Introduction
Caput Succedaneum is a common benign condition characterized by swelling (edema) of the baby’s scalp immediately following birth. It occurs as a result of birth-related trauma during delivery. In most cases, fluid build-up occurs beneath the scalp, and more profound injuries are rare. The infant’s head will have a cone-shaped appearance. Mostly the condition is not alarming and resolves on its own. It is important to differentiate caput succedaneum from other conditions that can result in similar swelling on the scalp region.
What Are the Causes?
Caput Succedaneum occurs due to birth-related trauma to the head of the fetus during vaginal birth. In most cases, it is associated with an extended labor course. As the fetus passes through the cervix, the fetal head is subject to pressure due to uterine contractions and vaginal wall contraction. Forceps delivery and vacuum-assisted delivery also increase the risk. Long deliveries create a situation in which premature breakage of the amniotic sac may occur. In the case of C-section deliveries where vaginal pressure is not a concern, if caput succedaneum occurs it is due to early loss of amniotic fluid.
What Are the Risk Factors?
Risk factors for Caput Succedaneum include the following:
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Maternal Nulliparity: These include females of the reproductive age group who have not given birth, including those women who had miscarriages or abortion
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Vacuum-assisted Delivery: In vacuum-assisted Delivery, a vacuum extractor is used for moving the baby out through the vaginal canal. Improper use can lead to birth-related trauma.
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Forceps-assisted Delivery: Using forceps during delivery also increases the risk for Caput Succedaneum.
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Protracted Labor: Protracted labor refers to slow cervical dilation or slow fetal descent.
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Macrosomia: Macrosomia refers to a condition in which the baby has excessive weight and is large.
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Premature Membrane Rupture: Premature membrane rupture occurs when the amniotic sac breaks before the mother is in full active labor.
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Oligohydramnios: A lack of amniotic fluid is called Oligohydramnios and occurs due to:
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Birth defects.
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Post-term pregnancy.
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Placental insufficiency.
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Preeclampsia (a complication during pregnancy characterized by high blood pressure).
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Braxton- Hicks Contractions: Braxton- Hicks contractions are irregular contractions resulting in false labor pain.
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Medical Negligence: Medical negligence may contribute to caput succedaneum in the following cases:
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When the baby is very large but still the physician does not do a C-section.
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Improper use of vacuum extractor.
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Improper forceps use in forces-assisted delivery.
What Is the Pathophysiology?
The hemorrhagic fluid accumulation related to Caput Succedaneum lies superior to the cranial suture lines and crosses the midline. The fluid collection is above the periosteum and epicranial aponeurosis and below the cutis layer of the scalp. The fluid collection superior to the cranial sutures leads to an edematous, pitting, and fluctuant mass that crosses the suture lines.
The location of the swelling depends on the cause of the trauma. If swelling occurs due to protracted labor, then the fetal head is compressed by uterine contractions, and swelling develops on the side opposite of contact.
What Are the Symptoms of Caput Succedaneum?
The symptoms of Caput Succedaneum include the following:
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Cone-shaped head.
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Puffiness under the scalp.
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Bruising to the scalp or color change on the swelling region.
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Swelling (edema) crosses the midline (pathognomonic feature).
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The edematous area on palpation is boggy, fluctuant, and soft.
How to Detect the Condition?
During the pregnancy visits, the risk of developing caput succedaneum or other birth-related trauma should be evaluated. The parents should be counseled about the possible complications. The condition does not usually require laboratory tests or imaging studies. Both an intrapartum and postpartum ultrasound can reveal hemorrhagic collection above the skull.
But most of the cases are clinically evaluated and do not require an ultrasound.
How Is the Condition Managed?
Only observation and reassurance are needed in most cases, as the condition usually resolves in forty-eight hours. But in some cases jaundice (yellowing of the skin, eye, and mucous membranes with increased bilirubin in the blood). The risk of developing jaundice is high due to hemorrhagic collection, which can break down into bilirubin. If left untreated, the condition (jaundice) progress to brain damage and even death.
What Are the Complications?
The complications associated with caput succedaneum are:
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Jaundice: The baby with caput succedaneum is at increased risk of developing jaundice, as the bruising can break down to bilirubin. Excess bilirubin in the blood leads to jaundice characterized by yellowing of the infant’s skin and eyes. Jaundice if not diagnosed early and properly treated can lead to kernicterus and even death.
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Scarring: Caput succedaneum can lead to scarring.
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Alopecia: Pressure on the scalp during childbirth can lead to a distinctive pattern of hair loss called halo scalp ring alopecia.
What Is the Prognosis of the Condition?
The condition has an excellent prognosis with proper observation. The condition is benign and mostly resolves in forty-eight hours without any treatment.
What Is the Differential Diagnosis?
The differential diagnosis for caput succedaneum involves the following conditions:
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Subdural Hemorrhage: Subdural Hemorrhage occurs between the arachnoid space and the dura and is associated with birth-related injury.
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Cephalohematoma: Birth-related trauma results in the rupture of capillaries situated beneath the periosteum leading to hematoma formation. The hematoma formed is a firm and fluctuant mass and unlike caput succedaneum, it does not cross the cranial suture lines. The condition mostly resolves on its own within two weeks to six months. Caput succedaneum presents as a singular mass that crosses the midline.
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Subgaleal Hemorrhage: In subgaleal hemorrhage, hemorrhage is situated beneath the epicranial aponeurosis. It is associated with birth-related injury and the swelling crosses the suture lines and spread diffusely. It can result in coagulopathy, seizures, hypovolemia, skull fractures, and hyperbilirubinemia. It occurs due to birth-related trauma and mostly occurs in forceps and vacuum-assisted delivery. The condition has a high mortality rate.
Conclusion
Caput succedaneum is a condition that can be very distressing for parents. The parents should be educated about the condition and the favorable long-term and short-term prognosis. It is a clinically benign condition that mostly resolves on its own, and only observation and reassurance are required.
