Cephalhaematoma versus subgaleal haemorrhage

Cephalhaematoma is a subperiosteal haemorrhage secondary to the
rupture of blood vessels. Its boundaries are limited by the individual
bones. In most cases, there is probably a hairline fracture of the
underlying cranial bone, which may be difficult to demonstrate but is
unimportant since it affects only the outer table of the skull. There
is usually no brain damage. A large amount of blood may be accumulated
and blood transfusion may be required. A large cephalhaematoma may be
associated with neonatal jaundice and anaemia.
The usual cause of cephalhaematoma are prolonged second stage of
labour or instrumental delivery particularly ventouse.
During resolution, there may be a hard swelling which takes several
months to disappear. In some cases, calcification of the swelling
leaving a relatively softer centre mimic depressed fractures.
Cephalhaematoma can be differentiated from the caput succedaneum ,
which is a soft swelling due to the edema of the skin presenting at
the cervix and it crosses the suture line. Caphelhaematoma is limited
to the one side of suture line.
Cephalhaematoma must also be distinguished from another scalp bleeding
called subaponeurotic haemorrhage (also called subgaleal haemorrhage),
which is bleeding between the scalp and skull bone (above the
periosteum).
Subgaleal haemorrhage is rare after normal vertex vaginal. It can be
found one in 1000 babies delivered by ventouse. The baby can become
shocked and mortality rate can be as high as 20%. The clue to the
diagnosis is a boggy swelling of the scalp that crosses the suture
line.