Division of Neonatology, Department of Pediatrics, Erciyes University School of Medicine, Kayseri, Turkey.
J Perinat Med. 2011 May;39(3):353-4. doi: 10.1515/jpm.2011.018. Epub 2011 Mar 10.
Vaginal delivery of the macrosomic fetus may result in hemorrhage of intra-abdominal organs. Mostly affected organs are the liver and adrenal glands. Hemorrhage of liver is usually occurs as a subcapsular hemorrhage and it is clinically presented an abdominal mass without symptoms of anemia. But intraparenchymal hemorrhage of liver is very rare and there is no sign of abdominal mass. However, in contrast to subcapsular hemorrhage, symptoms of anemia are rapidly developed in newborns. A macrosomic newborn by vaginal delivery at term. Within 6 h after delivery, the patient showed pallor without tachycardia and hypotension. In laboratory studies, hemoglobin level failed from 14 g/dL to 10 g/dL within 6 h. Physical examination revealed no signs of abdominal mass. Intraparenchymal hemorrhage in the sixth segment of liver and right adrenal hemorrhage were detected on the ultrasonographic scan. Hepatic function tests were normal in the whole follow-up period, and hemorrhage resolved within two weeks. Following months after discharge, adrenal hemorrhage also resolved without any complication. Hepatic hemorrhages, causing hemorrhagic anemia in neonates, usually occur in subcapsular form. Intraparenchymal hepatic hemorrhage should especially be considered in those newborns, which are rapidly developed symptoms of anemia without any abdominal mass.
阴道分娩巨大儿可能导致腹腔内器官出血。受影响的主要器官是肝脏和肾上腺。肝脏出血通常表现为包膜下出血，临床上表现为腹部肿块，无贫血症状。但肝脏实质内出血非常罕见，没有腹部肿块的迹象。然而，与包膜下出血不同，新生儿贫血症状迅速发展。一名足月经阴道分娩的巨大儿。分娩后 6 小时内，患儿出现面色苍白，无心动过速和低血压。实验室研究显示，血红蛋白水平在 6 小时内从 14g/dL 降至 10g/dL。体格检查未发现腹部肿块。超声扫描显示肝第六段实质内出血和右肾上腺出血。整个随访期间肝功能检查正常，出血在两周内消退。出院后数月，肾上腺出血也自行消退，无任何并发症。引起新生儿出血性贫血的肝出血通常以包膜下形式发生。对于那些没有任何腹部肿块但迅速出现贫血症状的新生儿，应特别考虑肝脏实质内出血。
