What is a Cephalohematoma?
A cephalohematoma is a common birth injury associated with labor in which forceps or vacuum extraction is necessary. This condition can also occur if the baby’s head happens to bang against the mother’s pelvic bone during labor. A cephalohematoma is a lesion on the newborn’s scalp due to an accumulation of blood under the cranial periosteum, most commonly located in the parietal area. These lesions do not typically cross cranial sutures because of the firm adherence of the periosteum to cranial sutures.
Cephalohematomas can sometimes be confused with a subdural hematoma which is a collection of blood inside the skull. A cephalohematoma on the other hand, is a collection of blood under the skin of the scalp due to the connection of tissues located under the scalp. This condition differs from a subdural hematoma as it remains on top of one of the skull bones and in almost all cases does not cross the midline.
Risks Associated With Cephalohematomas
Cephalohematomas are noted in approximately one to two percent of spontaneous vaginal deliveries and approximately three to four percent of forceps or vacuum-assisted deliveries. This condition typically does not present health risks to babies, but can cause anemia and jaundice within the first few days following birth. However, in rare instances this condition is an indication of an underlying skull fracture or brain trauma. Additionally, new cephalohematomas can be susceptible to infection during bacteremia. In very rare occurrences it will be reported that a newborn presents with a subperiosteal hematoma crossing a synostosed sagittal suture.
Additional risks concerning this type of birth injury is the onset of infection within the lesion. While this condition is seldom reported, physicians should monitor the infant for warning signs including an enlarging of the cephalohematoma, overlying erythema and tenderness, increasing head circumference, and additional signs of uncontrolled infection.
Treatment of Cephalohematomas
In most cases the lump associated with this condition takes a few weeks or months to heal, with three months being common. As the cephalohematoma heals the trapped blood and cells break down along with the other tissue components and are reabsorbed into the baby’s system. Oftentimes, the middle of the hematoma will start to disappear first while the outer rim hardens due to calcium, which can alarm parents and caretakers but is part of the normal healing process. X-ray detectable evidence of the hematoma will remain for sometime after the condition has healed; however, physical evidence will not.
In the case of an uncomplicated cephalohematoma, it is typically recommended that the lesion be allowed to heal of its own accord as they are most likely benign. In most cases, attempting to drain the cephalohematoma surgically is discouraged as there is a possibility of introducing microorganisms into a sterile space, as well as the propensity for a more unstable lesion to accumulate in the original location.