| Caput succedaneum | |
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| Newborn Scalp bleeds | |
| Specialty | Pediatrics  |
Caput succedaneum is a benign neonatal condition involving a serosanguinous (containing blood and serum), subcutaneous, extra-periosteal fluid collection with poorly defined margins caused by the pressure on the presenting part of the fetal scalp by the vaginal walls and uterus as the infant passes through a narrowed cervix during delivery. [1]
It involves bleeding below the scalp and above the periosteum. [2]
Risk factors for development of caput succedaneum include vertex presentation, vacuum-assisted delivery, forceps-assisted delivery [3] , prolonged labor [4] , maternal nulliparity, oligohydramnios, premature rupture of membranes, and macrosomia. [5] The cause of the fluid collection is due to pressure on the fetal scalp by the vaginal walls and uterus during vaginal delivery. As one side of the infant's head is compressed during delivery, blood and lymph flow to the compressed side is obstructed. As a result, blood and lymph flow to the scalp opposite the side being compressed is unable to flow appropriately. This leads to blood and lymph accumulation, causing distension opposite the side of compression. [3]
In the setting of vacuum-assisted delivery, a cup connected to vacuum pressure is placed onto the infant's scalp and used to provide extra pulling force on the head to assist with the birthing process during difficult or prolonged labor. The pressure from the vacuum along with the pulling force leads to injury and resultant swelling. This swelling is called a chignon, an artificial caput succedaneum. [1]
Caput succedaneum typically presents as a soft, boggy, uneven mass that crosses cranial suture lines. The size of the caput is typically 1-2 cm deep with a varying circumference dependent on degree of injury. Petechiae, purpura, and ecchymoses (bruises) may also be present. Since the fluid collection is not bound by suture lines, the swelling will shift with gravity as the baby's head is repositioned. [1]
Complications are rare with development of caput succedaneum. Possible complications include scarring, jaundice from ongoing red blood cell breakdown within the fluid collection [5] , and halo scalp ring alopecia, a temporary form of alopecia resulting from prolonged pressure on the scalp during delivery. [4]
Caput succedaneum is a benign, self-limited condition with typical treatment reserved to observation of the swelling and its resolution. Medical intervention is generally not required. Parents should be reassured that the condition is self-limited and not associated with any significant complications. Most cases will self-resolve within 48 hours after birth without any significant adverse long-term effects. [5]
For infants with a large caput succedaneum that either does not resolve within 48 to 72 hours after birth or enlarges more than 24 hours after birth, imaging studies for further evaluation are indicated. [3] Imaging studies are also appropriate for infants with caput succedaneum with worsening neurological status (e.g., decreased activity, trouble feeding, increased irritability) [6] or those with signs of hemodynamic instability (e.g., low blood pressure, abnormal heart rate, blue skin color, cold skin, loss of consciousness) [7] .
Childbirth, also known as labour, parturition and delivery, is the completion of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million human births globally. In the developed countries, most deliveries occur in hospitals, while in the developing countries most are home births.
Fetal distress, also known as non-reassuring fetal status, is a condition during pregnancy or labor in which the fetus shows signs of inadequate oxygenation. Due to its imprecision, the term "fetal distress" has fallen out of use in American obstetrics. The term "non-reassuring fetal status" has largely replaced it. It is characterized by changes in fetal movement, growth, heart rate, and presence of meconium stained fluid.
Vacuum extraction (VE), also known as ventouse, is a method to assist delivery of a baby using a vacuum device. It is used in the second stage of labor if it has not progressed adequately. It may be an alternative to a forceps delivery and caesarean section. It cannot be used when the baby is in the breech position or for premature births. The use of VE is generally safe, but it can occasionally have negative effects on either the mother or the child. The term ventouse comes from the French word for "suction cup".
A cephalohematoma, also spelled cephalohaematoma, is a hemorrhage of blood between the skull and the periosteum at any age, including a newborn baby secondary to rupture of blood vessels crossing the periosteum. Because the swelling is subperiosteal, its boundaries are limited by the individual bones, in contrast to a caput succedaneum.
Neonatal jaundice is a yellowish discoloration of the white part of the eyes and skin in a newborn baby due to high bilirubin levels. Other symptoms may include excess sleepiness or poor feeding. Complications may include seizures, cerebral palsy, or kernicterus.
Omphalitis of newborn is the medical term for inflammation of the umbilical cord stump in the neonatal newborn period, most commonly attributed to a bacterial infection. Typically immediately after an infant is born, the umbilical cord is cut with a small remnant left behind. Normally the stump separates from the skin within 3–45 days after birth. A small amount of pus-like material is commonly seen at the base of the stump and can be controlled by keeping the stump open to air to dry. Certain bacteria can grow and infect the stump during this process and as a result significant redness and swelling may develop, and in some cases the infection can then spread through the umbilical vessels to the rest of the body. While currently an uncommon anatomical location for infection in the newborn in the United States, it has caused significant morbidity and mortality both historically and in areas where health care is less readily available. In general, when this type of infection is suspected or diagnosed, antibiotic treatment is given, and in cases of serious complications surgical management may be appropriate.
