During prolonged and difficult deliveries, stress and pressure is placed on the skull of the baby, which may result in a birth injury commonly known as ‘conehead baby’ or ‘caput succedaneum’.
Infants are born with soft, malleable skulls. An infant’s skull consists of five bones that are joined together by fibrous sutures. These bones and sutures form two fontanelles.
Fontanelles, also known as soft spots, are soft membrane gaps between the bones of the skulls. These soft spots make the skull flexible, allowing for the baby to be safely born through the narrow birth canal. The malleable nature of the infant skull allows for the growth and development of the brain and as the child ages, the fontanelles merge to form a hard skull.
What is Caput Succedaneum?
Caput succedaneum is a birth injury characterized by the swelling and edema (swelling due to entrapment of excess fluid) around the skull of an infant after vaginal delivery. It is a relatively common condition that occurs in 1.8%-33.6% of vaginal deliveries.
The condition itself is benign and usually poses no danger to the infant, however, if it is accompanied by bruising, the infant is at risk of developing jaundice. If caput succedaneum left untreated, further complications can occur.
Causes of Caput Succedaneum?
Caput succedaneum is the result of excessive external pressure placed on the infant skull during vaginal delivery. During a normal vaginal delivery, the baby enters the birth canal headfirst. The vaginal canal applies a great deal of pressure on the skull of the baby. However, in a normal, timely delivery, the malleable skull of the infant withstands the pressure without facing any injury.
During prolonged deliveries, the immense pressure exerted by the vaginal canal on the infant skull for such an extended period of time results in swelling, and in some cases, bruising of the skull.
In some cases, babies delivered through C-section can also acquire this birth injury. Other cause of caput succedaneum includes using forceps and vacuum extractors during delivery.
The fetus surrounded by a protective fluid in the womb known as the amniotic fluid. In cases where the amniotic sac ruptures prematurely (PROM), or there is little amniotic fluid in the sac (oligohydramnios), the baby may develop caput succedaneum.
Without the cushioning layer of the amniotic fluid, the mother’s pelvic bones exert pressure on the infant’s skull. In such a case, caput succedaneum develops before labor and can be seen through an ultrasound.
Other complications that may cause caput succedaneum include macrosomic babies (babies with high birth-weight), Braxton Hicks contractions, and a primiparous mother (mother giving birth for the first time).
Symptoms
A physical exam of the infant after birth can help determine the presence or absence of caput succedaneum. The most common sign of the birth trauma is swelling or puffiness under the skin of the scalp. Pressing the soft swelling region often leaves a dimple that disappears after a while.
Other signs include bruising or discoloration of the swollen region. Caput succedaneum often confused with cephalohematoma. The latter displays more prominent swelling due to the accumulation of blood under the scalp.
After the swelling reduces, the baby’s head may appear to be a little pointed (conehead baby), a condition known as molding. The infant’s skull bones are soft and flexible; hence they easily change shapes under pressure without causing any damage to the brain. However, the condition goes away on its own with time.
Treatment of Caput Succedaneum?
The majority of caput succedaneum cases require no medical intervention and the condition goes away on its own within a few days. An attempt to drain the fluid from the scalp may result in further complications such as infections.
If swelling and edema are accompanied by bruising, then the infant may develop jaundice. Usually, a mild form of jaundice develops which requires little treatment efforts. In rare cases, the baby may develop a severe form of jaundice, which if left undiagnosed and untreated can then lead to kernicterus and consequently, permanent brain damage.
Long-Term Outlook
Caput succedaneum is not a serious life-threatening condition and usually goes away on its own without any need for treatment. Doctors can spot and diagnose the condition right after the delivery and take necessary steps if any are needed.