A cephalohematoma (not caput haematoma) is a collection of blood underneath the scalp of a newborn, located in the space between the skull bone and its periosteum (the membrane covering the bone).
Understanding Cephalohematomas
Cephalohematomas are typically caused by trauma to the baby's head during labor and delivery. The pressure exerted on the baby's head during passage through the birth canal can rupture small blood vessels, leading to the accumulation of blood. This collection of blood is confined by the periosteum to the surface of one cranial bone.
Causes
- Shearing Forces: The primary cause is the shearing forces on the skull during delivery, particularly during difficult or prolonged labors, or with the use of vacuum extraction or forceps. These forces can separate the periosteum from the skull.
- Instrumentation: Vacuum extraction and forceps deliveries increase the risk of cephalohematoma due to the direct pressure applied to the baby's head.
- Prolonged Labor: Longer labors can increase the amount of pressure on the baby's head.
Characteristics
- Location: Located between the skull and the periosteum, so it is contained within the boundaries of a single cranial bone. Most commonly seen over the parietal bones.
- Timing: May not be immediately apparent at birth and can develop or increase in size over the first few hours or days.
- Appearance: Feels like a firm, fluctuant (fluid-filled) swelling on the baby's head.
- Does Not Cross Suture Lines: An important characteristic is that it is limited by the cranial suture lines (the fibrous connections between the skull bones). This distinguishes it from caput succedaneum, which does cross suture lines.
Diagnosis
Diagnosis is typically made through physical examination. In some cases, if the cephalohematoma is large or there are concerns about underlying skull fractures, imaging studies (like X-rays) may be performed.
Treatment
Most cephalohematomas resolve on their own over weeks to months without any specific treatment. In rare cases, large cephalohematomas may require aspiration of the fluid, but this is generally avoided due to the risk of infection. Monitoring for jaundice is important as the breakdown of the blood in the hematoma can contribute to hyperbilirubinemia (jaundice).
Complications
- Jaundice (Hyperbilirubinemia): Breakdown of the collected blood can lead to elevated bilirubin levels, potentially requiring treatment for jaundice.
- Infection: Rare, but possible, especially if aspiration is performed.
- Calcification: In some cases, the hematoma can calcify (harden) over time.
- Underlying Skull Fracture: A cephalohematoma may indicate an underlying skull fracture, though this is uncommon.
Key Differences: Cephalohematoma vs. Caput Succedaneum
It's important to differentiate a cephalohematoma from caput succedaneum, another common birth-related head swelling:
| Feature | Cephalohematoma | Caput Succedaneum |
|---|---|---|
| Location | Subperiosteal (between skull and periosteum) | Subcutaneous (under the skin) |
| Suture Lines | Does NOT cross suture lines | Crosses suture lines |
| Contents | Blood | Serosanguinous fluid |
| Timing of Appearance | Develops in hours after birth | Present at birth |
| Resolution | Weeks to months | Days |
| Cause | Trauma during labor, often instrument-assisted | Pressure from the birth canal |
In summary, a cephalohematoma is a collection of blood under the scalp of a newborn, caused by trauma during birth, that is contained by the periosteum of a single cranial bone. It typically resolves without intervention but requires monitoring for complications such as jaundice.
