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Volume 342:892-893 March 23, 2000 Number 12
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Effect of Mode of Delivery on Neonatal Intracranial Injury

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 by Towner, D.
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To the Editor: Towner et al. (Dec. 2 issue)1 report that vacuum extraction, use of forceps, and cesarean section during labor are all associated with an increased rate of subdural or cerebral hemorrhage in neonates. They suggest that an abnormality of labor may be the underlying precipitating cause of the hemorrhage.

We suggest an alternative explanation: some of the neonates may have had a bleeding disorder. The incidence of hemophilia has recently been shown to be 1 per 5000 live births of male infants.2 On the basis of the size of the population in the study by Towner et al. . . . [Full Text of this Article]

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