What is Caput Succedaneum?
Caput succedaneum is a harmless swelling that can be seen on a baby’s scalp soon after birth. This swelling can cross the skull’s suture lines — the joints where the bones of the skull meet — and the middle line of the head. It’s often linked to different causes related to birth trauma, such as pressure on the baby’s head during a head down birth or when a vacuum-assisted delivery is used. It’s crucial to distinguish caput succedaneum from other, more serious causes of newborn head injury that might need more careful observation.
What Causes Caput Succedaneum?
Caput succedaneum is a condition caused by trauma to a baby’s head during vaginal birth. It is often linked to longer labor processes and when the baby is delivered head first. As the baby moves through the cervix, the head experiences pressure from both the uterus and the vagina.
Additionally, caput succedaneum can also occur when birth-assisting tools like forceps or vacuum devices – which help to guide the baby out – come into contact with the baby’s head. In the United States, these assisted methods are used in about 5% of all deliveries.
Risk Factors and Frequency for Caput Succedaneum
Caput succedaneum is a condition that can occur during childbirth, with several risk factors to be aware of. These include a lengthy labor period, a birth involving the aid of instruments like a vacuum or forceps, a lack of amniotic fluid (or oligohydramnios), a first-time pregnancy (primigravida), irregular contractions known as Braxton-Hicks, and the breaking of water before labor begins (premature rupture of membranes). The most significant risk factor, though, is vaginal delivery assisted by a vacuum, as it has a higher chance of causing caput succedaneum and scalp injury, even more so than forceps-assisted delivery. Some reasons a doctor might suggest a vacuum-assisted delivery include a long second stage of labor, worrying patterns in the baby’s heart rate, and the mother being too tired to continue.
To understand some of these terms better:
- A lengthy, or ‘protracted,’ active labor refers to when the cervix is dilating slower than expected (less than 1.2 cm per hour for first-time mothers and less than 1.5 cm per hour for those who’ve given birth before).
- The ‘prolonged second stage of labor’ varies depending on whether the mother has given birth before or not. For first-time mothers, it’s diagnosed when there’s no dilation after two hours with anesthetics, or after one hour without. For those who’ve given birth before, these thresholds are three hours and two hours respectively.
- ‘Operative vaginal delivery’ means using an instrument like a vacuum or forceps to assist in birth.
- ‘Primigravida pregnancy’ refers to a mother who is pregnant for the first time.
- ‘Braxton-Hicks contractions’ are basically ‘fake’ labor pains, as they’re irregular and do not result in childbirth.
- ‘Premature rupture of membranes’ is when the mother’s water breaks before contractions that lead to cervical dilation start.
Signs and Symptoms of Caput Succedaneum
Caput succedaneum is a condition that can cause swelling on a newborn’s scalp. This might occur due to various factors, such as
- Long-lasting labour
- First-time mother
- Delivery using a vacuum or forceps
- Low amniotic fluid in pregnancy (oligohydramnios)
- Premature breaking of the mother’s water bag (membranes)
- Large-sized baby (macrosomia)
Doctors can identify caput succedaneum as early as the first stage of labor by examining the baby’s scalp swelling during a physical examination or ultrasound. Important things a doctor looks for when evaluating the swelling include whether the swelling crosses the middle of the scalp, which is a key sign of caput succedaneum. There might also be bruising or red spots (petechiae and ecchymosis) around the area of swelling.
The swollen area usually feels soft and bumpy when touched. The diagnosis of caput succedaneum is usually made through a physical exam only. It is crucial for doctors to observe the swelling’s distribution and feel it during the exam. Checking and feeling the newborn’s scalp is a vital part of their initial examination.
Testing for Caput Succedaneum
During visits to the doctor before childbirth, it’s essential to discuss any potential risk factors that might lead to birth-related complications like caput succedaneum, which is a swelling on a newborn’s scalp. Doctors will inform and guide parents about the possibility of such complications and what can happen next (the prognosis).
