Cephalo- means “head” or “skull,” and a hematoma is a blood clot that occurs outside of a blood vessel. A cephalohematoma is a clot that occurs in the area between the skull and the periosteum (the membrane that covers the skull) as a result of ruptured blood vessels. Infant cephalohematomas are associated with the use of birth-assisting tools like forceps or vacuum extractors or prolonged or traumatic labors. Infant cephalohematomas usually heal without any major medical intervention, but if improperly treated, the consequences can be more serious.
Identifying and Diagnosing a Cephalohematoma
Usually, a cephalohematoma will manifest as a raised solid bump on a baby’s head. It appears several hours to a day after birth and is often largest on the second or third day. There may or may not be discoloration, and there is typically no significant blood loss.
Often, appearance alone is enough to diagnose a cephalohematoma. To verify, however, doctors may order an X-ray, CT scan, MRI scan, or ultrasound.
What Can Cause a Cephalohematoma?
Any type of trauma to the baby’s head can potentially cause a cephalohematoma, but it is most commonly associated with the use of forceps or vacuum extractors during labor and delivery or prolonged or traumatic labors. Because these forceps and vacuum extractors put infants at risk for cephalohematomas along with more serious conditions, there are certain circumstances under which instrument-assisted deliveries should not occur. Here are a few examples:
- The baby’s head is too high in the birth canal
- The baby’s head is not in the correct position (ex: face presentation)
- The baby is under 34 weeks of gestation. This puts them at risk of intraventricular hemorrhage, or excessive bleeding within the brain.
- There is cephalopelvic disproportion (CPD), a condition in which the baby’s head is too large to fit through the mother’s pelvis.
How Should Cephalohematomas Be Treated?
Generally, treatment for cephalohematomas is supportive in nature. They will, in most instances, go away on their own without any major medical intervention. However, doctors should carefully monitor the infant for potential complications that may require further treatment. Children with permanent brain damage from a cephalohematoma may require physical therapy, occupational therapy, speech therapy, adaptive/assistive equipment, specialized education, and other resources.
What Complications Can Arise in Infants with Cephalohematomas?
If cephalohematomas are not properly monitored and managed, the following complications can occur:
- Neonatal infection: If a cephalohematoma is punctured, it can result in an infection of the brain, skull, or spinal cord. For this reason, medical professionals are usually cautioned against draining a cephalohematoma. If an infant develops a severe infection, it should be treated with antibiotics.
- Jaundice: Infants with cephalohematomas tend to have high levels of bilirubin, which can result in jaundice. The most obvious symptoms of jaundice are a yellowing of the skin and eyes. Sometimes, doctors will need to treat babies who have jaundice with phototherapy (lights that help to break down the bilirubin). Left untreated, severe jaundice can lead to conditions such as cerebral palsy and hearing loss.
- Calcification of the hematoma: This causes a bony swelling that lasts for months. Sometimes these lead to skull deformities that can only be treated with surgery.
- Anemia: Occasionally, infants with large cephalohematomas lose so much blood that they develop anemia, which means they are not circulating enough oxygen to their organs. To avoid permanent damage, this condition must be addressed quickly. Anemia may be treated with dietary supplements, medications, or procedures such as blood transfusions.
Trusted Legal Help for Infant Cephalohematomas
A cephalohematoma may be associated with a birth injury from a forceps or vacuum extractor- assisted birth. It is a physician’s duty to follow standards of care, and if the quality of their care causes an injury, then the law allows these professionals to be held accountable for their mistakes. If your child has suffered a cephalohematoma or another birth injury from a medical mistake, please contact the legal professionals at Reiter & Walsh ABC Law Centers. We can help you secure the resources your child needs for therapy, rehabilitation, and medical care.
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Wong HW, Perry L. Maternal Child Nursing Care. 2006