A subgaleal haematoma is one of the most serious birth injuries a newborn can sustain.
It develops when blood accumulates in the space between the scalp and the skull, often resulting from the use of forceps or a vacuum extractor during a difficult delivery.
For parents, the days following such a birth are often consumed by fear for their child’s well-being monitoring in the neonatal intensive care unit, the anxiety of not yet understanding what happened, and the gradual realisation that the injury may not have been inevitable.
Subgaleal haematoma and subgaleal haemorrhages
Coleman Legal LLP has been consulted by several families affected where subgaleal haematomas have occurred during birth.
A subgaleal haematoma, also known as a subgaleal haemorrhage, is an accumulation of blood that forms between a newborn baby’s skull and the skin on the scalp.
This can occur after a difficult delivery, particularly where a vacuum extractor is required.
The condition can be life-threatening.
Emergency and immediate treatment lead to the best possible outcome.
Subgaleal haemorrhages may cause the draining of a significant amount of blood from the newborn baby, putting them at risk of severe birth injuries such as seizures, neonatal encephalopathy (brain damage) or, tragically, even death.
Causes of subgaleal haematoma
Subgaleal Haematomas/haemorrhages are caused by trauma to the head during labour and delivery.
Most commonly, this trauma is caused by the compression of a baby’s head through the mother’s pelvis during delivery.
The injury often occurs when vacuum extractors or forceps are used during delivery.
Vacuum extractors can cause head trauma when the clinician places the suction cup on the incorrect section of the baby’s head or applies too much force or pressure.
It can also occur when the cup is suctioned excessively or when too many attempts are made to use the vacuum extractor.
The majority (90%) of neonatal cases of subgaleal haematoma are the result of applying a vacuum to the head at delivery.
Risk factors for subgaleal haematoma
Some factors may make a neonate more susceptible to subgaleal haemorrhaging.
These risks must be considered as clinicians make decisions regarding the birth of a child.
Some of the most substantial risk factors for subgaleal haematoma in newborns are:
- Primiparity (first-time pregnancy)
- Male sex
- Prolonged second stage of labour
- Premature birth
- Cephalopelvic disproportion (where there is a mismatch between the size of a mothers pelvis and the baby’s head)
- Macrosomia (when the baby is a larger size than average)
Diagnosis and treatment for subgaleal haematoma
Newborns who underwent harrowing vacuum extraction or forceps delivery should be treated with a minimum of 8 hours of observation, regardless of the need for resuscitation.
Their vital signs should also be assessed hourly.
Head examinations should be done hourly if there is a concern about head swelling.
These actions will assist with the early diagnosis of haemorrhage.
Newborn babies diagnosed with subgaleal haematoma must be treated immediately to prevent any further damage.
Long-term outcomes for children
Where subgaleal haematoma and subgaleal haemorrhages are not detected and treated promptly, long-term adverse outcomes can occur.
- Neonatal encephalopathy: A type of brain damage caused by a lack of oxygen to the brain before or shortly after birth
- Seizures
- Brain damage
- Hypoxic-ischemic encephalopathy (HIE): A brain injury that happens when a baby’s brain doesn’t receive enough oxygen during delivery
- Periventricular leukomalacia: A type of brain injury that is most common in babies born prematurely or at a low birth weight. The white matter surrounding the brain’s ventricles is deprived of blood and oxygen.
- Cerebral palsy birth injury
- Developmental disabilities
- Kernicterus: A type of brain damage that can result from high levels of bilirubin in a baby’s blood. It may lead to athetoid cerebral palsy and also hearing loss. Kernicterus may also cause problems with teeth and vision. It may also cause intellectual disabilities.
Frequently Asked Questions
What causes a subgaleal haematoma, and when does negligence arise?
A subgaleal haematoma occurs when blood vessels rupture in the loose connective tissue between the scalp and the outer surface of the skull bone.
It is most commonly associated with the use of vacuum extraction (ventouse) during delivery, particularly when the instrument is applied incorrectly, used for too long, or used in circumstances where a caesarean section should have been performed instead.
Negligence may arise where the decision to use instruments was not clinically justified, where the technique was below the standard expected of a competent obstetrician, where fetal distress warning signs were not acted upon in time, or where the haematoma was not recognised and managed appropriately after birth.
How is a subgaleal haematoma claim investigated?
An investigation begins with obtaining all relevant medical records, your antenatal records, the CTG (cardiotocograph) trace from labour, delivery notes, and neonatal records.
An independent expert in obstetrics or neonatal medicine reviews these records and provides an opinion on whether the care given met the required standard.
Where the expert identifies a departure from accepted practice that caused or materially contributed to your child’s injury, this forms the basis of the claim.
We obtain records on your behalf and instruct an expert whose opinion is independent of any hospital or healthcare provider involved in the delivery.
Can I make a claim on behalf of my child?
Yes. A parent or guardian can bring a medical negligence claim on behalf of a child who lacks legal capacity due to age.
The claim is brought in the child’s name, with the parent or guardian acting as the ‘next friend’ for the purposes of the proceedings.
Where a claim settles on behalf of a child, the settlement must be approved by the court, which independently assesses whether the terms are in the child’s best interests.
Coleman Legal handles the full process, including the court approval application, where applicable.
Are the doctors and midwives separately liable?
Medical negligence claims arising from a birth injury may involve the obstetrician, one or more midwives, anaesthetic staff, and the hospital itself.
Each practitioner is assessed against the standard applicable to their role.
Obstetricians are registered with and governed by the Medical Council of Ireland; midwives are governed by the Nursing and Midwifery Board of Ireland (NMBI).
The hospital typically bears vicarious liability for its employees’ acts, and many birth injury claims are brought against the HSE or the relevant hospital rather than against the individual employees personally.
How long does a subgaleal haematoma claim take?
Birth injury claims are complex and generally take longer to resolve than other personal injury claims.
The time involved depends on the complexity of the medical evidence, whether liability is admitted or contested, and the extent of any long-term consequences for the child.
Many claims are resolved through negotiation without proceeding to a full court hearing.
Where the long-term neurological impact on the child is still being assessed, for example, where the child is very young, it may be advisable to allow time for that picture to become clearer before finalising any settlement.
Our solicitors will advise on the appropriate timing in your specific case.
