Can I pick a few brains?...

[StressedOutRN]

Brain bleed in a 36 weeker after > 24 hour ROM, a fairly ugly tracing & forcep delivery, but good gases... any thoughts on causes????

No evidence of skull fracture... Have you ever known forceps to cause a brain bleed with no fracture?

[NICURN29]

We have had one baby that I can think of that, I believe, had a subdural hematoma without skull fracture.

[TiffyRN, BSN, PhD]

The older gestation infants I have known that have had intraventricular bleeds have all proven to have clotting disorders in the end. This is assuming there was no trauma. Even with trauma, the bleeding would usually be closer to the surface, cephalohematoma or subdural. The thing is that most of those bleeding disorders require blood tests that are send outs so it takes several days if not not a couple of weeks to get the results (all those factor disorders like factors XIII & IX).

I'm sure it is possible that the bleed is possible from birth trauma, but without visible outer trauma (or skull fractures) I would 1st suspect a bleeding disorder. It may even be that the infant's bad strips were caused by the bleeding and that the bleeding occurred during the birth process, but that it was not due to unusual trauma but due to a clotting disorder.

[SteveNNP, MSN, NP]

What kind of bleed? IVH? subdural? Subgaleal? Subarachnoid?

If there's an IVH, it had to have been prenatally, as the fragile germinal matrix is fully developed and gone by 36 weeks.

Any kind of traumatic delivery [aeb forceps use] can cause a bleed. So can bleeding disorders and severe hypoxia.