Paeds Vivas · fetal-neonatal-and-perinatal
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.
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RACP DCEMRCPCH ClinicalRCPSC Pediatrics
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]
References6ShowHide
- [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