A cephalhematoma or cephalohematoma is a type of newborn birth injury that occurs during the labor process. Cephalhematoma may begin immediately but not become noticeable for several days, with swelling that appears two to three days after birth.
During vaginal delivery, the mother’s cervix grips the scalp of the child causing tearing of tiny vessels that nourish the underside of the periosteum which covers the skull leading to hemorrhaging underneath the periosteum. This hemorrhage results in a squishy swelling with distinct borders. The cephalhematoma may begin to form during labor, but it may enlarge slowly over the first few days after birth.
Other Types of Scalp Trauma
A cephalhematoma is often confused with a swelling in the scalp known as caput succedaneum that may be responsible for the misshapen appearance of the head associated with first-time vaginal deliveries. A caput succedaneum is made of serous fluid and though it can coexist with a cephalhematoma, a caput succedaneum is less well-defined and usually disappears in a day or two and is not considered serious.
A cephalhematoma is also similar to a subgaleal hematoma (hemorrhage), also called subaponeurotic hemorrhage. A subgaleal hematoma is blood above the periosteum between the scalp while a cephalhematoma is blood underneath the periosteum and cannot cross suture lines. Subgaleal hematoma is potentially lethal emergency while cephalhematoma may emerge over a period of days and will take weeks or months to subside, it is generally not life-threatening unless severe or complications develop.
Influence of Delivery Instruments
A cephalhematoma is almost always a complication of childbirth that occurs during labor and is often caused by use of an instrument to aid vaginal delivery, particularly vacuum or suction assistance.
Birth injury due to delivery device assistance have traditionally involved use of delivery forceps which have commonly been associated with cranial birth trauma and injury that may cause brain damage, cerebral palsy and developmental delays. Birth injury due to vacuum extraction is a more recent development that has become more common as forceps use has declined. The most common type of vacuum extraction involves the use of a device such as a Ventouse.
A ventouse is a vacuum device that has a suction cup that is placed on the head of a baby providing traction to “pull” the head out of the birth canal, so that delivery will progress more rapidly. After the head is delivered and protruding from the birth canal, the ventouse device is detached and the mother continues delivery.
The suction provided by use of a ventouse can leave the baby with a chignon-type bump, or temporary swelling that takes anywhere from two hours to two weeks to heal. Use of the ventouse can also increase the risk of caput succedaneum, a subgaleal hematoma, or cephalhematoma.
Cephalhematoma Physical Effects
Cephalhematoma is a condition that causes bleeding in the area on top of the skull. In most instances, the blood found in the cephalhematoma breaks down and components are reabsorbed in the body and will result in no long-term damage.
As healing progresses, calcium will be deposited in the area of the ameliorating or shrinking cephalhematoma causing a hard-distinct ridge to develop around the edge of the swelling, while the center of the swelling will feel like a soft balloon. The entire cephalhematoma will eventually become hard and calcified and over time, the calcification will so be reabsorbed into the body and disappear.
While an uncomplicated cephalhematoma will likely leave no physical impairment, rare complications can occur. Cephalhematoma can result in a newborn infant developing jaundice, hypotension, anemia, meningitis, or osteomyelitis. A cephalhematoma may also be accompanied by a skull fracture or brain trauma and injury, similar to cerebral palsy or other developmental injury.
While not common, a cephalhematoma with an accompanying skull fracture can lead to a leptomeningeal cyst or fluid-filled sac of the meningeal tissue. Severe cephalhematoma can become infected, take many months to resolve, or require surgical drainage.
Today it is more common for child births to be delivered by cesarean section when labor complications arise, which also helps to avoid birth injury. While natural vaginal birth requires less healing time than a cesarean section, considering the potential for birth trauma or injuries such as cephalhematoma, cesarean section birthing methods should be considered.
Cephalhematoma Legal Options
With advanced medical science, appropriate diagnosis and availability of cesarean section, birth injuries or trauma related to vaginal birthing methods (such as cephalhematoma) should be minimized. Parents of infants who suffered unnecessary injury or trauma and developed cephalhematoma as part of the vaginal birthing process, may wish to seek professional legal advice concerning their options.
The law firm of Seeger Weiss LLP has a team of qualified medical malpractice attorneys and lawyers who are experienced in birth injuries and trauma when health professionals deviate from acceptable standards of practice in providing medical care. Parents or caregivers who believe that a child’s case of cephalhematoma is related to a deviation in acceptable standards of medical practice, should contact Seeger Weiss for a free case evaluation, or call 888-610-6574.
- Cephalohaematoma, Radiopaedia 06/2019