Twelve hours after a vacuum-assisted delivery, a term newborn develops a rapidly enlarging, boggy, diffuse scalp swelling that crosses suture lines. The baby is pale with a dropping haematocrit. Which complication has occurred?

• A Cephalhaematoma
• B Caput succedaneum
• C Subconjunctival haemorrhage
• D Subgaleal haemorrhage ✓

Explanation

Subgaleal haemorrhage is bleeding between the galea aponeurotica and periosteum, a potential space extending across the whole scalp, so swelling crosses suture lines, enlarges progressively and can cause exsanguination and hypovolaemic shock. It is the feared complication specific to vacuum delivery. A cephalhaematoma is subperiosteal, limited by sutures, firm and does not expand acutely; caput is present at birth, soft and self-limiting; subconjunctival haemorrhage is a benign external finding unrelated to scalp swelling.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.