Spontaneous Fetal Skull Fracture in an Apparently Uncomplicated Vaginal Delivery

Fetal skull fracture is a rare occurrence in the absence of instrumentation at the time of vaginal delivery. While most commonly associated with the use of forceps, the etiology of spontaneous skull fractures remains elusive. We report a case of a 3355-g female Infant born at 41 weeks gestation by uncomplicated vaginal delivery (Apgars 8/8) after an unremarkable labor course. At two hours of life, the infant was found to be listless with a left parietal hematoma consistent with a subgaleal hemorrhage and imaging studies showed a small linear occipital fracture. The clinical course was complicated by hypotension and multi-organ failure, with the infant expiring on day of life 4. While most linear skull fractures are clinically insignificant, devastating complications including neonatal death can occur. Diagnosis of a fetal skull fracture requires a high level of suspicion, as it can occur even in uncomplicated vaginal deliveries.