Cephalohematoma

Robyn Mattox – 01/05/02

Description:

This is an area of bleeding over one of the cranial bones. It often appears several hours after birth as a raised lump on the baby's head. There is a very tough tissue layer that encapsulates bones, called the periosteum. It adheres strongly to the outer and inner surfaces of all the bones of the body, including the skull. A cephalohematoma is a collection of blood under the periosteum. It’s basically a bruise of the skull bone. It is almost always a complication of childbirth. The incideance of a cephalohematoma is 0.2 to 2.5% of live births. This most commonly occurs when the fetal head is forced through the birth canal; the head is propelled forward while the cervix grips the scalp tightly. This sliding, tearing force can tear tiny veins that nourish the bone under the periosteum. More common is prolonged pushing stages, forceps or vacuum extraction deliveries. This tearing of vessels causes bleeding (hemorrhage) under the tough periosteum, and a tense pocket of blood collects. This is apparently a painless process, although it can be indicative of a skull fracture. This is rare, but should be ruled out, especially in cases of trauma, such as forceps delivery or accident. In the case of fracture, the mass may cross suture lines.

Diagnosis:

• A bulge over part of the infant's skull, usually over the parietal bone on the side of the head; but definitely located over one of the skull bones and not randomly located
• If the blood collection is small, the mass will be soft, mushy.
• If the blood collection is large, the mass will be firm.
• Does not Cross suture lines. It conforms to the shape of the underlying bone.
• No overlying skin discoloration
• Appears by day 2-3 of life, not like a caput which is visible at birth.
• Over time border develops fine calcified rim

Risks:

• Anemia, if the blood collection is large
• If the blood collection is large, the re-absorption of the blood clot will generate a large amount of bilirubin as a breakdown product of this blood.  The bilirubin can cause hyperbilirubinemia (jaundice) of the infant, which may require phototherapy in unusual cases.
• Infection of the blood collection
• Occasionally, calcium deposits form in the blood collection if the blood remains there for a long while, and this can cause an unsightly hard bump, but the bump eventually resolves.
• Hypotension, if bleeding is large or uncontrolled.

Treament:

The body reabsorbs the blood. Depending on the size, most cephalohematomas take two weeks to three months to disappear completely.

• Watchful waiting is the usual treatment for an uncomplicated case.
• Physicians try not to put a needle into this blood collection because doing so might introduce infection, even with sterile technique.