Which condition presents as a scalp swelling that is most associated with vacuum-assisted delivery and requires consideration for monitoring?

• A. Caput succedaneum
• B. Cephalhematoma
• C. Subgaleal hemorrhage
• D. Dural venous sinus thrombosis

Answer: (C)

Recognizing subgaleal hemorrhage is essential when a scalp swelling is observed after vacuum-assisted delivery. This bleed occurs in the subgaleal space, a potential area beneath the scalp, often from torn emissary veins during instrumental delivery. Because the space can accumulate a large volume of blood, the resulting swelling can be diffuse and cross suture lines, sometimes appearing out of proportion to external signs. That hidden, ongoing blood loss means the infant can deteriorate quickly into hypovolemia or shock, so close monitoring is mandatory. Track vital signs and urine output, perform serial hematocrit or hemoglobin to detect ongoing blood loss, monitor head circumference and neurologic status, and be prepared to initiate fluids or blood product transfusion as needed in a NICU setting.

Caput succedaneum is simply diffuse scalp edema from birth trauma that crosses sutures but does not involve significant blood loss and typically resolves within a day or two. Cephalhematoma is a subperiosteal bleed that is usually localized (does not cross sutures) and tends to resolve over weeks without the rapid systemic risk seen with subgaleal hemorrhage. Dural venous sinus thrombosis is a rare neurologic condition presenting with seizures or focal deficits rather than a primary, rapidly enlarging scalp swelling tied to delivery.