Extracranial Hemorrhage

Extracranial hemorrhage can be classified by the location of the hemorrhage in the scalp. The layers of the scalp from external to internal are: skin, connective tissue, aponeurosis (galea), loose connective tissue and pericranium (remembered by the acronym 'SCALP'). Following normal vaginal delivery, scalp swelling is commonly observed and is termed caput succedaneum. This hemorrhage is typically located in the midline of the posterior parietal region. It seldom leads to a significant reduction in the hematocrit and is usually self-limiting. A hematoma in the subgaleal space, however, may lead to rapid loss in hematocrit, although evacuation is rarely indicated. A cephalohematoma is a subperiosteal hemorrhage attributed to skull distortion or skull fracture. It can also occur from placement of a fetal scalp monitor into the cranial vault. This hematoma is limited by the boundaries of the periosteum or suture lines, and for this reason dramatic loss of blood volume is rare. Most cephalohematomas resolve spontaneously, although some can ossify over time. This skull deformity may require surgical repair if it is in a visible location.

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