II. Epidemiology

  1. Incidence: 0.2 to 2.5% of live births

III. Causes

  1. Prolonged labor
  2. Instrumented delivery (e.g. forceps)

IV. Pathophysiology

  1. Rupture of blood vessels between skull and periosteum
  2. Results in subperiosteal blood collection
  3. Bleeding limited by Suture lines

V. Signs

  1. Cephalhematoma does not cross Suture lines
  2. Well-demarcated, fluctuant swelling
  3. Most commonly occurs over Parietal Bone
  4. No overlying Skin Discoloration
  5. Appears by day 2-3 of life and may worsen over the first few days
  6. May take months to resolve completely

VI. Differential Diagnosis

  1. Cranial Meningocele (Occipital Cephalhematoma)
    1. Pulsates, and increased pressure on crying

VII. Associated Conditions

  1. Linear Skull Fracture
    1. See Skull Fracture from Birth Trauma
    2. Now rare, but previously accompanied Cephalohematoma in 5 to 20% of cases (likely related to reduced use of forceps)

IX. Radiology

  1. Indications for Skull XRay or CT Head
    1. CNS signs
    2. Large Cephalhematoma
    3. Difficult delivery
  2. Findings
    1. Tangential view of Cephalhematoma
      1. Homogenous soft tissue density
      2. Sharply demarcated convex outer border
      3. Over time border develops fine calcified rim
    2. Skull Fracture may be associated finding
      1. See Skull Fracture from Birth Trauma

X. Course

  1. Resolves over 2 weeks to 3 months
  2. Residual calcification may occur in 1% of cases

XI. Management

  1. Observation in uncomplicated cases
  2. Significant blood accumulation therapy
    1. Transfusion
    2. Phototherapy
  3. Fracture
    1. See Skull Fracture from Birth Trauma

XII. References

  1. Gabbe (1996) Obstetrics, Churchill-Livingstone, p.661-2
  2. Behrman (2000) Nelson Pediatrics, Saunders, p. 489
  3. Weintraub (2000) Otolaryngol Clin North Am 33:1171-89 [PubMed]

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