Subgaleal hematoma which is the other name for subgaleal hemorrhage is a condition whereby bleeding occurs in between the skull periosteum and the scalpgalea aponeurosis leading to swelling. It is a very lethal condition in newborns.
Subgaleal hematona often results after a traumatic birth or a fracture in the skull that can either be due to a blow in the head or falling.
Concerning traumatic birth, it usually results when applying a vacuum in the head during ventouse assisted delivery. The vacuum assisted approach can lead to the rupture of emissary veins resulting to blood accumulation under the aponeurosis of the scalp muscle.
Some infants can lose about 50 to 70 percent of their blood leading to anemia, shock, coagulopathy and even death.
Subgaleal hematona is characterized by a fluctuant muddy mass that develops over the scalp and a shallow bruising of the skin which sometimes make the head appear twisted or unbalanced.
The swelling can develop a few hours after delivery but in some cases, it may be noticed just right after delivery. The infant may also feel dizzy and lightheaded.
3. Signs and symptoms
The initial localized signs of the disease are vague. It’s generalized with scalp swelling and a laxity of the scalp at the site of the cup application.
As haemorrhage accumulates further, the sensation on palpation looks like an old leather pouch filled with fluid.
Later signs include tachycardia, poor activity and pallor, tachypnoea, anemia, coagulopathy, hypotension, acidosis and death.
4. Vacuum Delivery
While subgaleal hematona occurs mostly following normal delivery, forceps delivery and caesarean section, the most frequent association is with vacuum delivery.
There should be thorough preparation and supervision during vacuum delivery and a lot of care should be taken during the process.
5. Risk Reduction
To minimize the risk of the condition, shearing forces on the scalp should be minimized.
This can be done by placing the centre of the cup over the flexion point which is situated on the sagittal suture six centimeters from the anterior fontanelle and three centimeters in front of the posterior fontanelle.
6. Maternal Effort is Important
During vacuum delivery, there should be a steady traction, applied only with maternal effort and only with contractions.
7. Ruptured blood vessels heals most of the time
The blood vessels that rupture usually heals most of the time. The body becomes able to transport the leaked blood away from there and dispose them.
However, some neonatal patients never recover from the condition at all.
8. Vitamin K prophylaxis
Vitamin K prophylaxis should be administered to all neonates delivered by vacuum as soon as possible after birth.
Late examination on head injuries can result to severe medical conditions, exposing patients to high risk of getting into a coma or even dying.
Careful evaluation should be scrupulously done to any swelling that becomes visible on the head.
10. Various approaches important for prevention:
– Avoiding vacuum extraction in infants at high risk of undergoing subgaleal hematoma.
– Appropriate techniques such as accurate positioning of the cup, application of traction and recognizing when to abandon the procedure in favor of another mode of delivery.
– Formally assessing the individual infant’s risk of the disease following every instrumental delivery.
– Prompt evaluation, revival and supportive treatment once the diagnosis is suspected.
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