What is Caput Succedaneum: Cephalohematoma V/S Caput Succedaneum

Overview 

Caput succedaneum is a common post-delivery condition followed by swelling or edema on the baby’s head shortly. The excessive pressure on the vaginal walls may cause the scalp to swell in the newborn. As we know that in a normal delivery, the baby comes out with his head so more pressure will be put over its head, which is nothing but the fluid under the skin which then bumps out over the head.

However, this condition is harmless and doesn’t indicate any injury to the brain or cranium, and resolves after a short period. Although, it could lead to newborn jaundice in some cases.

Cephalohematoma V/s Caput Succedaneum

So, the main difference between these two is that in cephalohematoma, the blood accumulates between the periosteum of the skull bone and in the skull bone itself, and does not cross suture lines. While in caput succedaneum there is diffuse swelling of the scalp, with subcutaneous fluid collection distinct from the periosteum with irregular margins.

Hence, it needs a medical diagnosis to know exactly what the condition is.

caput succedaneum  cephalohematoma 
  • The condition is recognized by a soft tissue swelling with an irregular outline. 
  • The condition is recognized by soft fluctuant swelling with a regular outline.
  • Its result is because of the excessive pressure of the fetal head against the cervix during labor or delivery, which decreases the blood flow to that area and causes swelling.
  • Its result due to subperiosteal hemorrhage. 
  • It is present at birth and does not increase in size.
  • It appears after birth and increases in size after 2-3 days.
  • Swelling causes suture lines
  • Swelling does not cause suture lines
  • It resolves out within a few hours to days. 
  • It may take several weeks to months to resolve. 

Complications

However, complications in caput succedaneum are rare, sometimes jaundice can result. While in cephalohematoma there are high chances of getting severe complications such as defective blood clotting, skull fracture, intracranial bleeding, and jaundice.

What Causes Caput Succedaneum?

The lump overhead and scalp results due to acute external pressure on the baby’s head during labor or delivery. Well, the external pressure comes from the birth canal itself. As in a normal vaginal delivery, the baby is pushed through his head first.

The Head becomes the focal point during the delivery as the fetus pushes itself through the very narrow birth canal. So, the main cause of the pressure is from the mother’s vaginal walls or uterus during labor. However, infants could also suffer from caput during a C-section, even so, the pressure on the baby’s head could still cause pressure over the head pre-delivery.

So, why don’t every baby come out with a bumpy head? Well, when pressure is constant in every labor and delivery, only a few cases have this condition. The answer is that the pressure of vaginal walls and uterus affects the macrosomic- high birth weight or after a difficult birth. Full-term babies or overdue babies are at higher risk of getting the condition than preterm babies.

Another reason for swollen scalp could be the premature rupture of the membranes surrounding the baby in the womb.

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Hence, if there is a premature rupture of the fetal membrane, the amniotic sac doesn’t provide cushiony protection to the baby’s head. Eventually, with less amniotic fluid, the fetus head tends to have greater pressure through the mother’s pelvic bones. However, caput succedaneum could also be stimulated by the use of a vacuum extractor or forceps to ease delivery.

Diagnosis Of Caput Succedaneum

So, as we know the primary symptom is a bumpy, swollen, or puffy on the top of the head just beneath the skin of the scalp. So, the area of the swelling may vary from a particular side or extend over the middle of the scalp. Typically the part of the head that comes out of the birth canal first would appear swollen.

Well, differentiating the caput succedaneum from that of other severe medical conditions with similar symptoms is crucial. For instance, some chronic conditions like hydrocephalus also appear as swelling in the head, but in different areas. And obviously, you and I can’t differentiate it, only a medical practitioner would be able to diagnose it and differentiate between caput succedaneum and other related conditions such as brain bleed or skull fracture through physical examination.

Commonly, caput succedaneum is confused with that of cephalohematoma. Diagnosed primarily with swelling in the head that occurs beneath the skin and later swelling within the skin. But on the good side, both conditions are normal and cause no harm to the child.

When these conditions are normal, they should not need treatment. But still, exceptions are always there in each case. So let’s see what can be done.

Treatment

Though caput succedaneum is not abnormal itself, it can make the baby’s appearance weird. Medically it’s not an emergency case and does not need any treatment. The baby will eventually recover after a few days without any specific treatment. Moreover, draining the fluid out will more likely cause infections, so it’s better to supervise the condition and leave it to treat on its own.

