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Retinal haemorrhages recorded following birth

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.


  • Retinal haemorrhages were recorded in 26% (range 21.4% – 40%) of infants following spontaneous vaginal delivery 1-4,6-8,15
  • Retinal haemorrhages were more common in instrumental deliveries 1-3,6-10,12,13,15
  • The strongest association was found with vacuum delivery 2,3,6,8,9,12,13,15 or a failed vacuum delivery followed by a forceps delivery (aka double instrumental delivery) 2,3,8,15
  • Infants delivered by caesarean section were less likely to develop retinal haemorrhages than those delivered by spontaneous vaginal delivery 1-4,6-8,10,11,14,15, apart from those undergoing an emergency second-stage caesarean section after failed instrumental delivery 2,3,12
  • Only four infants underwent elective caesarean section (no retinal haemorrhages recorded)
  • Eight Hispanic infants born via Caesarean delivery (no detail re: elective or otherwise) were examined and none had retinal haemorrhages 5. Two of eight had sub-retinal fluid identified by optical coherence tomography

Other obstetric correlates

Data relating to the duration of the second stage of labour, or the expulsive phase, were conflicting as to its association with retinal haemorrhages 6,7,14

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  1. Bergen R, Margolis S. Retinal hemorrhages in the newborn. Annals of Ophthalmology. 1976;8(1):53-56 [Pubmed]
  2. Berkus MD, Ramamurthy RS, O'Connor PS, Brown K, Hayashi RH. Cohort study of silastic obstetric vacuum cup deliveries: I. Safety of the instrument. Obstetrics and Gynecology. 1985;66(4):503-509 [Pubmed]
  3. Berkus MD, Ramamurthy RS, O'Connor PS, Brown KJ, Hayashi RH. Cohort study of silastic obstetric vacuum cup deliveries: II. Unsuccessful vacuum extraction. Obstetrics and Gynecology. 1986;68(5):662-666 [Pubmed]
  4. Cabrera MT, Maldonado RS, Toth CA, O'Connell RV, Chen BB, Chiu SJ, Farsiu S, Wallace DK, Stinnett SS, Panayotti GM, Swamy GK, Freedman SF. Subfoveal fluid in healthy full-term newborns observed by handheld spectral domain optical coherence tomography. American Journal of Ophthalmology. 2012;153(1):167-175. [Pubmed]

  5. Cabrera MT, O'Connell RV, Toth CA, Maldonado RS, Tran-Viet D, Allingham MJ, Chiu SJ, Farsiu S, Panayotti GM, Swamy GK, Freedman SF. Macular findings in healthy full-term Hispanic newborns observed by hand-held spectral-domain optical coherence tomography. Ophthalmic Surgery, Lasers & Imaging Retina. 2013;44(5):448-454 [Pubmed]

  6. Emerson MV, Pieramici DJ, Stoessel KM, Berreen JP, Gariano RF. Incidence and rate of disappearance of retinal hemorrhage in newborns. Ophthalmology. 2001;108(1):36-39 [Pubmed]
  7. Gonzalez Viejo I, Ferrer Novella C, Pueyo Subias M, Ronchera Oms JM, Bueno Lozano J, Ferrer Novella E, Vicente Aznar E, Honrubia Lopez FM. Hemorrhagic retinopathy in newborns: frequency, form of presentation, associated factors and significance. European Journal of Ophthalmology. 1995;5(4):247-250 [Pubmed]
  8. Hughes LA, May K, Talbot JF, Parsons MA. Incidence, distribution, and duration of birth-related retinal hemorrhages: a prospective study. Journal of AAPOS: American Association for Pediatric Ophthalmology and Strabismus. 2006;10(2):102-106 [Pubmed]
  9. Kuit JA, Eppinga HG, Wallenburg HC, Huikeshoven FJ. A randomized comparison of vacuum extraction delivery with a rigid and a pliable cup. Obstetrics and Gynecology. 1993;82(2):280-284 [Pubmed]
  10. Schoenfeld A, Buckman G, Nissenkorn I, Cohen S, Ben-Sira I, Ovadia J. Retinal hemorrhages in the newborn following labour induced by oxytocin or dinoprostone. Archives of Ophthalmology. 1985;103(7):932-934 [Pubmed]
  11. Svenningsen L, Eidal K. Lack of correlation between umbilical artery pH, retinal hemorrhages and Apgar score in the newborn. Acta Obstetricia et Gynecologica Scandinavica. 1987;66(7):639-642 [Pubmed]
  12. Svenningsen L, Lindemann R, Eidal K, Jensen O. Neonatal retinal hemorrhages and neurobehavior related to tractive force in vacuum extraction. Acta Obstetricia et Gynecologica Scandinavica. 1987;66(2):165-169 [Pubmed]
  13. Svenningsen L, Eidal K. Retinal hemorrhages and traction forces in vacuum extraction. Early Human Development. 1988;16(2-3):263-269 [Pubmed]
  14. Svenningsen L, Lindemann R, Eidal K. Measurements of fetal head compression pressure during bearing down and their relationship to the condition of the newborn. Acta Obstetricia et Gynecologica Scandinavica. 1988;67(2):129-133 [Pubmed]
  15. Williams MC, Knuppel RA, O'Brien WF, Weiss A, Spellacy WN, Pietrantoni M. Obstetrics correlates of neonatal retinal hemorrhage. Obstetrics and Gynecology. 1993;81(5 (part 1)):688-694 [Pubmed]


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