A term male infant delivered by vacuum extraction develops progressive scalp swelling within the first hour of life. The swelling is diffuse, boggy, crosses suture lines, and extends down to the neck. Heart rate is 178/min and capillary refill is prolonged. What is the most likely diagnosis?
- A Cephalhaematoma
- B Subgaleal haemorrhage ✓
- C Caput succedaneum
- D Subdural haemorrhage
Correct answer: B. Subgaleal haemorrhage
Explanation
Subgaleal haemorrhage is bleeding between the galea aponeurotica and periosteum, a space that communicates across the whole scalp, so blood spreads freely over suture lines and into the neck, causing hypovolaemic shock. Cephalhaematoma is subperiosteal and strictly limited by sutures, while caput is a soft superficial swelling present at birth that does not cause shock. The combination of rapid spread, crossing sutures and signs of blood loss is diagnostic.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.