While the birth of a baby is always a joyous occasion, it can be heart-wrenching for parents to learn that their baby has suffered a birth injury as a result of negligence. 

In cases of cephalohematoma, that can be exactly what happened. Cephalohematoma is a pooling of blood beneath the scalp. It occurs during the baby’s birth and can be caused by medical malpractice.

What is Cephalohematoma?

The trauma of moving through the birth canal can break small blood vessels on the baby’s head. Oozing blood from damaged blood vessels under the baby’s scalp accumulates on top of the skull but under the cranial membrane to form a cephalohematoma. 

Since the bleeding is slow and the accumulation is gradual, cephalohematoma will likely not be visible at the baby’s birth. As the hours and days go by after the birth, a cephalohematoma develops.

What Causes Cephalohematoma? 

In short, cephalohematoma is caused by pressure on the baby’s head. It typically happens after a difficult or prolonged labor and delivery. When forceps or vacuum extraction is used, it is more likely that a baby will suffer cephalohematoma. 

There are several factors that increase the risk of cephalohematoma, including:

  • Long labor
  • Prolonged second stage of labor
  • Macrosomia
  • Weak or ineffective uterine contractions
  • Abnormal fetal presentation
  • Instrument-assisted delivery (forceps or vacuum extraction)
  • Multiple gestations (twins, triplets, etc.)

Any factor that increases the cranial pressure and trauma to the fetus’ head can increase the risk of cephalohematoma. 

How Common Is Cephalohematoma?

Expecting mothers or mothers of infants may want to know how common cephalohematoma can be. It occurs in 0.4 – 2.5% of all live births. 

Cephalohematoma is more common in primigravidae (women pregnant for the first time), large infants, babies that are positioned sideways or breech. It is also more common in male babies than female, although it’s not known why. 

What Are the Symptoms of Cephalohematoma?

Since cephalohematoma is not immediately apparent upon a baby’s birth, it is critical for caretakers to repeatedly inspect and feel the baby’s head in the hours and days after birth. There should be an ongoing effort to assess and document the look of a cephalohematoma, once one is observed. 

A soft, raised area on the newborn’s head is the most common sign of cephalohematoma. A firm, enlarged bulge on one or more bones below the baby’s scalp is another sign. Unlike other broken blood vessel injuries, there is usually no apparent discoloration or bruising.

Other, less common, symptoms include:

  • Anemia
  • Jaundice (yellowing of the skin)
  • Infection

If any of these signs are observed, your baby should be immediately evaluated by a medical professional. 

How Is Cephalohematoma Diagnosed?

There are no clinical diagnostic tests for cephalohematoma. Diagnosis is based on the observation of the characteristic bulge on the baby’s head. To evaluate for other cranial concerns, doctors may order tests such as:

  • X-rays
  • CT scans
  • Ultrasound

These additional tests are especially indicated if symptoms from other systems, like circulatory or respiratory, exist. 

Can Cephalohematoma Be Treated?

Treatment of cephalohematoma in infants is extremely conservative and primarily observational. Medical professionals and caretakers will observe and document any changes in the cephalohematoma as the blood is slowly re-absorbed into the baby’s bloodstream. This process occurs over time. It can take up to three months for a cephalohematoma to resolve.

Sometimes, the center of the cephalohematoma begins to shrink before the edges, leaving a crater-like bulge on the baby’s head. One should never attempt to aspirate or drain a cephalohematoma. Since the blood has already clotted, it will not drain, and inserting a needle introduces the opportunity for infection. 

What Should I Do If My Baby Has a Cephalohematoma?

First, immediately have the baby evaluated by a medical professional. Only a medical professional is qualified to exclude other, more serious, conditions that may look like cephalohematoma.