A neonate with upper cervical spinal cord injury as a previously unrecognized complication of vacuum-assisted delivery and uterine fundal pressure

BackgroundNeonatal spinal cord injury is a rare complication of birth trauma which is typically reported after breech delivery and forceps delivery. Therefore, it is extremely difficult to recognize the occurrence of injury after vacuum-assisted delivery.Methods/ResultsWe report the case of a neonate with an upper cervical spinal cord injury that occurred during vacuum-assisted delivery accompanied by uterine fundal pressure. During delivery, the cardiotocogram showed persistent fetal bradycardia and a loss of baseline variability. The neonate was initially diagnosed with hypoxic-ischemic encephalopathy (HIE) and underwent therapeutic hypothermia therapy. However, after therapeutic hypothermia, upper cervical spinal cord injury and HIE were detected on head and cervical magnetic resonance imaging (MRI).ConclusionWhen a neonate born by vacuum-assisted delivery accompanied by uterine fundal pressure presents asphyxia, cervical MRI should be promptly considered to differentiate upper cervical spinal cord injury.