Caput Succedaneum

Caput succedaneum is the formal medical term for the area of localized swelling or edema which is commonly present on the head of a newborn baby following vaginal delivery. More simply, it is fluid under the skin on the baby's head.

Caput succedaneum is a very common and usually benign neonatal condition resulting from normal pressure and compression on the baby's head as it passes through the birth canal. Caput succedaneum itself is harmless as the swelling is limited to the scalp and is not a symptom of a deeper injury to the skull or brain. Although caput succedaneum itself is nothing to worry about and quickly resolves, it can lead to other complications including newborn jaundice.

Causes of Caput Succedaneum

The swelling in the head and scalp that characterizes caput succedaneum is the result of acute external pressures on the baby's head during labor and delivery. The primary source of this external pressure comes from the birth canal itself. In a normal vaginal delivery, the baby is pushed through the birth canal headfirst.

Head-first delivery makes the top of the head the focal point of significant pressure as the fetus pushes its way through the very narrow birth canal. The most common cause is pressure on the head from the mother's uterus or vaginal wall during childbirth. Babies can also suffer caput during a C-section, although the pressure on the infant's head could still stem from pressure on the head before the procedure.

These pressures are greater for babies that are macrosomic (high birth-weight) or after a prolonged, difficult birth. Full-term newborns or overdue newborns weigh more and are more at risk than preterm newborns. Swelling in the scalp can also be caused by the premature rupture of the membranes that surround the baby in the womb.

After the fetal membranes rupture, the amniotic sac is no longer available to act as a supportive cushion for the baby's head. With little amniotic fluid, the fetus' head is subject to greater pressure from the mother's pelvic bones. Caput succedaneum can also be triggered by the use of a vacuum extractor or forceps to facilitate vaginal delivery.

Symptoms of Caput Succedaneum

The primary symptom of caput succedaneum is a swollen, puffy, soft spot on the top of the head just under the skin of the scalp. The area may appear on one particular side or extend across the middle of the scalp. The swollen spot typically appears on the part of the head that went first through the birth canal.

Distinguishing the symptoms of caput succedaneum from other more serious medical conditions with similar physical symptoms is important. Potentially dangerous conditions such as hydrocephalus also result in swelling in the head, but usually in a different area.

The baby's doctor should easily be able to differentiate between the symptoms of caput succedaneum and other more serious conditions like a brain bleed or skull fracture with a simple physical examination. Caput succedaneum is easily confused with infant cephalohematoma. The former is swelling that occurs under the skin and the latter is swelling that occurs within the skin, but both are usually harmless.

Treatment of Caput Succedaneum

With caput succedaneum, the baby's appearance can be alarming. However, caput succedaneum is not a medical emergency nor is it usually a condition that requires any treatment. The baby will almost always make a complete recovery after just a few days without any treatment or management. Attempting to drain the fluid causing the swelling can cause infections so it is mostly a "keep an eye on and leave well enough alone" condition.

Potential Complications From Caput Succedaneum

In the vast majority of cases, caput succedaneum goes away on its own with any additional complications or long-term implications. But there are complications that in rare cases can be significant which is why you keep an eye on it. These complications include bruising of the skin over the swollen area with necrosis. The result can be scarring and alopecia, and, in rare cases, systemic infection.

This bruising can cause an increase in bilirubin levels in the blood. Excess bilirubin levels are the underlying cause of newborn jaundice, a common condition. This means that caput succedaneum can potentially lead to infant jaundice or make it worse.

When properly managed and treated (usually with exposure to sunlight) infant jaundice is not a serious condition. However, if it is not monitored and treated, some cases can worsen and eventually lead to a very serious and potentially life-threatening condition called kernicterus. Kernicterus occurs when excess bilirubin in the blood begins to invade and damage the brain resulting in serious and permanent brain damage.

Caput Succedaneum as Evidence of Birth Trauma

Even though it can potentially lead to complications like jaundice, caput succedaneum itself is not a serious concern. The real significance of caput succedaneum is that it is often one of the first, most notable indicators that the baby went through a particularly difficult and stressful delivery. If a baby is born with a caput succedaneum, it means that their head was subjected to significant external pressure during delivery.

