, from https://www.uptodate.com/contents/intracranial-epidural-hematoma-in-children-clinical-features-diagnosis-and-management?topicRef=6529&source=see_link
- Lam, A., Cruz, G. B., & Johnson, I. (1991). Extradural hematoma in neonates. Journal of ultrasound in medicine, 10(4), 205-209.
- Gregorio-Hernandez, R., Gonzalez-Valcarcel, M., Escobar-Izquierdo, A. B., Lopez-Lozano, Y., & Cabada-Del Rio, A. (2018). Neonatal epidural haematoma. Presentation of 3 cases and a literature review. Anales de Pediatría (English Edition), 88(1), 50-51.