吸引分娩による頭血腫に頭蓋骨骨折を伴わない硬膜外血腫を合併した1例

A Case of Epidural Hematoma Caused by a Vaccum Extraction without Any Skull Fractures and Accompanied by Cephalohematoma

I．はじめに

　分娩，娩出時の骨盤胎児不均衡，遷延分娩の際に用いられる吸引分娩は，1957年にMalmstrom^14,15）により導入されて以来その有用性ならびに安全性が報告されてきた^11,19,20）．しかしながら頭血腫等の分娩時頭部外傷の合併症が少なからず報告されている^{1,2,8,12,20,23,24）}．今回われわれは，頭血腫に頭蓋骨骨折を伴わない硬膜外血腫を合併した症例を経験したので文献的考察を加え報告する．

A case of epidural hematoma associated with cephalohematoma caused by a vacuum extraction was reported. Old liquefied hematoma was removed via a small burr hole in the parietal bone at the age of 23 days. No neurological deficits were recognized at the age of 6 months. As the dura mater does not easily detach from the overlying skull in the neonate, it is a very rare occurrence for this to happen as a complication of the use of forceps or in extractions.

To our knowledge, only 4 cases of epidural hemato-ma after vacuum extraction have been reported. The mechanism of the development of an acute epidural hematoma during extraction is reported to be due to direct force to the dura mater and skull induced by negative pressure of a vacuum extraction. In the present case, it seems that negative pressure produced a detachment of the dura mater from the overlying skull. It suggests that examinations including plain craniogram and CT scan should be performed as soon as possible in the neonate with cephalohematoma when they have been delivered by a vacuum extraction.