Child delivery can be a complex and challenging process, sometimes resulting in a birth injury like cephalohematoma. This type of birth injury occurs when blood pools between the newborn’s skull and periosteum due to trauma during delivery. Although this condition generally resolves naturally, it may lead to complications like anemia and jaundice. Below are answers to some of the most commonly asked questions about cephalohematoma.
What Is Cephalohematoma?
Cephalohematoma is a type of birth injury characterized by a collection of blood between a newborn’s skull and the periosteum, which is the membrane that covers the bone. It typically appears as a soft, raised bump on the head and results from trauma during delivery. This condition is generally not severe and often resolves on its own within a few weeks to months as the pooled blood gradually reabsorbs.
What Causes Cephalohematoma in Newborns?
Cephalohematoma in newborns is primarily caused by birth-related trauma from factors such as:
- Instrument-assisted delivery: Forceps or vacuum extractors exert pressure on the skull during delivery, which can rupture blood vessels.
- Prolonged labor: Spending extended time in the birth canal increases the risk of skull trauma.
- First-time deliveries: First-time mothers tend to have prolonged labor or tighter birth canals, which increases pressure on the newborn’s skull.
- Large baby size (macrosomia): Larger babies can struggle to pass through the birth canal, causing greater pressure and potential skull injury.
- Unusual fetal positions: Breech or abnormal fetal positions lead to difficult deliveries and apply extra pressure on the skull.
- Maternal health conditions: Conditions like gestational diabetes result in larger babies and challenging labor.
How Common Is Cephalohematoma as a Birth Injury?
Cephalohematoma is relatively common in difficult or extended deliveries. Approximately 2.5% of prolonged and challenging vaginal deliveries result in cephalohematomas. However, when vacuum extraction or forceps are used during assisted delivery, the risk rises to roughly 1 in 10 babies delivered this way.
How Does Cephalohematoma Impact Newborns?
Cephalohematoma can impact newborns in several ways, typically resulting in a noticeable bump on the head due to the collection of blood. This may cause initial bruising and tenderness but usually resolves over time. In some cases, the injury leads to complications like:
- Anemia: Blood accumulation under the periosteum may lead to significant blood loss, reducing the number of red blood cells in circulation. This can make newborns with cephalohematoma prone to anemia, which can cause fatigue, rapid heartbeat, and pale skin.
- Jaundice: The breakdown of red blood cells in the cephalohematoma releases bilirubin, which the liver processes. This can cause jaundice, which is a condition that turns the skin and eyes yellow.
- Infection: Although rare, the collection of blood beneath the scalp can lead to bacterial growth, which could result in an infection.
- Skull deformities: Persistent swelling caused by the pooled blood can result in temporary changes in skull shape. These usually resolve as the blood reabsorbs, but the pressure may cause a flat spot or irregular contours in the meantime.
- Calcification: If the blood within the cephalohematoma calcifies, a firm lump can form that may remain for months. This calcified lump can affect the head shape and potentially require medical intervention if it doesn’t dissolve over time.
What Are the Signs of Cephalohematoma?
Cephalohematoma usually presents several noticeable signs that help differentiate it from other birth injuries. The most common symptoms of cephalohematoma in newborns are:
- A raised, soft lump on one side of the baby’s head
- Discoloration or bruising around the lump
- Asymmetrical head shape due to localized swelling
- Yellowing of the skin and eyes due to increased bilirubin levels
- Pale skin, fatigue, and a rapid heartbeat due to low red blood cell levels
How Is Cephalohematoma Diagnosed?
Doctors typically diagnose cephalohematoma by conducting a physical examination of the newborn’s head. They will identify a raised, soft lump on the skull and may distinguish it from other conditions like caput succedaneum by observing the lump’s location and feel. If needed, imaging tests such as ultrasounds or X-rays help confirm the diagnosis by providing a clearer view of the underlying skull and revealing whether the injury involves a skull fracture or intracranial bleeding.
How Is Cephalohematoma Treated?
Most cases of cephalohematoma will resolve without treatment, as the pooled blood is naturally reabsorbed over time. Surgical intervention to drain the pooled blood is uncommon and typically reserved for cases involving persistent swelling or calcification.
Can Cephalohematoma During Birth Be Prevented?
In many cases, cephalohematoma during birth can be prevented with the best medical practices for delivery. Obstetricians must accurately assess the baby’s size and position to select the safest delivery method and reduce the need for forceps or vacuum extractors. When these tools are necessary, medical staff should handle them carefully to minimize the risk of head trauma. Proper prenatal care and monitoring are important for managing conditions like gestational diabetes, which can increase the risk of complications.
What Should Parents Do if They Suspect Their Child Has Cephalohematoma?
Parents who suspect their child has cephalohematoma must act quickly to ensure their well-being and prevent any complications. Here’s what they should do:
- Contact a health care provider: Parents should contact their pediatrician or another health care professional to ask questions and obtain an evaluation.
- Monitor symptoms: They should closely observe the child for signs of jaundice, anemia, or infection and report any changes to the health care provider.
- Seek additional tests: If they are recommended, parents should pursue imaging tests or bloodwork to confirm the diagnosis and identify any related health concerns.
- Follow medical advice: It’s important to carry out health care provider instructions for treatment, monitoring, or referrals to specialists.
- Stay informed: Parents should educate themselves on cephalohematoma and possible complications to recognize symptoms that require immediate care.
- Consider legal advice: If medical negligence is suspected, they should consult legal counsel to explore the next steps.
Can Parents Seek Compensation for Cephalohematoma During Birth?
Victims of negligence are generally entitled to seek compensation for all damages pertaining to the injury. To do so, parents must first prove that a negligent third party was responsible for the child’s cephalohematoma. To do so, parents typically need to establish the four elements of negligence:
- Duty of care: Demonstrate that the health care provider had a responsibility to provide care according to accepted medical standards. This duty arises naturally from the doctor-patient relationship.
- Breach of duty: Show that the health care provider breached this duty by failing to act as a reasonably competent provider would have under similar circumstances. For example, they conducted improper use of delivery instruments or failed to address complications during labor.
- Causation: Show that the negligence directly caused or significantly contributed to the injury.
- Damages: Provide evidence that the injury resulted in measurable damages, which could include medical costs, pain and suffering, and any long-term care expenses.
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