A chignon is a temporary swelling caused by a build-up of bloody fluid left on an infant's head after they have been delivered by vacuum extraction. A vacuum extraction is a type of assistance used during vaginal delivery by an obstetrician or midwife when the second stage of labor, where the cervix is fully dilated allowing for fetus delivery, is stalled. It anatomically resembles regular caput succedaneum, one of two most frequently occurring birth injuries to the head, the other being cephalohematoma, a usually harmless condition where blood accumulates under the newborn's scalp after vaginal delivery.
Subgaleal hemorrhage, also known as subgaleal hematoma, is bleeding in the potential space between the skull periosteum and the scalp galea aponeurosis.
Chorioamnionitis, also known as amnionitis and intra-amniotic infection (IAI), is inflammation of the fetal membranes, usually due to bacterial infection. In 2015, a National Institute of Child Health and Human Development Workshop expert panel recommended use of the term "triple I" to address the heterogeneity of this disorder. The term triple I refers to intrauterine infection or inflammation or both and is defined by strict diagnostic criteria, but this terminology has not been commonly adopted although the criteria are used.
Postterm pregnancy is when a woman has not yet delivered her baby after 42 weeks of gestation, two weeks beyond the typical 40-week duration of pregnancy. Postmature births carry risks for both the mother and the baby, including fetal malnutrition, meconium aspiration syndrome, and stillbirths. After the 42nd week of gestation, the placenta, which supplies the baby with nutrients and oxygen from the mother, starts aging and will eventually fail. Postterm pregnancy is a reason to induce labor.
A vaginal delivery is the birth of offspring in mammals through the vagina. It is the most common method of childbirth worldwide. It is considered the preferred method of delivery, as it is correlated with lower morbidity and mortality than caesarean sections (C-sections), though it is not clear whether this is causal.
In obstetrics, asynclitic birth, or asynclitism, refers to the malposition of the fetal head in the uterus relative to the birth canal. Many babies enter the pelvis in an asynclitic presentation, but in most cases, it corrects itself spontaneously during labor. Asynclitic presentation is not to be confused with a shoulder presentation, where the shoulder leads first.
Birth trauma refers to damage of the tissues and organs of a newly delivered child, often as a result of physical pressure or trauma during childbirth. It encompasses the long term consequences, often of cognitive nature, of damage to the brain or cranium. Medical study of birth trauma dates to the 16th century, and the morphological consequences of mishandled delivery are described in Renaissance-era medical literature. Birth injury occupies a unique area of concern and study in the medical canon. In ICD-10 "birth trauma" occupied 49 individual codes (P10–Р15).
Circumvallate placenta is a rare condition affecting about 1-2% of pregnancies, in which the amnion and chorion fetal membranes essentially "double back" on the fetal side around the edges of the placenta. After delivery, a circumvallate placenta has a thick ring of membranes on its fetal surface. Circumvallate placenta is a placental morphological abnormality associated with increased fetal morbidity and mortality due to the restricted availability of nutrients and oxygen to the developing fetus.
Artificial rupture of membranes (AROM), also known as an amniotomy, is performed by a midwife or obstetrician and was once thought to be an effective means to induce or accelerate labor. The membranes can be ruptured using a specialized tool, such as an amnihook or amnicot, or they may be ruptured by the proceduralist's finger. The different techniques for artificial rupture of membranes have not been extensively compared in the literature. In one study comparing amnihook versus amnicot for artificial rupture of membranes, use of an amnicot was associated with fewer neonatal scalp lacerations.
Neonatal meningitis is a serious medical condition in infants that is rapidly fatal if untreated. Meningitis, an inflammation of the meninges, the protective membranes of the central nervous system, is more common in the neonatal period than any other time in life, and is an important cause of morbidity and mortality globally. Mortality is roughly half in developing countries and ranges from 8%-12.5% in developed countries.
Prolonged labor is the inability of a woman to proceed with childbirth upon going into labor. Prolonged labor typically lasts over 20 hours for first time mothers, and over 14 hours for women that have already had children. Failure to progress can take place during two different phases; the latent phase and active phase of labor. The latent phase of labor can be emotionally tiring and cause fatigue, but it typically does not result in further problems. The active phase of labor, on the other hand, if prolonged, can result in long term complications.
Neonatal infections are infections of the neonate (newborn) acquired during prenatal development or within the first four weeks of life. Neonatal infections may be contracted by mother to child transmission, in the birth canal during childbirth, or after birth. Neonatal infections may present soon after delivery, or take several weeks to show symptoms. Some neonatal infections such as HIV, hepatitis B, and malaria do not become apparent until much later. Signs and symptoms of infection may include respiratory distress, temperature instability, irritability, poor feeding, failure to thrive, persistent crying and skin rashes.
Operative vaginal delivery, also known as assisted or instrumental vaginal delivery, is a vaginal delivery that is assisted by the use of forceps or a vacuum extractor.
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