Twelve hours after a vacuum-assisted delivery at +2 station, a term newborn is noted to have a diffuse, boggy, fluctuant swelling crossing suture lines, with pallor, tachycardia, and a falling hematocrit. What is the diagnosis and why is it the most feared cup-related injury?

• A Cephalhematoma, because it indicates underlying skull fracture
• B Caput succedaneum, because it signifies prolonged traction
• C Subgaleal hemorrhage, because blood can accumulate in a large potential space causing hypovolemic shock ✓
• D Extracranial edema from birth asphyxia, requiring only observation

Explanation

Subgaleal hemorrhage is bleeding between the galea aponeurotica and the periosteum, a potential space extending across the whole calvarium that can hold a large fraction of the neonatal blood volume, so shock and death can occur rapidly. Unlike cephalhematoma, it crosses suture lines and is boggy rather than firm. It demands volume replacement and urgent imaging.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.