Cephalohematoma and Birth Injuries

Cephalohematoma in newborns is a relatively common condition in which a small pool of blood develops into a mass just underneath the baby's scalp outside the skull. The blood Cephalohematomas are caused when the pressure on a baby's head during vaginal childbirth damages or ruptures very small blood vessels in scalp. The damage to the blood vessels causes them to hemorrhage (bleed internally) and the blood collects into a pool which forms into a benign mass.

If you are a parent and panicking about your child's cephalohematoma, that is completely normal. But cephalohematomas are a very common result of the labor and delivery process and they are rarely serious. Approximately 2 out of every 100 babies develop a cephalohematoma after birth ( 1% - 2 % of spontaneous vaginal deliveries and 3% - 4 % of forceps or vacuum-assisted deliveries). Cephalohematomas are not harmful or hazardous to a baby's health because the pooled blood mass develops outside the skull. The skull protects the brain from any potential damage from cephalohematomas.

The hallmark symptom of a cephalohematoma is a protrusion or bulge in the back of a baby's head which forms soon after birth. At first the bulge (which is the pool of internal blood) will feel soft to the touch. Gradually the pooled blood under the scalp will begin to calcify and the bulge will get harder and denser. Gradually the calcified blood massed under the scalp will erode away causing the hardened bulge reverse course and start shrinking away. It is very common for the area in the center of a cephalohematoma bulge to erode away first while the outer edges of the mass take a bit longer to go away. This leaves the bulge looking like a ring or crater.

In addition to the external bulge in the back of the baby's head, newborn babies with cephalohematoma may also have more subtle internal symptoms. Internal symptoms associated with cephalohematoma include:

• Infection: infection at the cephalohematoma is a potentially harmful complication that occurs in some cases.
• Jaundice: cephalohematoma may increase a baby's risk of developing newborn jaundice, a common condition resulting from excessive bilirubin levels in the blood.
• Anemia: low red blood cell levels (anemia) are a common symptom associated with cephalohematoma.

Cephalohematoma is caused by minor injury to the baby's head from external physical trauma or pressure during childbirth. A baby's head goes through a very difficult ordeal when it gets pushed through the mother's birth canal during vaginal delivery. Cephalohematoma results when acute pressure or external trauma to the baby's head during delivery damages and ruptures the small, fragile blood vessels surrounding the head under the scalp. The torn blood vessels essentially leak blood which collects into a pool under the baby's scalp forming the characteristic cephalohematoma bulge.

The exact source of the delivery head trauma which ruptures the blood vessels around the baby's head can vary. One of the most common sources of trauma is when the baby's head impacts the mother's pelvic bone as it proceeds into the birth canal. When this occurs the force of labor contractions will continue pushing the head against the pelvis until it gets around and goes through the birth canal.

Birth assistance tools are another very common source of childbirth head trauma leading to cephalohematoma. Birth assistance tools include devices such as obstetrical forceps and vacuum pump extractors. Doctors in the labor and delivery room utilize these medical devices to help facilitate vaginal deliveries when the baby is not being pushed through the birth canal by the mother's uterine contractions alone. Both vacuum extractors and obstetrical forceps work by gripping the baby's head. Even when these devices are used correctly and with a high degree of skill and care they can still cause enough force to the baby's head to damage blood vessels and trigger cephalohematoma.

Any baby who is delivered vaginally is at risk of developing cephalohematoma, but there are various factors which are known to significantly increase the risk of cephalohematoma. Anything that prolongs the labor and delivery process or makes it more complicated or difficult will automatically increase the risk of cephalohematoma for 2 reasons. First, the baby is much more like to injury on the pelvis or birth canal during a longer, strenuous delivery. Second, prolonged, difficult labor makes the use of birth assistance tools more likely which further increase the cephalohematoma risk. Risk factors for cephalohematoma include:

• Fetal Macrosomia: fetal macrosomia is the medical term for a baby that grows to big during gestation (over 9 lbs.). The bigger the baby the more difficulty they will invariably having passing through the narrow birth canal.
• Epidurals: the epidural is a very common method of maternal pain management during childbirth. However, getting an epidural numbs the mother's lower body and makes her less able to effectively push the baby out.
• Birth Assistance Tools: whenever doctors use a vacuum extractor or forceps to grab the baby's head and maneuver in through the birth canal the risk of cephalohematoma immediately increases.

Cephalohematoma itself is a completely harmless condition that goes away without any treatment. In some cases, however, cephalohematoma can lead to other health complications. The most common complication related to cephalohematoma is jaundice. When the blood in a cephalohematoma mass eventually breaks down and gets reabsorbed it causes bilirubin levels in the blood to increase. Jaundice is the result of excess bilirubin in the blood so babies with cephalohematoma are at increased risk of developing jaundice.

A rare but potentially dangerous complication that can result from cephalohematoma is infection. A cephalohematoma site presents a small risk of primary or secondary infection. Lesions on the skin can make the cephalohematoma site more vulnerable to bacterial infections. The vast majority of cephalohematoma infections are caused by the E. coli pathogen. Cephalohematoma infection typically develops in the first or second week after birth and symptoms include fever and inflammation near the site of the bulge. If you suspect your baby's cephalohematoma may be infected you should take them to the doctor immediately. Cephalohematoma infections can be very serious and require prompt medical intervention.

• Study on needle aspiration on large cephalohematomas
• Craniosacral therapy for this and similar head traumas
  
• Difference between cephalohematoma and caput succedaneum