This could mean that the baby suffered a more serious brain injury as a result of the oxygen deprivation during the difficult delivery. Medical professionals treating a baby with caput succedaneum should accordingly be particularly attentive to the symptoms of infant brain injury.

What Is the Difference Between Cephalohematoma and Caput Succedaneum?

Infant cephalohematoma and caput succedaneum have similar causes, most notably the use of forceps or a vacuum, a difficult delivery, or anything that puts pressure on the baby's head. The difference between the two comes down to location and type of bleeding.

Cephalohematoma is when blood is collected between the periosteum of the skull bone and the skull bone itself, so it does not cross suture lines. Caput succedaneum involves diffuse swelling of the scalp, with subcutaneous fluid collection unrelated to the periosteum with poorly defined margins. This is most often caused by pressure on the scalp against the dilating cervix during delivery.

Additionally, caput succedaneum is a highly common birth injury while cephalohematomas are rarer. The chances of a caput succedaneum are relatively high, even in a normal newborn.

Medical Literature

• Jacob, K., & Hoerter, J. E. (2022). Caput Succedaneum. StatPearls [Internet]. StatPearls Publishing. (This article described caput succedaneum’s etiologies, risk factors, presentations, and management.) 
• Taylor, S., & Hassan, W. A. (2021). Caput succedaneum and molding: ultrasound and digital correlations. Intrapartum Ultrasonography for Labor Management, 243-250. (This article provided an overview of caput succedaneum’s causes and features.)
• Levin, G, et al. (2019). Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction. Acta Obstet Gynecol Scand, 98(11),1464-1472. (This study looked at the factors associated with subgaleal hemorrhaging secondary to a vacuum-assisted delivery. The researchers found that the associated risk factors for subgaleal hemorrhage were second-stage duration, meconium-stained amniotic fluid presence, caput succedaneum, vacuum-assisted delivery duration, number of dislodgments, and fetal head station.) 
• Hassan, W.A., et al. (2015).  Intrapartum assessment of caput succedaneum by transperineal ultrasound: a two-center pilot study. Aust N Z J Obstet Gynaecol, 55(4), 401-403. (This study looked at how ultrasound-measured skin-skull distance could be used to properly diagnose caput succedaneum.)
• Lapeer, R.J. & Prager, R.W. (2001). Fetal head moulding: finite element analysis of a fetal skull subjected to uterine pressures during the first stage of labor. J Biomech, 34(9), 1125-1133.(This study reported on a non-linear model of a complete fetal skull deformation. The model’s design looked at the fetal skull shape recovery, the generation of a valid and compatible mesh, physical model specifications, and the deformation analysis. The researchers found that their analysis agreed with the conclusions of the clinical experiments on fetal head molding.) 
• Petrikovsky, B., et al. (1998). Cephalohematoma and caput succedaneum: Do they always occur in labor? American Journal of Obstetrics and Gynecology, 179, 906-908. (This study looked at cephalohematoma features prenatally detected by an ultrasound. The researchers found that the echogenic bulges that were at the fetal head’s temporal region or posterior to the occipital region were ultrasound-detected cephalohematoma features. They concluded that cephalohematomas could occur antepartum.)
• LeBlanc, C., et al. (1995). Cephalohematomas revisited: When should a diagnostic tap be performed? Clinical Pediatrics, 34, 86-89. (This article reviewed the best method for investigating infections and clarifying diagnostic aspiration indications in cephalohematoma cases. The researchers found that about 50 percent of aspirated cephalohematoma cases showed E. coli. They concluded that aspiration was “the diagnostic of choice” to determine infections in cephalohematomas.) 
• O'Brien W.F., et al. (1984). Effect of cephalic pressure on fetal cerebral blood flow. Am J Perinatol, 1(3), 223-226. (This study looked at cephalic pressure’s impact on fetal cerebral blood flow. The researchers monitored the response to cephalic pressure applied to a lamb. They found a cerebral blood flow redistribution occurred after the cerebral blood flow fell. The researchers also found that the cortex showed a small percentage of cerebral blood flow while the brainstem showed a greater percentage.)

FAQs: Caput Succedaneum

Below are easy-to-understand answers to some very common questions and concerns relating to caput succedaneum in newborns. Some of this is addressed above but some parents prefer to get their information in a question and answer type format.