cranial hematomas

Caput succedaneum

Caput:

  • path: subcutaneous, above periosteum, between skin and galea
  • pt: pressure against dilating cervix in head first delivery (vertex), after prolonged labor or vacuum assisted delivery
  • symptoms
    • extend across midline/sutures
    • poorly defined margins
    • discoloration
    • PE shows boggy region of scalp with pitting edema and ill defined borders that do not expand over time
    • usually serous fluid but can have blood
  • treatment: resolves over the first few days. Observe

Cephalhematoma

Cephalohematoma:

  • path/pt: subperiosteum hematoma (rupture of blood vessels between skull and periosteum) caused by surgical trauma or can be vacuum/forceps. Most common parietal
  • symptoms
    • bulging head
    • jaundice, hyperbilirubin from hemolysis
    • rare: anemia, hypotension
    • Do not cross suture lines. well demarcated
    • Can calcify or ossify leading to skull deformation
  • treatment: observe. Resolve in weeks to months

Subgaleal

Subgaleal

  • path: bleed between galea aponeurosis and periosteum
  • pt: vacuum apply to head in delivery.
  • symptoms
    • crosses midline
    • rapid expansion of swelling can be fatal due to shock and massive blood loss
  • treatment:
    • ICU monitor with fluid replacement and CBC/coagulation study