Protecting families after preventable newborn hemorrhage
Of all the birth injuries that a newborn infant can suffer, cephalohematoma is among the most common, occurring in 1–2 percent of all births. And while the typical prognosis for the injury isn’t serious, the fact that it is common enough to make its rarer complications a possibility should give parents of an infant with the condition pause.
While it’s rare to see birth injury cases centered around cephalohematoma — the injury usually resolves within weeks, of its own accord — it is often a co-occurring condition with other, more serious injuries. Proper treatment sometimes entails observation through X-rays, CT scans, MRIs and ultrasounds, which can be costly and time-consuming. And in some cases, cephalohematoma or a condition it gets mistaken for may lead to serious consequences.
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What is Cephalohematoma?
Cephalohematoma is an accumulation of blood between the baby’s skull and the skin of its scalp, which shows up as a lump on its head. For most infants, the condition doesn’t pose any threat to their brain — this is in contrast to a subdural hematoma, which occurs inside the brain’s membrane and can have severe implications.
In most cases, cephalohematoma will resolve itself within weeks, with the baby’s body reabsorbing the blood. But other cases will require medical intervention.
Risk Factors
The risk for cephalohematoma increases with difficult labor. This can be predicted by looking at certain factors:
- Fetus weighing 9 pounds or more (macrosomia)
- Fetus positioned for breech birth
- Cephalopelvic disproportion (unusual or small pelvic size and shape in the mother)
- Weak contractions caused by pain medications
- Mother is giving birth to twins or triplets (or quadruplets or quintuplets)
How is Cephalohematoma Caused?
Any trauma to the infant’s head can cause cephalohematoma, with the pressure rupturing the blood vessels and capillaries under the scalp. Sometimes a difficult labor will be at root, with the newborn’s head hitting the pelvic bone during delivery or being pressured by a narrow birth canal. But most often it’s caused by the following birthing tools:
Obstetric Forceps
When used correctly, these hinged pincers can be a valuable tool in guiding a baby’s head through the birth canal. But just a little too much pressure can lead to cephalohematoma.
Vacuum Extractor
A vacuum extractor is a vacuum pump attached to a suction cup, which is in turn affixed to the baby’s head to pull it through the birth canal. Although it requires less precision than the forceps, it can still exert too much pressure on a baby’s scalp.
How Can Cephalohematoma Lead to Anemia and Jaundice?
When the blood concentrated in a cephalohematoma is so excessive that it lowers the infant’s red blood cell levels, this can lead to anemia, which is a deficiency of red blood cells that results in weakness. In extreme cases, it may necessitate a blood transfusion.
The rapid reabsorption of the blood from the cephalohematoma may also lead to problems like jaundice — which occurs when there is an abnormally high level of bilirubin in the blood, which the returning red blood cells contain. Babies born with cephalohematoma are at higher risk of developing jaundice, and their jaundice may be harder to treat. In some cases, it may lead to brain damage, cerebral palsy, hearing loss and other permanent disabilities.
The Dangers of a Bad Diagnosis
While cephalohematoma on its own isn’t usually serious, a bad diagnosis can disguise a skull fracture or a subdural hematoma. If these injuries are overlooked, they can develop into more serious health issues and delays in mental development.
Draining the cephalohematoma may also be considered medical malpractice, as it increases the chances of infection and abscess. If however, the cephalohematoma becomes infected or abscessed on its own, drainage may be indicated. This must be managed carefully, as such infections may lead to meningitis.
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