From the Guidelines
A sphenoparietal skull fracture after forceps delivery is a serious complication that requires immediate neurosurgical evaluation and a skeletal survey, as recommended for all skull fracture cases in children 0 to 11 months old 1. This type of fracture involves the sphenoid and parietal bones of the infant's skull and typically occurs due to excessive pressure applied during difficult forceps-assisted deliveries. Management includes:
- Immediate neuroimaging (preferably CT scan) to assess the extent of the fracture and to rule out intracranial hemorrhage or brain injury
- Close monitoring for signs of increased intracranial pressure, including bulging fontanelles, irritability, lethargy, vomiting, and seizures
- Observation and pain management with acetaminophen (10-15 mg/kg every 4-6 hours as needed) for uncomplicated linear fractures However, if there is underlying brain injury, displacement of bone fragments, or cerebrospinal fluid leak, surgical intervention may be necessary, as suggested by the need for skeletal survey in complex or ping-pong skull fractures 1. Long-term follow-up with a pediatric neurosurgeon is essential to monitor healing and development, as these injuries can potentially lead to neurological complications. Prevention strategies include:
- Proper training in forceps use
- Considering alternative delivery methods when appropriate
- Careful assessment of fetal position and size before attempting instrumental delivery It is crucial to prioritize the infant's safety and well-being, and a skeletal survey, as recommended by the guidelines for skeletal survey in young children with fractures 1, should be performed to ensure no other fractures are present.
From the Research
Implications of Sphenoparietal Skull Fracture
The implications of a sphenoparietal skull fracture after the use of obstetric forceps are significant and can lead to various complications.
- Increased risk of intracranial injuries, such as venous thrombosis, intracranial arterial dissection (ICAD), and cerebrospinal fluid (CSF) leakage 2
- Delayed neurological deterioration, which can occur even if the patient is initially neurologically intact after trauma 3
- Risk of increased intracranial pressure (ICP), which may require surgical decompression and elevation of the depressed segment 3
- Potential for persistent manifestations of raised ICP, such as visual deterioration, which may require further treatment, such as a thecoperitoneal shunt 3
Skull Fracture Types and Complications
Different types of skull fractures can have varying complications, including:
- Depressed skull fractures, which present a high risk of increased intracranial pressure or hemorrhage to the brain 4
- Compound depressed skull fractures, which can expose the internal cranial cavity to the outside environment and increase the risk of infection 4
- Growing skull fractures, which can remain asymptomatic for years but may eventually present with emerging symptoms, such as dysphasia and hemiparesis, after secondary trauma 5
Instrumental Delivery and Skull Fracture
Instrumental delivery using obstetric forceps or spatulas can increase the risk of neonatal skull fracture, including parietal bone fracture 6