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Subgaleal Hemorrhage

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Subgaleal hemorrhage in neonates

Publicado en: Salud y medicina
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Subgaleal Hemorrhage

  1. 1. Subgaleal Hemorrhage Dr Padmesh V
  2. 2. • Collection of blood in space between galea aponeurotica and periosteum.
  3. 3. • Incidence: • 4 per 10,000 in non-instrumented deliveries • Up to 64 per 10,000 in vacuum extraction. • Etiology: • Most common cause: Difficult instrumental vaginal delivery, especially mid-forceps delivery and vacuum extraction.
  4. 4. • Risk factors: – Coagulopathies, – Prematurity, – Macrosomia, – Fetal dystocia, – Precipitous labor, – Intrapartum hypoxia, – Male sex, – Cephalopelvic disproportion, – Prolonged labor – Nulliparity
  5. 5. • Mechanism of Injury : Vacuum traction Pulls scalp away from stationary bony calvarium Avulses open the subgaleal space Bridging vessels are torn Bleed into subgaleal space.
  6. 6. • Loose connective tissue of subgaleal space is –very expansive –extends over entire area of scalp. • This space can accommodate the entire neonatal blood volume (>=250 mL in term baby) – hypovolemic shock, – disseminated intravascular coagulation, – multiorgan failure – death (25% cases)
  7. 7. • Clinical Manifestations: • Mean time to diagnosis is 1-6 h after birth. • Early manifestations: Diffuse swelling of scalp, pallor, hypotonia. • Pitting edema • Progressive posterior and lateral spread. • Periorbital swelling • Ecchymosis • Hypovolemic shock • Multiorgan failure, • Signs of cerebral irritation
  8. 8. • Clinical Manifestations: • Massive lesions  Extracranial cerebral compression  Rapid neurologic decompensation. • “Silent presentation”, in which fluctuant mass is not apparent initially. • Subgaleal hemorrhage should be considered in a neonate born through vacuum delivery, with shock & falling hematocrit even in the absence of a detectable fluctuant mass. • Close monitoring even in infants who are considered stable.
  9. 9. • Radiographic Manifestations. • Xray Skull: To look for fractures • CT Scan • Differential Diagnosis: • Unlike Cephalhematoma, Subgaleal hemorrhage is – more diffusely distributed, – has more rapid course, – significant anemia, – signs of CNS trauma (hypotonia, lethargy, seizures), – frequent lethal outcome.
  10. 10. • Treatment: • Prompt restoration of blood volume with FFP or blood. • Recombinant activated factor VII. • Use of tranexamic acid reported. • Note: • Bandaging may increase SGH mass effect and elevate ICP and is not recommended.
  11. 11. • Treatment: • If continued deterioration  neurosurgery as last resort. Bicoronal incision Exposure of subgaleal space. Cauterization of any bleeding points Drain left in the subgaleal space.
  12. 12. • Screening after vacuum delivery: • Examination of scalp and repeat review at 1 and 4 hours • Prognosis. • Around 25% mortality • Long-term prognosis for survivors good

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