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Subgaleal Haematoma in the Neonate

Subgaleal Haematoma in the Neonate. Max Brinsmead PhD FRANZCOG July 2011. Resources. RANZCOG Statement July 2009. Definition. Bleeding within the potential space between the scalp aponeurosis and periosteum From rupture of emissary veins which connect dural sinuses and scalp veins

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Subgaleal Haematoma in the Neonate

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  1. Subgaleal Haematoma in the Neonate Max Brinsmead PhD FRANZCOG July 2011

  2. Resources • RANZCOG Statement July 2009

  3. Definition • Bleeding within the potential space between the scalp aponeurosis and periosteum • From rupture of emissary veins which connect dural sinuses and scalp veins • Needs to be distinguished from... • Caput succedaneum (fluid only in extraponeutic tssues) • Cephalhaematoma which is bleeding between periosteum and the cranial bones

  4. SubGaleal Haemorrhage is important because... • Up to 250 ml of blood can collect in this space • With only a 1 cm increase in scalp thickness • This can be 50 – 75% of an infant’s blood volume • Losses of this order cause hypovolaemic shock, coagulopathy and death • Of babies admitted to NICU with this condition the mortality is 12 – 25%

  5. Who is at Risk? • Occurs at a rate of one in every 1666 after spontaneous delivery • But up to 1:5 after ventouse • Odds Ratio (OR) for Vacuum Delivery is 7.17 (CI 5.43 – 10.25) • OR for failed vacuum delivery is 16.4 • OR for Forceps Delivery is 2.66 (CI 1.78 – 5.18)

  6. Clinical Features • Low 5-min Apgar for an at risk baby should raise clinical suspicion • Tachyopnoea, tachycardia, pale & listless or irritable cry • Generalised scalp swelling and laxity scalp • Ballotable mass that extends beyond scalp sutures May extend from orbit to ears and down the neck • Serial head measures may be used • But intervention may be required long before this is documented

  7. How to Avoid Subgaleal Haemorrhage • Avoid ventouse before 34 completed weeks • And cautiously before 36 weeks • Also for babies with suspected bleeding disorder • Correct cup application • To the flexion point on the head • Steady traction only with contractions & maternal effort • Progress with every pull • Delivery completed (or close to completion) within 3 pulls

  8. How to Avoid Subgaleal Haemorrhage (2) • The delivery should be complete (or close to completion) within 20 minutes of suction • Consider Caesarean after 15 minutes with no progress • Detachment is not a “safety feature” of the instrument and should be avoided • Abandon the attempt after two (max 3) detachments (technical problems exempted) • Give Vitamin K asap after birth to all infants (and high risk babies in particular)

  9. Management of Suspected Subgaleal Haemorrhage • Appropriate observations of all babies after instrumental delivery • Avoid hats & bonnets (or remove them frequently) • For a high risk infant i.e. After any difficult ventouse • Perform cord blood gases , pH, Haematocrit and Platelet count • Hourly obs for 12 hours • Pulse oximetry desirable • Do not delay treatment with attempted imaging • Aggressive resuscitation with crystalloids and blood • Involve paediatrician. Will require NICU

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