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Figure 4.15. Massive scalp hemorrhage of the newborn (subgaleal hemorrhage). When there is rupture of the capillaries in the subaponeurotic area, there may be massive scalp hemorrhage with spread over the entire scalp and massive blood loss. Disseminated intravascular coagulopathy may ensue rapidly. This condition may occur as a result of a precipitous delivery or poor application of a vacuum extractor. Note the massive soft tissue swelling.

Figure 4.16. Frontal view of the same infant who had a massive scalp hemorrhage with a skull fracture. Note the ecchymoses of the upper eyelids and marked swelling from the bridge of the nose extending over the scalp. This is characteristic of a subgaleal hemorrhage as the aponeurosis of Galen attaches at the upper eyelids and has no attachment to the scalp until the nape of the neck and the sternocleidomas-toid muscle on the sides, hence the massive hemorrhage in the sub-galeal area of the head.

Figure 4.17. A massive scalp hemorrhage following vacuum extractor delivery. Note the limitation of bleeding at the nape of the neck and the sternocleidomastoid muscle. The bleeding into the subaponeurotic space may result in massive blood loss leading to hypovolemia and shock.

Figure 4.17. A massive scalp hemorrhage following vacuum extractor delivery. Note the limitation of bleeding at the nape of the neck and the sternocleidomastoid muscle. The bleeding into the subaponeurotic space may result in massive blood loss leading to hypovolemia and shock.

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