Caput Succedaneum and Cephalohematoma Birth Injuries

Caput 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 that 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. However, as 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.

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 development of caput succedaneum.

Fetal alcohol syndrome or prenatal cocaine or marijuana use does not cause a caput succedaneum or cephalohematoma.

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

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 under these circumstances; but if untreated, jaundice can lead to long-term complications such as kernicterus, a kind of brain damage which can cause:

• Hearing loss
• Athetoid cerebral palsy
• Impaired tooth enamel development
• Permanent upward gaze

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.

To diagnose caput succedaneum, no formal testing is typically required as a physical examination, and observation of apparent symptoms (such as swelling or bruising) is usually sufficient. However, should caput succedaneum arise in utero because of a premature rupturing of the maternal membranes, it can usually be detected via ultrasound.
As caput succedaneum 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.

As caput succedaneum almost always resolves itself 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.

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.
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.

The immediate cause of the cephalohematoma’s blood accumulation is damage to the blood vessels which are located under the scalp. This damage typically takes place during labor and delivery, which can be precipitated by a variety of factors such as:

• An infant’s head is larger than their mother’s pelvic area
• Using birth-assisting devices such as forceps or a vacuum
• Difficult and prolonged labor

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 developing other conditions, such as:

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

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.

To diagnose this condition, a physician will perform a physical examination of your child. 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. As cephalohematoma can indicate a birth trauma that has caused additional injuries to the skull or brain—especially in cases where your child has experienced a pre-term or complicated birth—further investigation is warranted to ensure your child’s safety.

Typically, your child will see the bump resolve on its own within three months. Physicians will not need to provide any treatment unless additional complications arise. Sometimes, the physician may recommend draining the accumulated blood. This is usually not recommended. 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. Should the condition result in jaundice (skin yellowing), light therapy, intravenous immunoglobulin, or exchange transfusion may be prescribed.
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.

Again, a cephalohematoma 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).

A subdural hematoma is a collection of blood located outside the brain. It differs from a cephalohematoma and a caput succedaneum. Subgaleal hemorrhage (SGH) is a life-threatening neonatal condition that is strongly associated with vacuum-assisted delivery (VAD). The factors associated with the development of SGH following VAD are not well-established. We aimed to evaluate the factors associated with the development of SGH following attempted VAD.

Caput medusae are swollen veins on your stomach near your bellybutton. It is a sign of liver disease. The cause of caput-medusae is portal hypertension, which 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.