Subgaleal hemorrhage

Subgaleal Hemorrhage

Subgaleal hemorrhage in a newborn.

A subgaleal hemorrhage is a type of extracranial hemorrhage that occurs in the potential space between the galea aponeurotica and the periosteum of the skull. This condition is most commonly seen in neonates and is often associated with birth trauma.

Pathophysiology

The subgaleal space is a large potential space that can accommodate a significant volume of blood. In the context of a subgaleal hemorrhage, blood accumulates in this space, leading to a fluctuant swelling of the scalp. The hemorrhage is usually due to rupture of the emissary veins, which are vulnerable to shearing forces during delivery, especially in cases involving vacuum extraction or forceps delivery.

Clinical Presentation

Subgaleal hemorrhage presents as a diffuse, boggy swelling of the scalp that crosses suture lines. Unlike cephalohematoma, which is confined to one cranial bone, subgaleal hemorrhage can extend over the entire scalp. The swelling may increase in size over the first few hours to days after birth.

Affected infants may exhibit signs of hypovolemic shock due to significant blood loss, including pallor, tachycardia, and hypotension.

Diagnosis

Diagnosis of subgaleal hemorrhage is primarily clinical, based on the characteristic presentation of scalp swelling. Ultrasound or MRI may be used to confirm the diagnosis and assess the extent of the hemorrhage.

Management

Management of subgaleal hemorrhage involves supportive care and monitoring for signs of hypovolemia. Intravenous fluids and blood transfusions may be necessary to stabilize the infant. Close monitoring of hematocrit levels and vital signs is essential.

Prognosis

The prognosis of subgaleal hemorrhage depends on the severity of the hemorrhage and the timeliness of intervention. With prompt recognition and management, most infants recover without long-term complications. However, severe cases can lead to significant morbidity or mortality due to hypovolemic shock.

Prevention

Preventive measures focus on minimizing birth trauma. Careful use of obstetric instruments and adherence to guidelines for assisted delivery can reduce the risk of subgaleal hemorrhage.

Related Pages

• Cephalohematoma
• Caput succedaneum
• Neonatal jaundice
• Birth trauma