A4020-g BLACK female was born to a 32-year-old, gravida 2, para 0, aborta 1 mother in a vacuum-assisted vaginal delivery after oxytocin was administered. Before delivery, manual rotation of the fetal head from the left occiput posterior position to the left occiput anterior position was performed. At 8 to 9 cm of cervical dilatation, the fetus had prolonged bradycardia leading to vacuum application. Apgar scores were 7/9 at 1 and 5 minutes.
Physical examination demonstrated a pale infant with a discolored, fluctuant mass over the right occipitoparietal area. The neonate was found to have a pulse of 160 beats per minute, respirations of 60 per minute, and a blood pressure of 54/32 mm Hg. Laboratory evaluation showed a hemoglobin level of 114 g/L, a hematocrit of 0.32, and a platelet count of 1.67×109/L. The infant received phytonadione.
In the first hours of life, the indurated area involved the