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出血,(特に)大量出血 / 多量に出血する

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/08/13 16:13:07」(JST)

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Subgaleal hemorrhage or hematoma is bleeding in the potential space between the skull periosteum and the scalp galea aponeurosis.

Causes

The majority (90%) result from applying a vacuum to the head at delivery (Ventouse assisted delivery). The vacuum assist ruptures the emissary veins (connections between dural sinus and scalp veins) leading to accumulation of blood under the aponeurosis of the scalp muscle and superficial to the periosteum.^[1] Subgaleal hematoma has a high frequency of occurrence of associated head trauma (40%), such as intracranial hemorrhage or skull fracture. The occurrence of these features does not correlate significantly with the severity of subgaleal hemorrhage.

Symptoms

The diagnosis is generally a clinical one, with a fluctuant boggy mass developing over the scalp (especially over the occiput) with superficial skin bruising. The swelling develops gradually 12–72 hours after delivery, although it may be noted immediately after delivery in severe cases. The hematoma spreads across the whole calvaria as its growth is insidious and may not be recognized for hours. If enough blood accumulates a visible fluid wave may be seen.

Patients with subgaleal hematoma may present with hemorrhagic shock.^[2] The swelling may obscure the fontanel and cross suture lines (distinguishing it from cephalohematoma). Watch for significant hyperbilirubinemia. The long-term prognosis is generally good. Laboratory studies consist of a hematocrit evaluation.

Management

Management consists of vigilant observation over days to detect progression.The subgaleal space is capable of holding up to 50% of a newborn baby's blood and can therefore result in acute shock and death. Fluid bolus may be required if blood loss is significant and patient becomes tachycardic. Transfusion and phototherapy may be necessary. Investigation for coagulopathy may be indicated.

References

^ AAP Textbook of Pediatrics
^ Ronald S. Gibbs; David N. Danforth; Beth Y Karlan; Arthur F Haney (2008). Danforth's obstetrics and gynecology. Lippincott Williams & Wilkins. p. 470. ISBN 978-0-7817-6937-2. Retrieved 12 April 2010. Cite uses deprecated parameters (help)

UpToDate Contents

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1. 新生児における機械的人工呼吸 neonatal birth injuries
2. 頭皮裂傷の評価およびマネージメント assessment and management of scalp lacerations
3. 小児における頭蓋骨骨折 skull fractures in children
4. 小児における硬膜外血腫：疫学、解剖学および病態生理 intracranial epidural hematoma in children epidemiology anatomy and pathophysiology
5. 手術的経膣分娩 operative vaginal delivery

English Journal

Risk Factors For Failed Vacuum Extraction And Associated Complications In Term Newborn Infants: A population-based cohort study.

Ahlberg M1, Norman M, Hjelmstedt A, Ekéus C.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.J Matern Fetal Neonatal Med.2015 Jul 2:1-23. [Epub ahead of print]
OBJECTIVE: The aims of the present study were to investigate risk factors for failed VE, and to compare neonatal complications among infants delivered by failed VE with those delivered by successful VE.METHODS: Population based study including all women (and their newborn infants) with singleton pre
PMID 26135756

Head and neck injuries from the Boston Marathon bombing at four hospitals.

Singh AK1, Buch K, Sung E, Abujudeh H, Sakai O, Aaron S, Lev M.
Emergency radiology.Emerg Radiol.2015 May 12. [Epub ahead of print]
The aim of this study was to evaluate the imaging findings of head and neck injuries in patients from the Boston Marathon bombing. A total of 115 patients from the Boston Marathon bombing presenting to four hospitals who underwent imaging to evaluate for head and neck injuries were included in the s
PMID 25962489

Subdural to subgaleal shunts: alternative treatment in infants with nonaccidental traumatic brain injury?

