Birth Trauma, Cephalhaematoma and Caput
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Direct answer
Birth trauma to the scalp includes caput succedaneum, cephalhaematoma and subgaleal haemorrhage, which differ mainly in where the swelling or bleeding lies relative to the sutures. Caput crosses sutures and resolves within days, and cephalhaematoma stays under one bone and resolves over weeks. Subgaleal haemorrhage also crosses sutures, and it can cause major blood loss.
What you must remember
- Caput succedaneum: Diffuse serous or serosanguinous scalp oedema above the periosteum, present at birth and crossing suture lines.
- Cephalhaematoma: Subperiosteal bleeding confined by sutures, often appearing hours after birth and resolving over weeks to months.
- Subgaleal haemorrhage: Bleeding into the loose space beneath the galea aponeurotica; it crosses sutures and can be life-threatening.
- Vacuum association: Vacuum extraction is strongly linked to cephalhaematoma and subgaleal haemorrhage.
- Jaundice: Breakdown of extravasated blood raises bilirubin, so a neonate with cephalhaematoma or bruising needs bilirubin monitoring.
- Skull fracture: A linear skull fracture may accompany cephalhaematoma and needs evaluation if the findings are atypical.
Differentiating the three scalp lesions
The key test is whether the swelling crosses suture lines, which separates caput from cephalhaematoma. Subgaleal haemorrhage is included because it is the most dangerous of the three and can be easily missed at first examination.
| Feature | Caput succedaneum | Cephalhaematoma | Subgaleal haemorrhage |
|---|---|---|---|
| Layer | Scalp soft tissue | Under the periosteum | Under the galea aponeurotica |
| Crosses sutures | Yes | No | Yes |
| Onset | At birth | Often hours after birth | At or soon after birth |
| Resolution | Within days | Weeks to months | Variable; can cause shock |
| Management | Observation | Observation and bilirubin check | Monitor haemoglobin, transfuse if needed |
Caput and cephalhaematoma are managed conservatively, but subgaleal haemorrhage needs active monitoring for falling haemoglobin and shock. Aspiration of a cephalhaematoma is avoided because it carries a risk of infection. Clinical review should document the size and firmness of the swelling at each examination.
Cephalhaematoma is recognised by a firm, well-defined swelling that does not cross sutures. Monitoring for enlargement, jaundice and anaemia continues until the swelling resolves.
Where the exam tries to catch you
Birth trauma questions usually hinge on the suture-crossing feature, the timing of onset and the dangerous lesion.
- Trap: Calling every scalp swelling a caput Correct: Caput crosses sutures, whereas cephalhaematoma does not, so a swelling confined by a suture is a cephalhaematoma.
- Trap: Dismissing a boggy, spreading scalp swelling with falling haemoglobin Correct: Subgaleal haemorrhage can produce shock, so haemoglobin is checked and hypovolaemia treated urgently.
- Trap: Attributing neonatal jaundice to physiological causes alone when cephalhaematoma is present Correct: Breakdown of the extravasated blood adds to bilirubin, so bilirubin must be measured.
Frequently asked questions
How does caput succedaneum differ from cephalhaematoma?
Caput succedaneum is diffuse scalp oedema that crosses suture lines and is present at birth. Cephalhaematoma is subperiosteal bleeding that stays within one skull bone and does not cross sutures. The suture-crossing feature is the main differentiating test.
Why is subgaleal haemorrhage dangerous?
Subgaleal haemorrhage is bleeding into the loose potential space beneath the galea aponeurotica, which can hold a large volume of blood. The bleed crosses sutures and may cause hypovolaemia and shock. Early recognition and transfusion may be needed.
Does cephalhaematoma need treatment?
Cephalhaematoma usually resolves spontaneously over weeks to months, so conservative observation is the standard approach. It needs evaluation for skull fracture and monitoring for jaundice. Aspiration is generally avoided because of the risk of infection.
Which delivery method is linked to cephalhaematoma?
Vacuum extraction is strongly associated with cephalhaematoma and subgaleal haemorrhage because the cup applies suction to the scalp. Forceps and prolonged difficult deliveries also carry some risk. Careful documentation of cup placement and duration is good practice.