Six hours after a difficult vacuum-assisted delivery, a term neonate develops a boggy, diffusely spreading scalp swelling that crosses suture lines and continues to enlarge. Heart rate is 168/min and capillary refill is delayed. What is the MOST likely diagnosis?

• A Subgaleal haemorrhage ✓
• B Cephalhematoma
• C Caput succedaneum
• D Subdural haemorrhage

Explanation

Subgaleal haemorrhage is bleeding between the galea aponeurotica and the periosteum, a potential space that extends across suture lines and can hold most of the neonatal blood volume, producing progressive swelling with hypovolemic shock. This makes it the most dangerous instrument-related birth injury. Cephalhematoma is subperiosteal and strictly limited by cranial sutures, which excludes it here. Caput also crosses sutures but is present at birth, soft, and does not progressively enlarge with signs of blood loss.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.