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What is subgaleal hematoma?

Subgaleal hematoma (also known as subaponeurotic hematoma) is an accumulation of blood in the soft tissue space between the epicranial aponeurosis of the scalp and the skull periosteum. It is an uncommon but potentially life-threatening condition found in newborns (the prevalence of moderate to severe subgaleal hematomas is around 1.6 per 10,000 normal deliveries and 4.6 per 10,000 instrumental-assisted deliveries).

Causes of subgaleal hematoma

Subgaleal hematoma is mostly caused by rupture of the emissary veins that connect the dural sinuses and the scalp veins. The rupture typically is associated with a complication to vacuum or forceps-assisted delivery. In rare cases, such as in newborns having a family history of bleeding disorders, the hematoma may occur spontaneously.

Diagnosis of subgaleal hematoma

Diagnosis is typically clinical by history-taking and physical examination of the head. Although not necessary to make the clinical diagnosis, imaging tests for subgaleal hemorrhage may be performed with CT and MRI to identify the presence of accompanying fractures.

Signs and Symptoms

Signs and symptoms of a subgaleal hematoma include:

• The presence of a boggy, fluctuant mass in the baby’s scalp, particularly on the occiput, resulting from the blood sac in the loose connective tissue under the aponeurosis. In minor and moderate cases, the swelling develops gradually in 2-72 hours after delivery, with a reddish appearance of the overlying skin. In more severe cases, it may appear immediately.
• The baby may present with pallor and flaccid appearance due to hypovolemia shock from excessive bleeding.

Treatment

Babies with subgaleal hematoma should receive neonatal intensive care. Surgical procedure to remove the hematoma is not an option. Treatment is generally aimed to manage the underlying hemorrhage and improve the vital signs of the baby.

A pressure bandage may be applied to the upper head to lessen bleeding and prevent movement that could worsen the condition. Patient monitoring includes a minimum of 8 hours’ vigilant observation following the delivery that continues to several days to oversee  progression of clinical condition. Blood transfusion and fluid boluses of crystalloid, glucose and sodium bicarbonate may be administered if blood loss is significant.

The long-term prognosis of surviving babies is generally good.