Caput succedaneum is diagnosed in a clinical setting based on its features, and typically, no further testing or imaging like ultrasound is needed. Although ultrasound can show a clear image of any blood collection above the baby’s skull during and after birth, it’s not necessary for diagnosing caput succedaneum.
Treatment Options for Caput Succedaneum
Caput succedaneum is typically managed by watching and waiting. Most of the time, it will get better on its own within two days, so the main course of action is simply to observe the baby and provide reassurance. During this time, it’s important for healthcare professionals to keep an eye on the baby for signs of neonatal jaundice, a common condition in newborns that can cause a yellow color in the skin and eyes.
In rare cases, caput succedaneum might lead to an increase in bilirubin, a substance normally found in the blood, which is then reabsorbed back into the body. This could signal or worsen a case of hyperbilirubinemia, a condition where there’s too much bilirubin in the blood. This can lead to jaundice, so if this happens, additional care and treatment may be needed.
What else can Caput Succedaneum be?
When a newborn baby shows signs of scalp swelling, a detailed health history and physical exam should be carried out. This is to help figure out if the baby simply has caput succedaneum, which is a harmless condition that resolves on its own, or if they have other more serious causes of scalp swelling that need close attention and management. Some of the other potential causes of scalp swelling in newborns include:
- Cephalohematoma: This is associated with birth trauma (like instrument-assisted delivery, prolonged delivery) that causes capillaries beneath the periosteum (a membrane that covers the outer surface of all bones) to rupture. It leads to a hard unstable mass that doesn’t cross the midline of the skull or the cranial suture lines. The mass generally increases during the first day of the baby’s life and rarely involves brain hemorrhage and infection. However, monitoring for hyperbilirubinemia in the newborn is recommended. It usually resolves between two weeks to six months and can sometimes appear as two separate masses which are different from caput succedaneum, a single mass that crosses the midline.
- Subgaleal hemorrhage: This hemorrhage is linked to birth trauma and occurs beneath the epicranial aponeurosis, a membranous layer that covers the upper part of the skull. It usually comes as scalp edema that crosses the suture lines and then spreads out. This condition is associated with a high mortality rate and can lead to seizures, skull fractures, and hypotonia (low muscle tone). It can also cause hypovolemia (decreased blood volume), coagulopathy (a condition in which the blood’s ability to clot is impaired), and hyperbilirubinemia. Subgaleal hemorrhage is also related to vacuum and forceps-assisted delivery. The space where the hemorrhage occurs (subgaleal space) is large, and the fluid accumulation has the potential to extend behind the eyes and onto the neck. Compared to the edema found in caput succedaneum, both cross the midline since the fluid collection is above the cranial suture lines in both cases, but subgaleal hemorrhage is more spread out.
- Subdural hemorrhage: This is hemorrhage linked to birth trauma that happens between the dura and arachnoid space, which are layers of the meninges, the protective coverings of the brain.
What to expect with Caput Succedaneum
Caput succedaneum, a minor condition often seen in newborns, usually gets better on its own within two days without any issues. It’s considered to be harmless and has a very good outlook as long as it’s monitored.
Possible Complications When Diagnosed with Caput Succedaneum
Complications linked with caput succedaneum, a condition in newborns where there’s swelling on the top part of the infant’s head, are not common. However, some complications have been reported in scientific studies:
- Scarring
- Jaundice, which makes the skin and the whites of the eyes turn yellow
- Halo scalp ring alopecia, a condition that causes hair loss in a ring around the scalp
Preventing Caput Succedaneum
In general, caput succedaneum is a harmless condition often seen in newborns, where there’s a swelling on the baby’s scalp. Healthcare professionals who work with newborns may regularly see this condition. However, for parents and family members, the sight of this swelling can be concerning. Therefore, it’s essential to reassure them and explain what it is all about, along with the short and long-term expectations, which are usually positive.
When possible, it is a good idea to provide information about caput succedaneum during prenatal visits. Arranging for this early education about potential issues that can occur during birth, including maternal and fetal complications, can help set expectations and prepare parents for what might happen during and after delivery. This helps ensure they are not caught off guard and reduces anxiety and worry.
