A cephalhematoma is a collection of blood on the head of a newborn baby. It is considered one of the birth traumas.
What is a cephalhematoma?
Cephalhematoma is also called a head blood tumor or cephalhematoma. It occurs in newborns and appears on the baby’s head as a collection of blood. In most cases, birth trauma is caused by an excessively narrow birth canal. While the hematoma initially appears flaccid, it later becomes a bulging lump. However, after a few weeks, it recedes on its own. The term cephal comes from the Greek and stands for “belonging to the head”. Cephalic hematoma occurs during natural childbirth, when small blood vessels located between the periosteum (periosteum) and the outer bone of the skull rupture. This is due to the large shear forces acting on the baby’s head in the birth canal. In newborns, the skull is still soft, so it can be deformed. A cephalhematoma shows up once or twice in one hundred births. In some cases, incomplete fracture of the skull bone also occurs, which physicians call an infraction.
Causes
Cephalic hematoma is particularly common with forceps deliveries or the use of suction cups. In these methods, special forceps spoons or a suction cup are attached to the baby’s skull to make delivery easier. The development of cephalhematoma is caused by the action of gravitational forces. These act on the infant through the narrowness of the birth canal, displacing the soft tissues of the head. This, in turn, can cause the scalp to shear away from the bone. Blood vessels located beneath the periosteum tear in the process, causing bleeding. In most cases, this bleeding is quite severe due to the intensive blood supply to the periosteum. If the space between the bone and the periosteum, which can only be stretched slightly, fills up, the bleeding stops. Eventually, a bulging elastic swelling develops. There are some risk factors that bring about cephalhematoma. These are primarily forceps delivery as well as suction cup delivery. In some cases, rapid passage of the baby’s head through the mother’s pelvis may also be responsible for the development of the head hematoma. The same is true for a very narrow birth canal. These factors also cause gravitational forces that cause a cephalhematoma to develop. Also among the risk factors is the vertex position, also called occipital position. This is when the baby’s head does not lie forehead-first in the maternal pelvic inlet as intended. This results in more difficult entry into the birth canal.
Symptoms, complaints and signs
A cephalhematoma becomes noticeable shortly after the birth process as a bulging, elastic lump that is sensitive to touch. During the first 24 hours after birth, there is an enlargement of the cephalic hematoma, but it is then confined to the region of the skull bone. In most cases, the unilateral hematoma forms on a parietal bone (Os parietale), from which the upper as well as the posterior side of the skull is formed. A cephalhematoma has the size of a chicken egg and takes the shape of a hemisphere. The periosteum is very sensitive to pain, so the baby often behaves restlessly and cries when the head tumor is externally affected. In rare cases, multiple or very large cephalhematomas occur. As a result, there is a risk of onset of anemia (anemia) due to blood loss. In the worst case, volume deficiency or even circulatory shock are also possible. If the cephalhematoma does not resolve on its own, this may indicate blood clotting disorders.
Diagnosis and course of the disease
Discovery of a cephalhematoma usually occurs shortly after birth by a midwife or pediatrician. Sometimes, however, the head hematoma is masked by birth swelling of the head, so parents do not notice it until several days later. During the examination, the attending pediatrician will then ask the parents when they noticed the hematoma, whether the swelling has changed since it was discovered, whether it is possible that the baby had a head injury, and how the baby was born. It is also important to know whether forceps or a suction cup were used during the birth process.The next step is the physical examination of the baby. Here, the doctor checks whether there is a limitation of the cranial sutures or an overshoot. Furthermore, he checks the consistency of the swelling. Also of interest are any neurological symptoms. The child’s eyes and hearing are also tested. The course of the cephalhematoma is usually positive. Although the size of the cephalhematoma increases in the first few days, it recedes on its own in the weeks and months that follow. A feared, but very rare complication, is infection of the hematoma, which can be life-threatening.
Complications
Cephalhematoma is a very serious condition. If it is not treated, the child may die. In most cases, cephalhematoma occurs right after birth, so there is a severe enlargement of the head. This is mainly filled with blood. Due to the strong filling with blood, various complications of the child’s head can occur. As a rule, the periosteum is very sensitive, so that severe pain occurs. The child cries a lot and is very restless. It is not uncommon for circulatory shock to occur as well. Sometimes the cephalhematoma may disappear on its own. If this is not the case, the affected person usually suffers from blood clotting disorders. These can also restrict further life. Direct treatment of the cephalhematoma usually does not take place if the blood flows back again. If this is not the case, the blood can also be taken directly from the head to prevent secondary damage. Usually, the life expectancy of the affected person is not limited by the cephalhematoma.
