Faulty fetal packing: a case series and literature review.

Background: Faulty fetal packing is an under-recognized nontraumatic entity often confused with depressed skull fracture.

Objective: To describe cases of faulty fetal packing at our institution and their common features, management, and outcomes compared to existing literature.

Materials and methods: Institutional review board approval was obtained for this retrospective study. A retrospective search through a radiology database at a quaternary freestanding children's hospital from 2014-2022 was performed for cases of faulty fetal packing. Clinical characteristics, imaging findings, management, and outcome were recorded.

Results: Five cases of faulty fetal packing were identified. These neonates were born at 37-41 weeks, one by vaginal delivery and four by Cesarean section, all after long labor or difficult extraction. Parietal skull depressions were noted at birth or by 16 days after birth, and no associated traumatic findings were identified on imaging. The depressions were initially diagnosed as fractures. All patients were managed by observation, and depressions significantly improved by 2-4 months in four cases; one case was lost to follow-up after 16 days. No adverse outcomes were reported.

Conclusion: Skull depressions seen in faulty fetal packing should be considered in the differential diagnosis of depressed skull fracture. They typically resolve with conservative management.