What Is Caput Succedaneum?
Caput succedaneum is a typically benign, common occurrence during childbirth that causes swelling under a newborn’s scalp. The force of the vaginal wall contracting during childbirth is the primary trigger, and though the condition can look concerning, it usually resolves on its own. Caput succedaneum can also result from pressure inside the womb before delivery.
For the majority of caput succedaneum cases, the edema is simply under the skin rather than a deeper injury to the brain. Though caput succedaneum resolves quickly and without medical intervention in most cases, it can be a factor in other complications, like jaundice.
What causes caput succedaneum?
Though caput succedaneum is a very common condition, it’s still a concern for young parents. It is caused by pressure on the top of the baby’s head, typically during vaginal delivery, but it can occur in utero as well.
In utero caput succedaneum occurs when the amniotic sac breaks too early. Early amniotic rupture occurs primarily in children who have a higher birth weight (macrosomic). Their increased weight puts pressure on the uterine membranes.
Long deliveries can also create a scenario in which the amniotic sac breaks prematurely. This, too, can result in caput succedaneum. The force of the mother’s birth canal squeezing for prolonged periods can cause significant pressure when the amniotic sac ruptures.
When caput succedaneum occurs during a C-section delivery—in which vaginal pressure does not play a factor—the early loss of amniotic fluid is the cause. A condition called oligohydramnios can also occur when there is too little amniotic fluid in general, which can be a contributing factor in increased pressure during birth.
Finally, one other factor in caput succedaneum is the use of forceps or a vacuum extractor during birth. These instruments are used when the birth is prolonged or the baby is stuck, and their use increases the risk of complications.
Symptoms of Caput Succedaneum
Fortunately, the only real symptom of caput succedaneum is a swollen area on the child’s head. The area is usually at the top of the scalp, or it can spread to the sides, but it’s almost always at the point that first exits the vaginal canal.
A superficial swelling of the scalp is the only symptom of caput succedaneum. If other symptoms occur or the swelling extends into the skull, that becomes a different condition. Hydrocephalus, for instance, also causes swelling of the head, but the underlying edema occurs under the skull, which puts pressure on the brain.
Your physician should be able to determine if the swelling on your child’s head is caused by caput succedaneum or another condition. While some other similar conditions like cephalohematoma are also typically benign, the force of birth can cause skull fractures or other injuries. A pediatric doctor will be able to determine the extent of the injuries and whether or not they are serious.
How is caput succedaneum treated?
Though caput succedaneum looks alarming—particularly on a tiny newborn—it’s almost always harmless. Because there is little likelihood of long-term damage, medical professionals will almost always suggest simply allowing the swelling to resolve on its own. Direct intervention by removing the edema surgically can cause more harm than good.
Complications of Caput Succedaneum
Localized swelling of your baby’s scalp after birth is common and will usually resolve on its own. In rare cases, complications from caput succedaneum occur, such as bruising in the area of the edema. This can lead to permanent scarring or hair loss (alopecia) on the skin of the scalp, but again, these are rare complications.
If bruising does develop, it can stress a newborn’s system and lead to increased bilirubin in the blood, a condition known as jaundice. Newborn jaundice is a common condition, but caput succedaneum can make it worse. The typical treatment for jaundice is light therapy, and it generally resolves within a few weeks of birth.
In some cases, newborn jaundice can become hazardous, which typically occurs when it’s left unmonitored or untreated. Rampant jaundice can lead to kernicterus, where the bilirubin crosses the blood-brain barrier. Excess bilirubin in the brain is a life-threatening medical condition and must be dealt with seriously, or brain damage can result.
Fortunately, because health care centers experience newborn jaundice regularly, treatment is easily available, and kernicterus is rare.
Another condition caused by a difficult delivery is cephalohematoma, an accumulation of blood between the periosteum and skull. The periosteum is a network of connective and vascular tissue between the bones and other tissues of the body; blood accumulation in this space in newborns is caused most frequently by birth trauma.
Causes of Cephalohematoma
When the infant’s head exits the cervix and enters the birth canal, there is a significant force exerted upon it. Prolonged pressure can cause both cephalohematoma and caput succedaneum, and the delivery doctor may resort to vacuum extraction to help delivery along. The use of forceps or extractors can cause this or other birth injuries.
Other factors that contribute to cephalohematoma are:
- Weak or incomplete uterine contractions
- Higher birth weight (macrosomia)
- Abnormal fetal presentation
- Prolonged labor
- Having more than one child at a time
In most cases, cephalohematoma isn’t dangerous and will resolve on its own, like with any bruise. Though bruising of a newborn’s scalp is distressing, it shouldn’t necessarily be cause for alarm. With that said, any type of injury sustained during birth can indicate a potentially deeper injury, and your doctor should consider these indications carefully.
Succedaneum vs. Cephalohematoma
Cephalohematoma is typically localized in a specific area, like any other bruise, and doesn’t cross suture lines. Caput succedaneum is a diffuse fluid collection and can extend under the scalp across the midline of a newborn’s head.
Both conditions will typically resolve on their own in the overwhelming majority of cases. Your doctor will observe your child’s progress, and if something needs to be done, they will intervene.
Additionally, both conditions are caused by the same factors; increased external pressure, usually due to a long delivery. The pressure can come from the mother’s pelvic bones, premature rupture of membranes in the uterus, or forceful extraction with medical devices such as forceps.
While both cephalohematoma and caput succedaneum are generally benign, the causal factors for these conditions can indicate more serious damage. When a newborn baby is subject to increased pressure during birth, it can be deprived of oxygen. Decreased oxygen during birth can lead to many different severe injuries, including:
- Cerebral palsy
- Cognitive delays
- Difficulty learning or speaking
- Slow development during childhood
While the use of forceps or vacuum extraction during birth are common occurrences, they are not without their risks. If you are concerned that your family suffered medical malpractice during your child’s birth, you need to speak with a birth injury lawyer.
The results of some birth injuries will not manifest for weeks, months, or even years later. The presence of caput succedaneum or cephalohematoma are indications that trauma occurred, and you might need to assess whether deeper problems exist.
There are tests for newborns that can confirm the existence and severity of an injury.
Apgar tests are administered to newborns after delivery, and they measure your child’s basic vital functions. They measure breathing rate, how well the baby is doing outside the womb, and several other important statistics related to a successful birth.
All newborns are given this test, and if it shows any indication of concern, your doctor will follow up. Apgar tests are great for discovering injuries from birth or other problems and help your pediatrician make a treatment plan.
Using a CT scan or MRI, your doctor can determine the extent of any trauma that occurred to your child’s brain. Visible birth trauma can cause cerebral palsy or HIE, hypoxic-ischemic encephalopathy. These conditions often need lifelong support, and the sooner they’re diagnosed, the better they can be treated.
The blood present in the umbilical cord is a snapshot of the oxygenation of blood when the baby was in the womb and can tell doctors if the child was hypoxic. If blood tests indicate hypoxia, further testing can assess the extent of the damage.
The cephalohematoma or caput succedaneum newborn babies experience can indicate more serious trauma. If medical malpractice occurred during your child’s birth, you could be eligible for compensation. Speak with a birth injury lawyer to determine what steps you should take and whether you’re owed compensation for birth negligence.