When should you see a doctor?
In most natural births, cephalhematoma is not a cause for concern. Normally, the aftermath of childbirth results in continuous relief of symptoms within a few days until freedom from symptoms is achieved. Since an intensive examination of the newborn is carried out by the obstetricians as well as pediatricians immediately after the delivery, the parents do not have to take any measures in case of an inpatient birth. In the routine examinations and tests, the health condition of the child is thoroughly examined and changes are observed in detail. If there is any deterioration, medical treatments are initiated immediately. If a home birth takes place, the midwife provides the necessary initial care for mother and child. She automatically initiates further steps in case of worrisome health conditions of the newborn and consults a doctor in case of problems. If a sudden birth occurs without an obstetrician present, a doctor should always be consulted to clarify the health condition of the mother as well as the child. If the cephalhematoma does not steadily regress within the first few days of life or if there is a further increase in symptoms, a visit to the doctor is required as soon as possible. Serious disorders are present that may lead to the neonate’s demise without medical care.
Treatment and therapy
Special treatment of cephalhematoma is not required because it resolves on its own. Puncture to aspirate the blood is not recommended because the risk of infection to the baby is too great. Thus, there is a risk of a life-threatening abscess. The only medical treatment method is the administration of vitamin K, which the body needs to produce proteins, which in turn are important for blood clotting. If a head wound is present at the cephalhematoma, it must be treated sterilely.
Outlook and prognosis
The prognosis of the disease is favorable. Although in severe cases the formation of the hematoma may cause the neonate to die, in most situations medical care is not necessary. Normally, the congestion of blood formed at birth gradually drains away within a few days after birth, leading to relief of symptoms. Therefore, the organism completely regulates the formation of the hematoma by its own natural means. The cephalhematoma is further observed immediately after birth by the attending physicians as well as the birth team. At the same time, the infant is appropriately spared and clinically cared for. Sufficient rest is important so that the blood circulation can regulate itself.If relief of symptoms is evident, no further action is necessary. Some patients experience a worsening of the conditions. In this case, medical intervention is required to avert a life-threatening situation. Rarely, an abscess develops. This happens in particular if the blood has been aspirated to the outside through a puncture. An abscess must be treated immediately by the attending physician to avoid serious complications. Since sepsis is imminent in these cases, death of the newborn may occur if sepsis is not treated comprehensively as soon as possible.
Prevention
Preventing cephalhematoma is almost impossible. For example, the head hematoma does not form until the birth process.
Aftercare
In most cases of cephalhematoma, the options for aftercare are relatively limited. The earlier a doctor is contacted in this case, the better the further course of the disease often is, so the affected person should see a doctor at the first signs and symptoms of the disease. As a rule, treatment is not necessary for cephalhematoma, as it should disappear on its own. If this is not the case, a doctor should be contacted immediately. The blood should not be aspirated from the cephalhematoma, since in the worst case an abscess can form from it, which in the worst case leads to death. In general, in the case of a cephalhematoma, taking vitamin K has a positive effect on the further course of the disease and can significantly accelerate healing. If the cephalhematoma is located on the head, the site must be disinfected in any case. As a rule, no further follow-up measures are necessary in this case.
What you can do yourself
A cephalhematoma does not require any special treatment. It usually regresses on its own after a few days, with no further symptoms. Parents should make sure that the wound heals well and that no irritating substances or pathogens reach the injured area. The bruise can be treated with the help of various home remedies, such as cool compresses, aloe vera or a gentle ointment of calendula or arnica. Alternatively, compresses with onions or parsley are a good option – the pediatrician should give his approval before using these remedies. In addition, a cephalhematoma can be alleviated by the administration of vitamin K. Depending on the size of the bruise, vitamins can be provided either through diet or supplements. Sterile care is indicated for a head wound. This carries an increased risk of complications, so treatment must be monitored by a medical professional in all cases. After the hematoma has subsided, attention should be paid to abnormalities in the infant’s behavior. If any unusual symptoms are noticed, a visit to the pediatrician is recommended.
