Two days after a vacuum-assisted delivery, a term neonate is noted to be pale and lethargic. There is a boggy, fluctuant swelling of the scalp that crosses both suture lines and the anterior fontanelle, and the hematocrit has fallen from 52% to 33%. What is the diagnosis?

• A Cephalohematoma
• B Caput succedaneum
• C Subaponeurotic cyst of the newborn
• D Subgaleal hemorrhage ✓

Explanation

Subgaleal hemorrhage is blood tracking between the galea aponeurotica and periosteum, a potential space extending across the whole calvarium, hence a boggy swelling crossing sutures with progressive expansion and hypovolemia. It carries significant mortality and is classically associated with vacuum extraction. Cephalohematoma is confined by sutures and does not cause such rapid volume loss, while caput is present at birth, pitting, and self-limited.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.