Cephalhematoma - a Cranial Injury that can Happen at Birth

A Cephalhematoma is one of the most common cranial injuries that an infant may suffer especially during a forceps-assisted delivery or vacuum extraction. It can also result from a prolonged labor. It is characterized by the swelling of an infant's scalp as a result of hemorrhaging or a collection of blood between the infant’s skull—most often the parietal or occipital bone and the periosteum, a tough thin tissue that surrounds the bone. Although it is most common in the parietal and occipital regions, it can also happen in other locations. The swelling will appear as a squishy or slightly hardened and reddish lump on the baby’s head.

The bleeding is started when there is a tearing of the tiny vessels that nourish the periosteum when undue pressure is applied to the scalp of the infant during delivery. The swelling may start to form on the fetus’ scalp during labor when the mother’s cervix grips the fetus’ scalp and slowly enlarge in the first few days after delivery.

Forceps and Vacuum Extraction

The use of forceps and ventouse in delivery puts the infants at high risk of cranial birth injuries such as cephalhematoma. A ventouse is a medical device used in vacuum extraction. It is equipped with a suction cup that is placed on the infant’s head and provides traction that helps pull the baby’s head out of the vaginal canal. Once the baby’s head is out, the ventouse is removed and the mother delivers the baby by herself. The pressure provided by the ventouse suction can lead to cephalhematoma.

Cephalhematoma is distinct from Caput Succedaneum which is also characterized by swelling in a newborn’s scalp. However, the swelling in the Caput Succedaneum is caused by the pressure from the uterus or a vaginal wall during a head-first delivery and not by hemorrhaging. Also, the swelling in the Caput Succedaneum is temporary and will disappear in a day or two while it will take two weeks to three months for the swelling or bump in the Cephalhematoma to go down, as the blood is slowly absorbed back into the body.

Cephalohematoma should also not be confused with Subgaleal hemorrhage, which is another collection of blood between the scalp and the skull bone but above the periosteum while Cephalhematoma is hemorrhaging under the periosteum.

In most cases, no medical intervention such as draining is required because the swelling will eventually go down as the blood is slowly re-absorbed from the periphery to the centre. Although, severe cephalhematoma may take longer to resolve as it can become infected and require surgical drainage. Also, the swelling will harden and will appear as a depressed skull fracture. To determine the extent of the hematoma, the infant may be made to undergo a head CT scan. The procedure could also rule out skull fractures.

The best intervention for Cephalhematoma is observation. The parent should be vigilant to any changes in the infant’s condition. A cephalhematoma can appear secondary to a skull fracture or brain trauma and injury, thus the CT scan becomes a necessity. A large cephalhematoma may cause the baby to develop jaundice, hypotension, anemia, meningitis, or osteomyelitis.