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 head first.
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.
Once 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 a 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 later 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 and 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 for 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 more rare. The chances of a caput succedaneum are relatively high, even in a normal newborn.
- Levin, G, et, al: Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction. Acta Obstet Gynecol Scand 2019; 98(11):1464-1472. This kind of brain bleed presents as a compressible mass that crosses suture lines.
- Hassan, W.A., et. al: Intrapartum assessment of caput succedaneum by transperineal ultrasound: a two-center pilot study. ([In press])Aust N Z J Obstet Gynaecol. 2015. Study discusses how caput succedaneum can also be expressed as ultrasound measured skin-skull distance.
- Schwimer, S. R., Lebovic, J. (1986). In utero sonographic demonstration of a caput succedaneum. Journal of Ultrasound in Medicine, 5, 711-712.
- Lapeer RJ, Prager RW (2001)Fetal head moulding: finite clement analysis of a fetal skull subjected to uterine pressures during the first stage of labor. J Biomech, 1125-33.
- LeBlanc, C, et. al (1995). Cephalohematomas revisited: When should a diagnostic tap be performed? Clinical Pediatrics, 34, 86-89
- Petrikovsky, B., et. al (1998). Cephalohematoma and caput succedaneum: Do they always occur in labor? American Journal of Obstetrics and Gynecology, 179, 906-908. Discussion the association of caput and premature rupture of membranes.
- O'Brien WF, et. al (1984). Effect of cephalic pressure on fetal cerebral blood flow. Am J Perinatol 1984; 1(3):223-6. 5
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.
Caput succedaneum is an area of swelling under a newborn baby’s scalp because of some external trauma to that are of the head during vaginal childbirth. It is usually harmless and goes away after several weeks.
Caput is not considered a serious injury and the swelling generally goes away on its own within a month without any treatment. However, caput succedaneum is a potential indicator that that the baby underwent a difficult or stressful birth and could have other more serious internal injuries as a result.
Again, caput succedaneum is caused by external pressure or force on the baby’s head during delivery which ruptures small blood vessels beneath the scalp. This pressure can simply be caused by passing through the birth canal or the result of delivery assistance tools such as vacuum extractors or forceps.