A cephalohematoma is a collection of blood that forms between a newborn’s skull bone and the periosteum, which is the membrane covering the outer surface of the bones. This condition typically appears shortly after birth, though the swelling may not be immediately noticeable and can take hours or even a few days to become evident. It results from the rupture of small blood vessels in the scalp during the birthing process.
Understanding Cephalohematoma
A cephalohematoma presents as a distinct, firm bulge on the newborn’s head. This swelling is characterized by its confinement to the boundaries of a single skull bone, meaning it does not cross the cranial suture lines. This characteristic distinguishes it from other types of birth-related scalp swelling, such as a caput succedaneum, which can extend across suture lines.
The primary cause of a cephalohematoma is the pressure exerted on the fetal head during labor and delivery. As the baby passes through the birth canal, or when assistance is required, the delicate blood vessels connecting the periosteum to the skull can rupture. This pressure can be intensified by a prolonged labor or the use of assistive devices, such as vacuum extractors or forceps.
The bleeding that leads to a cephalohematoma is typically slow, which explains why the swelling may not be immediately apparent at the moment of birth. It often develops gradually over the first one to three days following delivery. While the condition can occur in any delivery, the risk may increase with factors like the baby’s size or if multiple births are involved.
Diagnosis and Management
Medical professionals primarily diagnose a cephalohematoma through a physical examination of the newborn’s head. Healthcare providers will assess the size and location of the hematoma during this examination.
In most instances, no specific treatment is necessary for a cephalohematoma. The body naturally reabsorbs the pooled blood over time, allowing the swelling to diminish and eventually disappear on its own. The primary course of action involves careful observation and monitoring of the hematoma’s size and characteristics.
Imaging studies, such as X-rays, CT scans, MRI scans, or ultrasounds, are generally not required for an uncomplicated cephalohematoma. However, they may be considered if there are concerns about an underlying skull fracture or other more serious conditions that need to be ruled out.
Potential Considerations
The resolution of a cephalohematoma typically spans several weeks to a few months. While some may resolve within the first month, others can take longer, up to three months or more, for the blood collection to completely disappear. As the blood is absorbed, the mass may initially feel softer, then become firmer or even develop a crater-like appearance as the center resolves before the edges.
A common consideration with cephalohematomas is the potential for jaundice. As the body breaks down the accumulated red blood cells within the hematoma, bilirubin levels in the bloodstream can rise. This increased bilirubin can lead to a yellow discoloration of the skin and eyes, which may require monitoring or treatment with phototherapy in some cases.
Calcification of the hematoma is a less frequent occurrence, happening in a small percentage of cases, approximately 3-5%. This involves the hardening of the blood collection as calcium deposits form around it. While most cephalohematomas resolve without long-term effects, rarely, if calcification is significant or causes cosmetic concerns, surgical intervention might be considered, though this is uncommon.