Subgaleal Haemorrhage (RANZCOG)

Question 1

Where does a subgaleal haemorrhage occur?

Answer 1

between epicranial aponeurosis and underlying periosteum. Potential space 250mL = 1cm increase in scalp thickness.

Question 2

Mortality rate SGH

Answer 2

12-25%

Question 3

Signs of SGH

Answer 3

Apgar @5min <7
haemodynamic instability
cogulopathy
acidosis
increase in HC

scalp swelling/laxity of scalp. fluctuant. ballot able across suture lines. pitting oedema. gravity dependent.

irritable neonate

Question 4

Aspects of delivery associated with SGH?

Answer 4

inappropriate cup placement, poor descent, prolonged traction, >20min, >3 tractions, >2 pop offs.

vacuum extraction (OR 7.17) or forceps (OR2.66)

Question 5

What should prompt level 2 neonatal care in the context of SGH risk?

Answer 5

> 20 min application, >3 pulls, >2 pop-offs
5min Apgar <7min
at clinician request (difficult del)
abnormal level one neonatal observations (activity, colour, heart rate, pallor, abnormal exam of head)