Magnetic resonance imaging of subdural haemorrhage following instrumental vaginal delivery in clinically normal neonates

Abstract

This study aimed (1) to image clinically normal newborn infants to detect the presence of any intracranial bleed and (2) to establish the natural history of the bleed. Newborn babies were imaged within 48 hours of delivery and all details of the labour and delivery were recorded. MR imaging was carried out on a dedicated 0.2T Niche MR system on the special care baby unit. Images were obtained in axial and coronal planes using T1, T2 plus gradient echo weighted images; similarly for the follow-up imaging. χ² test was used for analysis. One hundred and two newborn infants were scanned. Forty-five had a normal vaginal delivery, 10 were ventouse (three metal cup, seven silastic), 10 were emergency sections, 15 were elective sections, 22 were forceps (19 Neville Barnes, three Keillands). Five had subdural collections that were clinically silent throughout their duration and had resolved fully within 4 weeks.All five babies with subdural collections had been delivered by forceps following an attempt at a ventouse delivery. In total 15 babies were delivered by forceps following a ventouse delivery and one by emergency caesarian section following an attempted ventouse delivery. The method of delivery was the only statistically significant factor in these babies (duration of labour, fetal blood pH, etc. were not statistically significant) for the presence of a subdural collection, using the χ² test (P < 0.001).