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Vertex haemangioma: an unusual cause of intrapartum haemorrhage

Intrapartum haemorrhage occurs in up to 2% of all pregnancies. The main causes are placenta praevia or placenta abruption. Other causes include marginal bleeding and the so-called heavy show, which is cervical bleeding secondary to gradual cervical dilatation with simultaneous detachment of membranes or the result of trauma. Cases of bright red vaginal bleeding particularly following amniotomy should raise suspicion of vasa praevia, especially if followed by sudden fetal bradycardia. In some situations, a succenturiate lobe may be located in the lower segment and lead to antepartum or intraprtum haemorrhage. We report a case of vertex haemangioma, initially diagnosed as a succenturiate lobe which presented with intrapartum bleeding. A 33 year old Caucasian primigravida’s anomaly scan at 20 weeks revealed a ‘succenturiate’ lobe and a posterior placenta. The main part of the placenta was not low lying. But there was no comment on the position of the succenturiate lobe. Her antenatal course was otherwise uneventful. She was admitted in labour at 39 weeks following spontaneous rupture of membranes. The amniotic fluid was clear. On abdominal palpation, the fetal lie was longitudinal, the presentation cephalic and the presenting part was engaged. The abdomen was soft and non-tender. On vaginal examination, the cervix was 3 cm dilated but a soft mass with an apparent ‘placental texture’ was felt through the cervix. The fetal head could be felt around the edge of the mass. Soon after the vaginal examination, there was brisk vaginal bleeding followed by fetal bradycardia. An emergency caesarean section was performed. A live baby girl weighing 2.76 kg was delivered. The placenta looked normal with no evidence of retroplacental haematoma, succenturiate lobe or velamentous insertion of the cord. The baby, however, was pale and hypotonic. She had a soft subcutaneous mass about 4 cm in diameter overlying the vertex. It was bleeding. A pressure dressing was applied. The infant breathed spontaneously and was given facial oxygen. Her Apgar scores were 7, 8, and 8 at 1, 5 and 10 minutes, respectively. She was admitted to the neonatal intensive care unit. She was poorly perfused and hypotensive and was therefore given volume expansion with normal saline. Her initial haemoglobin was 10.2 g/dL and subsequently she was transfused two units of blood. Platelet count was 237 10/L. The bleeding from the