An infantile hemangioma (hee-man-jee-OH-muh) is a type of birthmark that happens when a tangled group of blood vessels grows in or under a baby's skin. Infantile hemangiomas become visible in the first few days to weeks after a baby is born. Hemangiomas that are visible at birth are called congenital hemangiomas. There are three main types: Superficial (on the surface of the skin): These look flat at first, and then become bright red with a raised, uneven surface. Deep (under the skin): These appear as a bluish-purple swelling with a smooth surface. Mixed: These hemangiomas have both superficial and deep components

1. CONGNITAL
HEAMATOMA
JOEL RAJAN U

2. Congenital Hematoma is a damage that occurs as a result of physical pressure during the birthing
process, usually during transit through the birth canal. Many new-borns have minor injuries during birth.
Infrequently, nerves are damaged or bones are broken
Congenital Hematoma
 A birth injury describes any type of harm to a baby before,
during, or shortly after delivery.
 Many babies suffer from minor injuries during the delivery
process. Most of these injuries heal by themselves without
treatment. In other cases, prompt and proper treatment can help
manage birth injuries — so it’s important to seek medical help
from a doctor as soon as you suspect an injury.
 Some serious birth injuries have no cure, and your child may
have a disability for the rest of their life.

3. Causes
 The Congenital Hematoma caused when the pressure on
a baby's head during vaginal childbirth damages or
ruptures very small blood vessels in scalp. The damage to
the blood vessels causes them to haemorrhage (bleed
internally) and the blood collects into a pool which forms
into a benign mass.
 Approximately 2 out of every 100 babies develop a
cephalohematoma after birth ( 1% - 2 % of spontaneous
vaginal deliveries and 3% - 4 % of forceps or vacuum-
assisted deliveries).

4. Types Of Congenital Hematoma
•Brachial palsy. This occurs when the
group of nerves that supplies the arms and
hands (brachial plexus) is injured.
•Bruising or forceps marks.
•Caput succedaneum.
•Cephalohematoma.
•Facial paralysis.
•Fractures.
•Subconjunctival haemorrhage

5. Symptoms
•Seizures.
•Skull fractures.
•Difficulty suckling, eating or swallowing.
•Arched back while crying.
•High-pitched crying, grunting or overall fussiness.
•Low oxygen levels.
•Lowered heart rate.
•Sensitivity to light

6. Risk Factors
•Fatal Macrosomia: fatal macrosomia is the medical term for a baby
that grows to big during gestation (over 9 lbs.). The bigger the baby the
more difficulty they will invariably having passing through the narrow
birth canal.
•Epidurals: the epidural is a very common method of maternal pain
management during childbirth. However, getting an epidural numbs
the mother's lower body and makes her less able to effectively push
the baby out.
•Birth Assistance Tools: whenever doctors use a vacuum extractor or
forceps to grab the baby's head and maneuver in through the birth
canal the risk of cephalohematoma immediately increases.

7. Complications Of Congenital Haematoma
Complications such as placenta previa, placental abruption, anaemia, and
preeclampsia can limit the supply of oxygen and nutrients to the foetus,
increasing the risk of birth defects. Severe cases may be fatal to the foetus.
High blood pressure. High blood pressure occurs when the arteries that
carry blood from the heart to the organs and the placenta are narrowed.

8. Diagnosis
•APGAR Score
•Brain Imaging for Diagnosis of Hypoxic
Ischemic Encephalopathy (HIE)
•Umbilical Cord Blood Gases and
Hypoxic Ischemic Encephalopathy

9. Treatment
 The most important factor in treating a birth injury is time. If an injury is
caught early on, it can be treated before it seriously harms the baby.
 Birth injuries outside of cerebral palsy or Erb’s palsy can be treated.
However, the success of these treatments depends on the birth injury.
 Birth injuries come in many different forms. While a baby might be
able to recover from a mild issue like jaundice, a severe brain injury
could be permanent. Some issues, like intrauterine fatal demise, do
not have a treatment for the baby.

10. Surgeries include:
•Burr Hole Surgery: Drill small holes in the skull to relieve the pressure caused by the
blood in this procedure. Burr hole surgery is one of the most common treatments for less
severe hematomas.
•Craniotomy: An oval-shaped piece of the skull called a bone flap is removed to allow the
pressure to escape. Once the surgery is completed the bone flap is put back. A craniotomy
may be recommended if the hematoma is particularly large or has clotted into a solid mass.
•Craniectomy: This is very similar to a craniotomy in that a bone flap is removed. However,
it is not put back in at the end of the surgery. Though it has a poorer overall outcome than a
craniotomy, those who undergo a craniectomy have a lower chance of suffering another
hematoma.
Burr Hole Surgery Craniotomy Craniectomy

11. Other potential treatments for hematomas include:
•Diuretics: These water pills, while mainly used to increase
urine flow, also help reduce swelling in the brain caused by
hematomas.
•Medications: Corticosteroids may be prescribed to reduce
brain inflammation and swelling. Other drugs may be used if
seizures are present.

12. CASE HISTORY ANALYSIS

13. Case Study
A male full-term neonate, born after an uneventful pregnancy, was seen at the
maternity ward 30 h postpartum with focal seizures of his left hand and forearm. He
was born by caesarean section, after a prolonged second stage delivery of 19 h.
During the caesarean section, several manipulations were necessary for the delivery
of the head. The Apgar score was 4 at 1 min and 9 at 5 min. At physical examination
no congenital abnormalities or malformations wee seen

14. Investigations
Physical examination 30 h after birth showed twitches in the patients left hand and
forearm. Neurologic and general paediatric physical examination was normal. The
cerebral function monitoring (CFM) suggested a centro-parietal epileptic focus however
the EEG was normal. Cranial sonography showed no abnormalities. Culture of
cerebrospinal fluid was sterile, but the cerebrospinal fluid contained some erythrocytes.
MRI of the cerebrum (figure 1) showed an epidural haematoma and a small arachnoidid
haematoma on the right parietal side. Diffusion-weighted imaging showed cortical
highlighting on both parietal-occipital sides. Screening for haematological and
metabolic disorders was negative. Phenobarbital stopped the epileptic activity

15. Figure 1
Inversion recovery prepared turbo spin echo sequence MRI:
epidural haematoma on the right parietal side

16. Symptoms
seizures,
anaemia,
apnoea and bradycardia

17. Diagnosis
 Neonatal epidural haemorrhage Due to Congenital haematoma

18. Cause
Neonatal epidural haemorrhage is very uncommon, but when it occurs it is often a
complication of vacuum and forceps assisted delivery. Perinatal epidural
haemorrhage in the absence of both vacuum/forceps assisted delivery and underlying
disorders is even more rare.

19. Treatment
The optimal approach to treatment varies, ranging from watchful waiting
to urgent surgical evacuation

20. THANK YOU!