Caput Succedaneum and Cephalohematoma Birth Injuries

Caput succedaneum and cephalohematoma are similar – but distinct – birth injuries that cause a baby’s head to swell.

While there are important differences between caput succedaneum and cephalohematoma, the common thread between the two is they both scare parents but they are typically not serious and will heal themselves over a relatively short period.

My Child Has Caput Succedaneum and I’m Worried… What Should I Do?

For most concerned parents, you should know that caput succedaneum and cephalohematoma are not a big deal when not coupled with a brain bleed or other cerebral insult. So many people reading this are parents who have been told their child has caput succedaneum. When it is your newborn child — and I have four myself — it is easy to panic. But the good news is that in the vast majority of cases, caput succedaneum ends up being insignificant and it resolves on it own without intervention.

The bad news is that these conditions can lead to more severe complications in the absence of a health care provider’s prompt diagnosis, vigilance, and effective treatment. The possibility that one of these conditions is connected with or arising from a more serious birth injury also means that immediate medical attention should be given to diagnosing and providing any necessary treatment for these conditions.

You can not underscore enough the importance of prompt and effective diagnosis and treatment of caput succedaneum or cephalohematoma. What would otherwise have been harmless can grow to become a more serious —sometimes lifelong — condition on account of medical negligence. This can arise from failing to recognize the issue during or after delivery, a failure to provide proper treatment (such as a C-section, when warranted), or even failing to diagnose precipitating causes of the injuries before birth.

If your child has suffered from one of these conditions because of medical neglect, you should be eligible to receive compensation. Contact me if you are looking for answers about your child’s case.

Let’s look at the most common questions about caput succedaneum and cephalohematoma.

What is caput succedaneum?

caput succedaneum injuryCaput succedaneum is a birth injury characterized by swelling or edema to a baby’s scalp observable shortly after delivery, as caused by pressure on a baby’s head. This swelling of the newborn scalp extends across the edematous region above the periosteum that crosses suture lines where the bony plates of the skull join together. (In contrast, neonatal cephalohematoma does not cross the suture lines.)
Although this can cause some discomfort, it is not a life-threatening condition. But caput succedaneum can lead to other health issues such as jaundice, it is important that if your child may have this condition that prompt diagnosis and treatment is provided right away. Although the condition will usually disappear of its own accord, the possibility that it is connected with or caused by a more serious condition necessitates greater care to ensure no more serious condition develops.

What causes caput succedaneum?

Caput succedaneum is caused by pressure on the head of the fetus and usually occurs after a lengthy, difficult delivery. Often, these may just be the normal pressures exerted by the uterus and vaginal walls upon the baby’s head during a head-first delivery. Prolonged pressure from the dilated cervix or vaginal walls on the baby’s head can cause swelling, puffiness, and bruising.
If the baby’s delivery proves to be longer and more difficult than is typical, the risk of developing this condition will increase.
Using forceps or other extraction tools – especially forceps or vacuum-assisted deliveries – can increase the chances of this condition arising. Finally, this condition can also on some occasions develop even as early as 31 weeks, should the mothers’ membranes rupture too soon. In such a case, ultrasound can usually detect the development of caput succedaneum.
Other risk factors for caput succedaneum include:
  • Protracted active labor course
  • Operative vaginal delivery, especially vacuum-assisted delivery, which is the most significant risk factor for developing caput succedaneum and scalp injury.
  • Oligohydramnios
  • Primigravida pregnancy
  • Braxton-Hicks contractions
  • Premature rupture of membranes.

What are the symptoms of caput succedaneum?

Because the bleeding is gradual, there may be a delay in the diagnosis of a cephalohematoma.

The most prominent symptom of caput succedaneum is puffiness under the skin of the scalp. As a result, your baby’s head might appear to be abnormally large, bulging around the affected area. Once the swelling goes down, the baby’s head resumes its normal shape. Some additional, less common changes which can affect the appearance of your baby’s head include:

  • Bruising (and/or color changes) of the baby’s scalp
  • Increased molding (elongation) of the baby’s head
cephalohematoma caput succedaneum similarities

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Doctors typically express caput succedaneum in terms of these changes in appearance, and symptoms of minor discomfort. But there is a risk that more serious complications can arise along with or because of the condition.

