Two days after a vacuum-assisted vaginal delivery, a term neonate develops a fluctuant, boggy swelling over the parietal region that crosses suture lines. The baby is pale and the hematocrit has fallen. What is the MOST likely diagnosis?
- A Cephalhematoma
- B Subgaleal hemorrhage ✓
- C Caput succedaneum
- D Subdural hemorrhage
Correct answer: B. Subgaleal hemorrhage
Explanation
Subgaleal hemorrhage is blood between the galea aponeurotica and periosteum, a potential space extending across the whole calvarium, so the swelling crosses suture lines and can expand massively, causing hypovolemia and jaundice. It is the feared complication of vacuum extraction due to traction tearing emissary veins. Cephalhematoma is subperiosteal and strictly limited by sutures. Caput is a soft edematous swelling present at birth that does not enlarge progressively or cause falling hematocrit.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.