Subgaleal hemorrhage or hematoma is bleeding in the potential space between the skull (periosteum) and the scalp (galea aponeurosis).
The majority (90%) result from applying a vacuum to the head at delivery (Ventouse assisted delivery). The vacuum assist ruptures the emissary veins (connections between dural sinus and scalp veins) leading to accumulation of blood under the aponeurosis of the scalp muscle and superficial to the periosteum. Subgaleal hematoma has a high frequency of occurrence of associated head trauma (40%), such as intracranial hemorrhage or skull fracture. The occurrence of these features does not correlate significantly with the severity of subgaleal hemorrhage.
The diagnosis is generally a clinical one, with a fluctuant boggy mass developing over the scalp with superficial skin bruising. The swelling develops gradually 12–72 hours after delivery, although it may be noted immediately after delivery in severe cases. The hematoma spreads across the whole skull as its growth is insidious and may not be recognized for hours. If enough blood accumulates a visible fluid wave may be seen.
Patients with subgaleal hematoma may present with hemorrhagic shock. The swelling may obscure the fontanel and cross suture lines (distinguishing it from cephalohematoma ). Watch for significant high levels of bilirubin (the chemical in your body which gives bruises their colour)
Management consists of vigilant observation over days to detect progression.The subgaleal space is capable of holding up to 50% of a newborn baby’s blood and can therefore result in acute shock and death. Fluid bolus ( A fluid bolus is a rapid infusion of intravenous fluid or medication that is usually administered to correct a life-threatening condition) may be required if blood loss is significant and patient becomes tachycardic. Transfusion and phototherapy (light therapy) may be necessary.