Blauwblomme T1, Di Rocco F, Bourgeois M, Beccaria K, Paternoster G, Verchere-Montmayeur J, Sainte-Rose C, Zerah M, Puget S.
Journal of neurosurgery. Pediatrics.J Neurosurg Pediatr.2015 Mar;15(3):306-9. doi: 10.3171/2014.9.PEDS1485. Epub 2015 Jan 2.
OBJECT: The ideal treatment for subdural hematomas (SDHs) in infants remains debated. The aim of this study was to analyze the safety and efficiency of subduro-subgaleal drainage in SDH.METHODS: The authors conducted a single-center open-label study between August 2011 and May 2012. Data were prospe
PMID 25555119

Japanese Journal

未熟児脳室内出血と出血後水頭症の周術期管理

宮嶋雅一,木村孝興,近藤聡英,下地一彰,新井一
脳神経外科ジャーナル 22(4), 276-282, 2013
未熟児の水頭症の主な病因は脳室内出血であり, 出血の程度と水頭症の発症には相関がある. 髄鞘化に乏しい未熟な脳は圧迫を受けると容易に変形するため, 未熟児では頭囲が拡大する前に著明な脳室拡大を生じる. 周術期管理は, 利尿剤やステロイド剤の投与などの内科的治療と腰椎穿刺の反復, 髄液リザーバー留置による間欠的髄液穿刺排液, 脳室帽状腱膜下シャント, PIカテーテルによる持続脳室ドレナージなどの外 …
NAID 130003379611

帽状腱膜下血腫を初発症状とした重症新生児血友病Aの一症例

大関一裕,島村直紀,荻野寛子,岡田真衣子,高下敦子,大橋祥子,藤中義史,増永健,瀧川逸朗
日本周産期・新生児医学会雑誌 = Journal of Japan Society of Perinatal and Neonatal Medicine 48(1), 127-130, 2012-05-20
NAID 10030648046

新生児頭蓋内出血をめぐる諸問題(<特集>小児脳神経外科における諸問題)

師田信人,荻原英樹,上甲眞宏
脳神経外科ジャーナル 20(11), 790-801, 2011-11-20
新生児頭蓋内出血の諸問題点につき,早産低出生体重児・成熟児に分けて検討した.新生児では血管脆弱性・止血凝固機能の未熟性のため,頭蓋内出血を発症すると重症化しやすい.特に胚芽層は胎生24〜32週にかけて存在するが,血流豊富なだけでなく血行力学的弱点も有し,早産低出生体重児脳室内出血の出血源となる.出血の機序・好発部位は,早産低出生体重児と成熟児で大きく異なる.前者では胚芽層からの脳室上衣下〜脳室内出 …
NAID 110008762357

Related Pictures

Subgaleal hemorrhage - TrialExhibits Inc. Subgaleal Hemorrhage Coronal View of Upper Head - TrialExhibits Inc. Subgaleal Hemorrhage - Dr Padmesh - Neonatology Subgaleal Hematoma - YouTube Newborn Subgaleal Hematoma and Medical Malpractice Pediatric Radiology on Instagram: “- P578 - Skull Hematomas . Caput Worsening of Head Injury (Subdural Hematoma Stock Photo - Alamy

★リンクテーブル★

リンク元	「帽状腱膜下出血」
関連記事	「hemorrhage」

「帽状腱膜下出血」

Subgaleal hemorrhage
	Classification and external resources
	Newborn Scalp bleeds
ICD-10	P12
ICD-9	767.1

　　[★]

英: subgaleal hemorrhage
同: 帽状腱膜下血腫
関: 分娩損傷

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帽状腱膜下出血 : 約 1,920 件
帽状腱膜下血腫 : 約 1,250 件

図：SPE.98

「hemorrhage」

　　[★]

n.

出血

関: bleeding

[1] AAP Textbook of Pediatrics

[GibbsDanforth2008-2] Ronald S. Gibbs; David N. Danforth; Beth Y Karlan; Arthur F Haney (2008). Danforth's obstetrics and gynecology. Lippincott Williams & Wilkins. p. 470. ISBN 978-0-7817-6937-2. Retrieved 12 April 2010. Cite uses deprecated parameters (help)

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subgaleal hemorrhage