Cephalhaematoma and subgaleal haemorrhage — branching viva

Branching viva on the anatomical-plane classification of birth scalp swellings, the suture-line discriminator, recognition and resuscitation of a subgaleal haemorrhage, and the complications and prevention bundle around operative vaginal delivery.

branching clinical structured oral4 min readVerification in progress

Prompt

A term newborn delivered by vacuum extraction has a diffuse boggy scalp swelling crossing the suture lines, with pallor and a heart rate of 180. The examiner asks: 'Walk me through your diagnosis and immediate management.'

Branch 1 — The bedside assessment and the plane

Examiner: "You are called to the postnatal ward. Talk me through your assessment of this swelling." [3]

Map the swelling to the suture line first. A swelling that crosses the sagittal and lambdoid sutures and the anterior fontanelle is subaponeurotic (subgaleal) or subcutaneous (caput); a swelling that stops at the suture of one bone is subperiosteal (cephalohaematoma). [3] [8]
Feel the consistency. Diffuse, boggy and fluctuant, with ecchymosis tracking into the eyelids, forehead and neck, is subgaleal; firm, well-circumscribed and non-pitting is cephalohaematoma; soft, pitting and oedematous is caput. [8]
Assess the perfusion. Pallor, tachycardia, prolonged capillary refill and hypotension are the signs of the hypovolaemic shock that makes a subgaleal bleed dangerous. [3]

Paediatrics Fellowship Pro

You have read the opening of this viva. 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

Cephalhaematoma and subgaleal haemorrhage — branching viva

branching clinical structured oral4 min readVerification in progress

Branch 1 — The bedside assessment and the plane

Examiner: "You are called to the postnatal ward. Talk me through your assessment of this swelling." [3]

Map the swelling to the suture line first. A swelling that crosses the sagittal and lambdoid sutures and the anterior fontanelle is subaponeurotic (subgaleal) or subcutaneous (caput); a swelling that stops at the suture of one bone is subperiosteal (cephalohaematoma). [3] [8]

Feel the consistency. Diffuse, boggy and fluctuant, with ecchymosis tracking into the eyelids, forehead and neck, is subgaleal; firm, well-circumscribed and non-pitting is cephalohaematoma; soft, pitting and oedematous is caput. [8]

Assess the perfusion. Pallor, tachycardia, prolonged capillary refill and hypotension are the signs of the hypovolaemic shock that makes a subgaleal bleed dangerous. [3]

Paediatrics Fellowship Pro

You have read the opening of this viva. 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