Subgaleal hematoma. A complication of instrumental delivery.

Subgaleal hematomas (SGH) are rare but potentially fatal accumulations of blood beneath the galea aponeurotica of the scalp in the newborn. One hundred twenty-three SGH cases are summarized from the literature. Sixty-four percent occurred after instrumental delivery. The lesion is most often associated with mid-forceps operations (14 cases) and vacuum extraction (60 cases), but SGH also has been recorded after spontaneous vaginal delivery (35 cases) and after cesarean section (11 cases). Intrapartal hypoxia of the fetus and neonatal coagulopathies are prominent features of both spontaneous and instrumental delivery cases. Other risk factors include prematurity, macrosomia, prolonged labor, cephalopelvic disproportion, primiparity, male sex, and African lineage. Mortality for SGH is 22.8%. Early recognition, differentiation from benign cephalohematoma, and prompt treatment by adequate blood replacement and correction of coagulopathies are the major determinants of successful management.