Cephalohaematoma_Flashcards
What is a cephalohaematoma?
A cephalohaematoma is a swelling on a newborn’s head that appears several hours after delivery, caused by bleeding between the periosteum and skull, typically affecting the parietal region.
What is a common complication of a cephalohaematoma?
Jaundice may develop as a complication of a cephalohaematoma.
How long does it typically take for a cephalohaematoma to resolve?
A cephalohaematoma can take up to 3 months to resolve.
What is the difference between a caput succedaneum and a cephalohaematoma?
Caput succedaneum involves swelling of the soft tissues of the scalp, presenting at birth and crossing suture lines, whereas a cephalohaematoma involves bleeding under the periosteum, appearing hours after birth and confined to one cranial bone.
summarise
Cephalohaematoma
A cephalohaematoma is seen as a swelling on the newborns head. It typically develops several hours after delivery and is due to bleeding between the periosteum and skull. The most common site affected is the parietal region
Jaundice may develop as a complication.
A cephalohaematoma up to 3 months to resolve.
Comparison of caput succedaneum and cephalohaematoma
A concerned 32-year-old woman enquires about a swelling that has appeared on her baby’s head, reporting confidently that the swelling was not there at birth, having first noticed it half an hour ago. The baby was born 12 hours ago at 38 by vaginal delivery with forceps.
On examination, there is a well-demarcated, fluctuant swelling that does not cross suture lines, situated over the parietal bone. The baby appears well otherwise, with normal skin colour and tone, as well as normal observations.
What is the most likely diagnosis?
Caput succedaneum
Cephalhaematoma
Chignon
Normal skull shape
Subgaleal hemorrhage
Cephalhaematoma
Cephalohaematoma: Several hours after birth, doesn’t cross suture lines, can take months to resolve
Cephalhaematoma is the correct answer - this is a haemorrhage between the skull and the periosteum of any age human, including a newborn baby, secondary to rupture of blood vessels crossing the periosteum. Because the swelling is subperiosteal, its boundaries are limited by the individual bones, in contrast to a caput succedaneum. The swelling often appears after 2-3 days after birth and may persist for months as the blood clot is slowly re-absorbed. If severe, the child may develop jaundice, anaemia or hypotension. In some cases, it may be an indication of a linear skull fracture or be at risk of an infection leading to osteomyelitis or meningitis. Cephalhaematoma is more common in prolonged and/or instrumental deliveries.
Caput succedaneum is a fluid collection with poorly defined margins caused by the pressure of the presenting part of the scalp against the dilating cervix (tourniquet effect of the cervix) during delivery. For the purpose of exams, this swelling would cross suture lines. The swelling is also present at birth and typically over the vertex. Therefore, this is not the most likely diagnosis.
A chignon is a swelling of an infant’s head after a ventouse suction cup has been used for the delivery. While this may be a valid differential without a visual aid given the instrumental delivery, a chignon would be apparent immediately and tends to disappear rather quickly, generally after a few hours (though it may last up to two weeks), therefore it is not the most likely diagnosis in this case.
Normal skull shape is not consistent with your examination findings of a well-demarcated, fluctuant swelling which is new and has appeared two days after birth.
A subgaleal haemorrhage is bleeding in the potential space between the skull periosteum and the scalp galea aponeurosis. Diagnosis is generally clinical, with a large fluctuant boggy mass developing over the scalp (especially over the occiput), crossing suture lines and with superficial skin bruising (making it a less likely diagnosis in this case). The swelling develops gradually 12-72 hours after delivery, although it may be noted immediately after delivery in severe cases. If enough blood accumulates, a visible fluid wave may be seen. Patients may develop periorbital ecchymosis (‘raccoon eyes’). They may also go into haemorrhagic shock and/or become jaundiced, while the baby in this case remains well.
A mother is concerned about a swelling she has noted on her newborn’s head. The girl was born four hours ago, using forceps delivery due to a prolonged second stage of labour. On examination, there is a swelling in the parietal region which does not cross the suture lines. The consultant tells her that it may take several months to resolve. Which type of head injury is this likely to be?
Caput succedaneum
Subdural haematoma
Subgaleal haemorrhage
Extradural haematoma
Cephalohaematoma
Cephalohaematoma: Several hours after birth, doesn’t cross suture lines, can take months to resolve
This newborn has had a prolonged delivery which eventually required instrumental extraction. This predisposes to extracranial injuries. Extracranial injuries can include caput succedaneum which is a bleed in the subcutaneous tissue, a subgaleal bleed which occurs in the subaponeurotic space, or cephalohaematoma which occurs between the periosteal membrane and cranial bone.
This bleed is a cephalohaematoma. It typically develops several hours after birth, and unlike subgaleal bleeds or caput succedaneum won’t cross suture lines. It is managed conservatively but can take months to resolve.