Complications From Caput Succedaneum

In most cases, caput succedaneum goes away on its own along with additional complications or long-term interference. But wait, there can be significant complications that may arise out of it, that’s why the child should be under supervision until fully recovered. Those complications involved bruising of the skin over the swollen part with necrosis. The bruising can result in scarring, alopecia and in some rare cases can even cause systemic infection.

Furthermore, this bruising could increase the level of bilirubin in the blood. And excessive bilirubin levels can cause newborn jaundice which is also a common condition. It means that caput succedaneum can lead to jaundice or can make it even worse.

But if properly managed and treated, jaundice isn’t a serious condition. Though, if not treated and managed properly, some cases may even get worse that eventually leads to a severe and life-threatening condition known as kernicterus. So, this condition occurs when excess bilirubin in the blood starts attacking, damaging the brain resulting in permanent brain damage.

Caput Succedaneum As A Birth Trauma

Even so, it can lead to newborn jaundice, it’s not a serious condition at all. However, caput succedaneum is the thing that tells us about the struggle and stressfulness of the delivery as a first notable sign in the newborn. So, it will tell you how the delivery went through. Consequently, if the baby is born with a swollen scalp, it says that the head of the baby was subjected to excessive external pressure during the labor.

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Although, in some cases, it could even tell that the baby may have gone through oxygen deprivation during the delivery. This is why the doctors of medical professionals dealing with deliveries should be careful while attempting such a case as a caput succedaneum, to control brain injuries and complications.

Conclusion

Caput succedaneum is a condition that results in a lumpy or bumpy head of the newly born during labor and delivery. Though it’s common and doesn’t need a specific treatment at all, the baby should be taken under supervision until it recovers fully. Some other conditions can also occur with symptoms related to this condition, which is why medical practitioners should be careful about brain injuries in newborns.

Frequently Asked Questions

What is caput Succedaneum and Cephalhematoma?

Cephalohematoma is the condition in newborns when the blood is accumulated between the periosteum of the skull bone or in the skull bone itself. However, it’s not cross suture lines. It includes diffusing swelling of the scalp, with subcutaneous fluid collection distinct to the periosteum with irregular margins.

How is caput Succedaneum different from Cephalhematoma?

Both the conditions have internal bleeding common. The main difference is about the location of blood pools. So in caput succedaneum, the blood pools are located just under the skin, a few inches away from the periosteum layer.

Is Caput Succedaneum normal?

Yes, caput succedaneum is normal and often results due to the excessive pressure over the infant’s head during labor and delivery. So, the vaginal and uterus walls cause excessive pressure due to which the head appears lumpy and swollen post-delivery, which recovers itself within a few hours to days. However, it doesn’t cause damage to the brain or bones of the cranium.

When does caput Succedaneum resolve?

Caput succedaneum typically resolves within a few days or weeks, without any specific treatment. While in the case of cephalohematoma, it resolves without the need of any superficial management within 2-6 weeks post-delivery.

Which is worse caput or Cephalohematoma?

None of them are worse. They both are birth complications that are normal and often happen in difficult deliveries. In both conditions, the baby’s head gets swollen due to the collection of blood under the skin, however, they are different in some cases, but can be resolved on their own over time and with proper supervision.

How do you manage Caput Succedaneum?

Well in most cases, caput succedaneum won’t cause any damage or severe illness and resolve with time. Though, in some cases bruising over the skin may result in jaundice due to the excessive level of bilirubin in the blood. But jaundice can be manageable too and probably won’t affect the child much.

How is caput Succedaneum diagnosed?

A caput succedaneum could be diagnosed with prenatal ultrasound, either after or before the labor or final delivery. It can be found as early as 31 weeks of pregnancy. The biggest reason for causing it pre-delivery is the premature rupture of the fetal membrane and a low level of amniotic fluid.

What is Cephalohematoma?

Cephalohematoma involves the collection of blood under the scalp. So, it happens during delivery due to the breakage of the blood vessels of the fetus as a result of small trauma.

Can Cephalohematoma cause jaundice?

Yes, it can cause jaundice. Cephalohematoma usually results in bruising of the skin and elevates the bilirubin levels in the blood, which then causes jaundice. Because the fusion of the blood in the head lowers the infant’s RBC level.

What does Caput mean in Labour?

Caput succedaneum results due to the diffuse swelling of the newly born scalp. The swelling is followed by the excessive pressure of the head against the dilating cervix and vaginal walls during labor. So, you can say it happens during the difficult delivery or delivery of heavyweight.

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