Cephalohematoma is a birth injury characterized by the accumulation of blood between an infant’s scalp and skull. The condition develops hours or a few days after birth and not considered fatal for the baby.
Cephalohematoma is a common birth injury that occurs in 1%-2% of vaginal deliveries and 3%-4% of vacuum or forceps assisted deliveries. During labor, blood vessels in the scalp of the infant ruptured and blood pools in between the skull and the scalp. Since the blood trapped between the scalp and the skull, the brain remains free of pressure.
Causes of Cephalohematoma
Cephalohematoma, commonly known as newborn hematoma, is the rupture of blood vessels in the infant scalp as a result of the baby’s head passing through the birth canal.
During a normal delivery, the vaginal walls exert a pressure on the baby’s scalp, however, the infant’s soft skull can tolerate this pressure. Certain circumstances increase the amount of pressure being applied to the baby’s skull. The increased pressure on the neonate skull damages blood vessels of the scalp, causing a hematoma to develop.
Reasons for the increase in pressure and subsequently cephalohematoma include:
- Prolonged delivery
- Baby with a weight higher than the average normal weight of newborns (macrosomia)
- Primigravidae (mother’s giving birth for the first time)
- Breech birth
- Baby is in a transverse position during the start of the labor
- Forceps or vacuum-assisted delivery
- Multiple gestations (pregnancy with more than one baby)
- Abnormal progression of labor (weak uterine contractions)
Cephalohematoma is more likely to develop in male neonates than females.
Symptoms of Cephalohematoma
The most prominent sign of a developing cephalohematoma is a swollen bulge that forms 2-3 days after delivery. The blood-filled protrusion is initially soft but as the blood calcifies, the lump gets harder. Slowly, the hard mass of blood breaks down and gets absorbed. Swelling from the cephalohematoma takes about a few weeks or a month to fully go down.
Usually, the center of the cephalohematoma shrinks first, leaving behind raised edges that create a crater-like effect. Eventually, the entire mass shrinks.
In severe cases, the infant may be at a risk of developing jaundice, anemia, hypotension, or an infection due to the cephalohematoma.
Diagnosis
The doctor derives a conclusive diagnosis after performing a full physical exam of the infant. The appearance of the bulge gives a clear indication of cephalohematoma. The doctor may recommend an X-ray, CT scan, or MRI to confirm the findings.
Treatment of Cephalohematoma
In most cases, cephalohematoma clears up on its own in a few weeks or a month without any long-term effects. In rare instances, it takes as long as three months for the mass to completely break down and shrink.
Draining the blood may cause an infection and further complicate the condition. If the infection not treated on time, it may lead to meningitis. Meningitis is a fatal condition characterized by the inflammation of the membrane surrounding the brain.
The loss of blood due to cephalohematoma may increase the risk of anemia in infants. The baby’s red blood cell count plummets due to the formation of the blood pool. In such a case, blood transfusion becomes necessary.
Babies born with cephalohematoma have are at a greater risk of developing jaundice as a result of elevated bilirubin levels in the blood.
The breakdown of calcified blood produces bilirubin. As the red blood cells break down, and the hardened mass on the skull shrinks, levels of bilirubin increase. This causes the baby to develop jaundice. The most common symptoms of jaundice include yellow discoloration of the skin and eyes. The doctor may use light therapy, or phototherapy to treat neonates with jaundice.
In severe cases, when timely and effective treatment is not provided, the infant may develop cerebral palsy or permanent hearing loss.
Long-term Outlook
Cephalohematoma does not affect the brain and normal development of the child. The condition mostly causes no long-term effects or disabilities. The baby makes a full recovery in a few week
In the majority of the cases, cephalohematoma poses no real danger to the neonate’s life and goes away on its own with time. If the baby’s skin or eyes start to turn yellowish, contact a doctor.