Hanigan W C, Morgan A M, Stahlberg L K, Hiller J L
Department of Neurosciences, University of Illinois College of Medicine, Peoria 61656.
Pediatrics. 1990 Apr;85(4):534-9.
The clinical and radiologic descriptions of three neonates with tentorial hemorrhage after vacuum extraction are reported. All patients were full term, with Apgar scores of 8 or more; one patient experienced fetal distress during delivery. Within 36 hours after birth, the neonates had multiple generalized seizures; computed tomography or magnetic resonance imaging outlined distinctive tentorial hemorrhages with extension over the superior surface of the cerebellum or inferior surface of the occipital lobe. One patient had diffuse hypoxic-ischemic injury, and another had bilateral temporal lobe infarcts. Treatment included medical control of seizures and intracranial hypertension; one patient had surgical evacuation of bilateral subdural hematomas. Follow-up from 1 to 5 years showed significant developmental delays in two patients. These cases demonstrate that the forces generated on the fetal cranium by vacuum extraction are similar to those produced by forceps and result in tentorial laceration, venous rupture, and subdural hemorrhage. Because these hemorrhages may be associated with significant ischemic injury, serial radiologic evaluation is recommended for the detection of persistent structural abnormalities.
报告了3例真空吸引术后发生小脑幕出血的新生儿的临床和影像学描述。所有患儿均为足月儿，阿氏评分8分或更高；1例患儿在分娩期间出现胎儿窘迫。出生后36小时内，新生儿出现多次全身性惊厥；计算机断层扫描或磁共振成像显示出独特的小脑幕出血，并延伸至小脑上表面或枕叶下表面。1例患儿有弥漫性缺氧缺血性损伤，另1例有双侧颞叶梗死。治疗包括药物控制惊厥和颅内高压；1例患儿接受了双侧硬膜下血肿的手术清除。1至5年的随访显示，2例患儿有明显的发育迟缓。这些病例表明，真空吸引对胎儿颅骨产生的力量与产钳产生的力量相似，会导致小脑幕撕裂、静脉破裂和硬膜下出血。由于这些出血可能与严重的缺血性损伤有关，建议进行系列影像学评估以检测持续性结构异常。
