Diffuse scalp swelling and pallor after vacuum delivery — subgaleal haemorrhage

OSCE on a term newborn delivered by vacuum extraction who develops a diffuse boggy scalp swelling with pallor and tachycardia, testing the suture-line discriminator, the recognition of subgaleal haemorrhage, the resuscitate-before-investigate principle, coagulation correction, and the prevention and counselling bundle.

osce neonatal birth-injury scenario3 min readVerification in progress

Prompt

A term infant delivered by vacuum extraction for prolonged second stage, with two cup detachments, develops a diffuse boggy scalp swelling crossing the suture lines and fontanelle, with pallor, a heart rate of 180 and a capillary refill of 4 seconds; the candidate must perform the focused assessment, state the diagnosis and the discriminator, decide on immediate resuscitation before investigation, describe the fluid and blood-product management, correct the coagulopathy, and state the prevention and counselling bundle.

Clinical information for the examiner

Setting: Postnatal ward, four hours of life. Term infant (39 weeks, 3.4 kg) delivered by vacuum extraction after a prolonged second stage; two cup detachments occurred during the delivery. Vitamin K was given intramuscularly at birth. [9]

On your arrival:

Heart rate 180 bpm (was 130), respiratory rate 70, SpO₂ 94% in air, capillary refill 4 seconds, the infant is pale. [4]
Scalp: a diffuse, boggy, fluctuant swelling over the whole vault that crosses the sagittal and lambdoid sutures and the anterior fontanelle, with ecchymosis tracking into the upper eyelids and the nape of the neck. [3]

Paediatrics Fellowship Pro

You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References6Show ledger

[1]Aziz K Part 5: Neonatal Resuscitation 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics, 2021.PMID 33087555
[3]Babata K Subgaleal hemorrhage in neonates: a comprehensive review and summary recommendations. J Perinatol, 2025.PMID 39284927
[4]Colditz MJ Subgaleal haemorrhage in the newborn: A call for early diagnosis and aggressive management. J Paediatr Child Health, 2015.PMID 25109786
[8]Pollina J Cranial birth injuries in term newborn infants. Pediatr Neurosurg, 2001.PMID 11641618
[9]Ghidini A Neonatal complications in vacuum-assisted vaginal delivery: are they associated with number of pulls, cup detachments, and duration of vacuum application? Arch Gynecol Obstet, 2017.PMID 27677283
[12]Kim HM Intracranial hemorrhage in infants with cephalohematoma. Pediatr Int, 2014.PMID 24274929

Diffuse scalp swelling and pallor after vacuum delivery — subgaleal haemorrhage

osce neonatal birth-injury scenario3 min readVerification in progress

Clinical information for the examiner

On your arrival:

Heart rate 180 bpm (was 130), respiratory rate 70, SpO₂ 94% in air, capillary refill 4 seconds, the infant is pale. [4]

Scalp: a diffuse, boggy, fluctuant swelling over the whole vault that crosses the sagittal and lambdoid sutures and the anterior fontanelle, with ecchymosis tracking into the upper eyelids and the nape of the neck. [3]

Paediatrics Fellowship Pro

You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References6Show ledger

[1]Aziz K Part 5: Neonatal Resuscitation 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics, 2021.PMID 33087555
[3]Babata K Subgaleal hemorrhage in neonates: a comprehensive review and summary recommendations. J Perinatol, 2025.PMID 39284927
[4]Colditz MJ Subgaleal haemorrhage in the newborn: A call for early diagnosis and aggressive management. J Paediatr Child Health, 2015.PMID 25109786
[8]Pollina J Cranial birth injuries in term newborn infants. Pediatr Neurosurg, 2001.PMID 11641618
[9]Ghidini A Neonatal complications in vacuum-assisted vaginal delivery: are they associated with number of pulls, cup detachments, and duration of vacuum application? Arch Gynecol Obstet, 2017.PMID 27677283
[12]Kim HM Intracranial hemorrhage in infants with cephalohematoma. Pediatr Int, 2014.PMID 24274929