The most important of these for you to know is newborn jaundice, which is characterized by a yellowish-green skin pigmentation because of bilirubin accumulation. If treated immediately, there are typically no long-term problems that will arise from jaundice. But untreated, jaundice can lead to long-term complications such as kernicterus, a kind of brain damage which can cause:

Also, if there is a skull fracture underneath your baby’s swelling or if bleeding is extensive, the risks posed by caput succedaneum can be much more serious which is why a full, prompt diagnosis is medically warranted.

How is caput succedaneum diagnosed?

Formal testing is not required to diagnose caput succedaneum. Physical examination and observation of apparent symptoms (such as swelling or bruising) will typically suffice.  However, should caput succedaneum arise in utero because of a premature rupturing of the maternal membranes, it can usually be detected via ultrasound.
Because caput hematoma can sometimes be caused by or accompanied by more serious conditions, a greater level of examination may be warranted to ensure there are no other related issues such as a skull fracture or extensive bleeding, which can cause more serious complications.

What is the treatment for caput succedaneum?

As caput succedaneum almost always go away on its own within a few days, there is typically no need for treatment. Measures such as trying to drain the scalp area may only exacerbate the condition by leading to infections. If a more serious complication such as jaundice has arisen, additional treatment is recommended to prevent lasting harm to your baby. With jaundice, treatments prescribed vary but may include light therapy, intravenous immunoglobulin, or exchange transfusion.

What is cephalohematoma?

Cephalohematoma is like caput succedaneum, as both conditions are birth injuries characterized by swelling in a baby’s head. It is a clinical diagnosis. So there is no definitive test for cephalohematoma.

Cephalohematomas are a relatively common occurrence in newborns, affecting 1-4% of live births. They are often associated with trauma that occurs during the birth process. Cephalohematomas are a swelling that forms on the head of a newborn baby due to the accumulation of blood under the scalp. This swelling is usually caused by the separation of the newborn’s blood vessels, which can happen during a difficult delivery or from the use of instruments like forceps or vacuum extraction.
What distinguishes cephalohematoma is that it is a hemorrhage (accumulation) of blood under the scalp and above the baby’s skull. Fortunately, it rarely poses any risk to the brain cells because the blood accumulates above the skull, which means the blood is not applying pressure to the brain.
This condition is also similar but distinct from a subgaleal hematoma, which is characterized by blood accumulating above the periosteum (the membrane covering the outside of bones) directly under the scalp, while cephalohematoma is an accumulation of blood underneath the periosteum. But the similarities stop there. Subgaleal hemorrhages and hematomas carry a grave risk is a bleed that causes a birth injury or death.

What causes cephalohematoma?

The immediate cause of the cephalohematoma’s blood accumulation is damage to the small blood vessels which are located under the scalp.  What happens is pressure on the fetal head causes the rupture of these small blood vessels. This can happen in any vaginal delivery.  The risk is greater if a mechanical device such as a vacuum or forceps is used in labor and delivery.  Other causes include
  • An infant’s head is larger than their mother’s pelvic area
  • Use of an epidural
  • Difficult and prolonged labor

What are the symptoms of cephalohematoma?

The most obvious symptom of cephalohematoma is a soft, unusual bulge on the back of your baby’s skull. Because of its location under the periosteum, you will probably not see any cut or bruise on the surface of the skin over the bulge.

Expect the bulge to feel harder as the blood calcifies and then shrinks and disappears after a few weeks under normal circumstances. Aside from this bulge, there are often no additional (or obvious) symptoms as a result of cephalohematoma. However, cephalohematoma can cause your child to develop other conditions, such as:

  • Jaundice (yellowing)
  • Anemia (low red blood cell counts)
  • Hypotension (low blood pressure)
  • Meningitis
  • Infection (such as osteomyelitis)
  • Skull Deformation

Furthermore, if accompanied by a more serious condition such as a skull fracture, cephalohematoma can also lead to the growth of this fracture into a leptomeningeal cyst.

Although cephalohematoma is typically not a serious condition, if these other conditions arise from or accompany it there is a possibility that your child may experience developmental delays, motor skill deficiencies, and a non-resolution of the condition. In more acute instances, long-term risks include the development of cerebral palsy. For this reason, your child must be promptly diagnosed and provided with any necessary treatment for this condition, even though it is typically only a minor affliction.

How is cephalohematoma diagnosed?

