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

Background Neonatal 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/Results We 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). Conclusion When 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.