From the Research
A subgaleal hemorrhage is a serious condition characterized by bleeding in the potential space between the periosteum of the skull and the galea aponeurotica, which can lead to significant morbidity and mortality if not promptly recognized and treated. This condition most commonly affects newborns during difficult deliveries, particularly when vacuum extraction or forceps are used 1. The bleeding can spread extensively across the scalp because the subgaleal space has no anatomical boundaries. Symptoms include progressive swelling of the scalp that crosses suture lines, fluctuant mass, pallor, and potentially signs of hypovolemic shock if significant blood loss occurs.
Causes and Risk Factors
The causes of subgaleal hemorrhage include instrumental delivery, especially with the use of vacuum extraction 1, as well as mild head trauma, coagulation disorders, and accidental or abusive hair pulling 2. Risk factors for subgaleal hemorrhage in newborns include prematurity, macrosomia, prolonged labor, cephalopelvic disproportion, primiparity, male sex, and African lineage 3.
Diagnosis and Treatment
Diagnosis of subgaleal hemorrhage is based on clinical presentation and imaging studies, such as computed tomography (CT) scans. Treatment primarily involves supportive care, including monitoring vital signs, managing pain, and blood transfusions in severe cases 1. Conservative management with non-elastic bandage packing and direct compression may also be effective in some cases 4. In severe cases, surgical intervention may be necessary to correct coagulopathy and anemia.
Prognosis and Outcomes
The prognosis for subgaleal hemorrhage is generally good with prompt recognition and treatment, but the condition can be life-threatening if left untreated. Mortality rates for subgaleal hemorrhage have been reported to be as high as 22.8% 3. With proper management, most subgaleal hemorrhages resolve within 2-3 weeks, but the condition can lead to significant morbidity, including anemia, coagulopathy, and hemodynamic instability if not recognized and treated promptly.