To diagnose this condition, a physician will perform a physical examination of your child by a pediatrician. Although the appearance of the bulge alone can often be enough to make a diagnosis, your doctor may also request additional tests such as X-Ray, CT scan, MRI Scan, or ultrasound to ensure there are no additional problems, such as intracranial hemorrhage or skull fractures.  Because, in very rare cases, a cephalohematoma can indicate a birth trauma causing additional injuries to the skull or brain.  This is especially true if your child has experienced a pre-term or complicated birth. In this case, further investigation is warranted to ensure your child’s safety.

What is the treatment for cephalohematoma?

When a newborn has a cephalohematoma, the best treatment is to wait and let the body naturally reabsorb the collected fluid. Typically, your child will see the bump resolve and the cephalohematoma will go away on its own within three months. Physicians will not need to provide any treatment unless additional complications arise.  In rare cases, the cephalohematoma may not resolve and calcification or ossification may occur. If the cephalohematoma has not disappeared after 6 weeks, a skull x-ray or CT scan may be necessary.

Draining a cephalohematoma

Sometimes, the physician may recommend draining the accumulated blood. This is usually not recommended but it makes sense in some cases.

Complications such as infections and/or abscess formations can arise from draining. If the condition results in a lowering of your baby’s red blood cell count (anemia), additional treatment such as a blood transfusion may become necessary.

Jaundice and Cephalohematomas

Just like with caput succedaneum, newborns are more prone to jaundice because a a cephalohematoma can cause jaundice (skin yellowing) in newborns because the clotted blood in the cephalohematoma can interfere with the normal process of breaking down and eliminating bilirubin, a yellow pigment produced when red blood cells break down.

Bilirubin typically travels through the bloodstream and is processed by the liver, but if there is a buildup of bilirubin, it can cause the skin, eyes, and other tissues to appear yellow, a condition known as jaundice. This can occur when the blood from a cephalohematoma interferes with the liver’s ability to break down and eliminate bilirubin, leading to an increased level of bilirubin in the blood and resulting in jaundice. It is important for newborns with cephalohematoma to be carefully assessed for jaundice and treated promptly if necessary.

Should the condition result in jaundice, light therapy, intravenous immunoglobulin, or exchange transfusion may be prescribed.

Newborns with cephalohematomas have a higher risk of developing jaundice in the first days after birth, so they need to be monitored for yellow discoloration of the skin, eyes, or mucous membranes. If they show signs of jaundice, a test to measure their bilirubin level will be done.

Can jaundice be a big deal?  Yes.  But in most cases, it goes away as easily a cephalohematomas do.

Treating hardened cephalohematomas

There is debate about the best way to treat cephalohematomas that have hardened and formed a clear outer and inner layer of bone. Some believe that early surgery is better, while others believe it is not necessary unless there are other clinical indications.

In patients with later-stage ossification or calcification, surgery may be necessary to improve the outcome, decrease the risk of elevated intracranial pressure, and improve the appearance. The surgical technique involves removing the overlying newly formed bone, the soft tissue mass, and the underlying original bone. The depressed region can then be remodeled as a bone graft.

Cephalohematomas can be treated safely with surgery, such as craniotomy or craniectomy and cranioplasty, and have good outcomes with minimal evidence in the following years.

If the condition does not rectify itself within a few months, it is recommended that you seek renewed medical attention and consider whether additional treatment is necessary.  A misshaped head is rare but even in that unlikely even the problem can usually be resolved with cosmetic surgery.

How long does cephalohematoma last?

Again, a cephalohematoma in a newborn will probably last for weeks as opposed to months. Some rare cases of cephalohematoma last over three months that might require further treatment. The problem is that the child has a lump filled with pooled blood. The treatment, if this continues unabated, is to drain that pulled blood out of the child’s head (which is not a big thing but comes with a risk of infection).

What is a subdural hematoma?

A subdural hematoma is a collection of blood located outside the brain. It is different from a cephalohematoma and a caput succedaneum.  The big difference is that a subgaleal hemorrhage (SGH) is a life-threatening neonatal condition that puts pressure on the child’s brain. A subdural hematoma is strongly associated with vacuum-assisted delivery (VAD). The factors associated with the development of SGH following VAD are not well-established.

What is caput-medusae?

Caput medusae are swollen veins on your stomach near your belly button. It is a sign of liver disease. The cause of caput-medusae is portal hypertension. This is high pressure in the portal vein. You can see caput medusae in newborns. But it is rare. This condition is unrelated to caput succedaneum.

Why is Caput Succedaneum Usually Harmless?

Caput succedaneum is usally harmless because it does not place pressure on the brain. the collection of blood is sitting above the skull, not under it where it might put pressure on the brain.

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