II. Epidemiology
- Incidence: 0.2 to 2.5% of live births
III. Causes
- Prolonged labor
- Instrumented delivery (e.g. forceps)
IV. Pathophysiology
- Rupture of blood vessels between skull and periosteum
- Results in subperiosteal blood collection
- Bleeding limited by Suture lines
V. Signs
- Cephalhematoma does not cross Suture lines
- Well-demarcated, fluctuant swelling
- Most commonly occurs over Parietal Bone
- No overlying Skin Discoloration
- Appears by day 2-3 of life and may worsen over the first few days
- May take months to resolve completely
VI. Differential Diagnosis
- Cranial Meningocele (Occipital Cephalhematoma)
- Pulsates, and increased pressure on crying
VII. Associated Conditions
- Linear Skull Fracture
- See Skull Fracture from Birth Trauma
- Now rare, but previously accompanied Cephalohematoma in 5 to 20% of cases (likely related to reduced use of forceps)
VIII. Complications of severe Cephalhematoma
IX. Radiology
- Indications for Skull XRay or CT Head
- CNS signs
- Large Cephalhematoma
- Difficult delivery
- Findings
- Tangential view of Cephalhematoma
- Homogenous soft tissue density
- Sharply demarcated convex outer border
- Over time border develops fine calcified rim
- Skull Fracture may be associated finding
- Tangential view of Cephalhematoma
X. Course
- Resolves over 2 weeks to 3 months
- Residual calcification may occur in 1% of cases
XI. Management
- Observation in uncomplicated cases
- Significant blood accumulation therapy
- Transfusion
- Phototherapy
- Fracture
XII. References
- Gabbe (1996) Obstetrics, Churchill-Livingstone, p.661-2
- Behrman (2000) Nelson Pediatrics, Saunders, p. 489
- Weintraub (2000) Otolaryngol Clin North Am 33:1171-89 [PubMed]