From the Research
The incidence of neonatal skull fracture after forceps vaginal delivery is approximately 1 in 4,589 forceps deliveries, as reported in the most recent and highest quality study available 1. This relatively rare complication occurs more frequently with forceps than with vacuum extraction or spontaneous vaginal delivery. The risk increases with difficult forceps applications, particularly when there is cephalopelvic disproportion, improper forceps placement, or excessive traction force applied during delivery. Most skull fractures associated with forceps are linear fractures of the parietal bone, which typically heal without intervention and rarely cause long-term neurological sequelae. However, depressed skull fractures, though less common, may require neurosurgical evaluation. Some key points to consider include:
- The use of forceps is associated with a higher risk of cutaneous lesions compared to vacuum delivery 1
- Vacuum delivery is associated with a higher risk of extensive caput succedaneum compared to forceps delivery 1
- Clinicians should monitor neonates after forceps delivery for signs of increased intracranial pressure, such as lethargy, poor feeding, vomiting, or seizures
- Routine imaging is not recommended for asymptomatic infants after forceps delivery, but should be performed if physical examination reveals palpable skull abnormalities or if neurological symptoms develop
- The overall risk of serious complications from these fractures is low, with most cases resolving spontaneously without specific treatment Other studies have reported similar findings, including a study that found that depressed skull fractures were associated with maneuvers and the use of forceps during delivery 2, and another study that reported a case of spontaneous neonatal skull fracture following a normal vaginal delivery 3. However, the study by 1 provides the most recent and highest quality evidence on this topic. It is essential to note that the correct use of forceps is crucial to avoid this kind of lesion in the newborn, especially in cases of difficult delivery 4. Additionally, only practitioners who are adequately trained or are under supervision should undertake instrumental delivery 5.