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O&G CasesNeonatal care — birth trauma

O&G Cases · Neonatal care — birth trauma

Subgaleal haemorrhage after vacuum — emergency management station

Emergency management station for subgaleal haemorrhage after a difficult vacuum. Tests parallel resuscitation, the RANZCOG C-Obs 28 tiered surveillance protocol, escalation to retrieval, and communication with the parents. Includes assessor key and marking domains.

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Target exams

FRANZCOGMRCOGABOG
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Target exams

FRANZCOGMRCOGABOG
Prompt
A term infant (40+2 weeks, 3980 g) is born by vacuum for prolonged second stage. Two cup detachments, total application time 18 minutes. Apgars 8 and 9. At 4 hours the scalp is boggy, crossing suture lines and extending behind both ears. HR 178, capillary refill 4 seconds, pallor. You are the obstetric registrar; the neonatal registrar is 10 minutes away.

Station brief

Format. Emergency management station, approximately 12 minutes. You are the obstetric registrar on the postnatal ward. A midwife is with you; the neonatal registrar is 10 minutes away and has been called. The assessor will run the clock and feed you new observations. [1]

Candidate instruction. Lead the management of suspected subgaleal haemorrhage after a difficult vacuum delivery. Verbalise your resuscitation steps, your surveillance framework, your escalation triggers, and your communication with the team and the parents. [1][2]

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References5ShowHide
  1. [1]Colditz MJ, Lai MM, Cartwright DW, Colditz PB Subgaleal haemorrhage in the newborn: A call for early diagnosis and aggressive management J Paediatr Child Health, 2015.PMID 25109786
  2. [2]Babata K, Vadlamudi G, Bailey NA, et al. Subgaleal hemorrhage in neonates: a comprehensive review and summary recommendations J Perinatol, 2025.PMID 39284927
  3. [3]Uchil D, Arulkumaran S Neonatal subgaleal hemorrhage and its relationship to delivery by vacuum extraction Obstet Gynecol Surv, 2003.PMID 14515066
  4. [4]Doumouchtsis SK, Arulkumaran S Head injuries after instrumental vaginal deliveries Curr Opin Obstet Gynecol, 2006.PMID 16601472
  5. [5]Bahl R, Hotton E, Crofts J, Draycott T Assisted vaginal birth in 21st century: current practice and new innovations Best Pract Res Clin Obstet Gynaecol, 2024.PMID 38462263
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