Despite modern medicine, childbirth injuries are not uncommon. Unfortunately, some of the applications of modern medicine can directly correlate to the incidence of a birth injury. Such is common with a condition like caput succedaneum.
What is Caput Succedaneum?
Caput succedaneum is a type of injury called an edema. Edema is essentially swelling caused by an excess of fluid in a certain area of the body. Specifically, caput succedaneum occurs on the head or scalp of a newborn only a short period after birth. It can more generically be referred to as the severe swelling of an infant’s skull.
Caput succedaneum during childbirth has one frequently seen risk factor. If a woman is experiencing prolonged labor, the chance of having a succedaneum increases. Prolonged labor, specifically the prolonged second stage of labor, is classified depending on whether they have given birth previously or not. If the woman has gone through delivery before, when there is no dilation after three hours of anesthetics or two hours without the use of anesthetics it is considered prolonged. However, for first-time deliveries, if no dilation is present after one hour with anesthetics or two hours without anesthetics, the birth may be classified as prolonged. After that period of time, physicians may need to proceed with operative vaginal delivery1.
Causes of Caput Succedaneum in Childbirth
The most common cause of caput succedaneum occurs during operative vaginal delivery. Operative vaginal delivery refers to the process of using tools to assist in delivery. Such tools often include vacuum machinery and forceps.
Vacuum delivery, also referred to as ventouse-assisted delivery, is a type of assisted delivery that uses a suction cup-like technology to extract a baby safely. Such tools may be used when a mother’s effort to push or bear down would be risky. The procedure begins by attaching the plastic cup of the vacuum device onto the baby’s head. They can then use the pump to generate suction force to help guide the baby through the birth canal. This prevents the baby’s head from moving back up the birth canal between the mother’s contractions. The suction pressure created by the plastic cup on the baby’s head could cause excess fluid to build up under the scalp of the baby, especially if misapplied2.
A similar assisted delivery procedure involves forceps for extraction. This is similar to a vacuum extraction. However, instead of attaching a suction cup to the head of the baby, a doctor will use forceps to grasp the sides of the baby’s head. Forceps are a type of spoon-shaped tong that gently hold the baby’s head. This helps the physician pull and guide out the baby as you push through contractions. Again, this could cause swelling and fluid buildup on the baby’s scalp when misapplied3.
Though the most common causes of caput succedaneum occur from the assisted delivery process, other causes might be more natural. For example, there could be a premature rupture of the amniotic sac prior to labor. This is known as the mother’s water breaking prior to active labor. This can lead to a variety of complications, including caput succedaneum, due to the lack of protection to the baby.
Symptoms of Caput Succedaneum
The symptoms of caput succedaneum are typically noticeable within the first few minutes after delivery. The first and most recognizable symptom of caput succedaneum is when the baby is born with a conehead like appearance of the head. This conehead appearance is possible because the individual bones that make up the skull are not fused together yet in a newborn’s head. The excess pressure from the vacuum or forceps, or due to the squeezing out of the birth canal, may lead to this appearance. The misshapen head of a newborn with caput succedaneum typically rounds out after birth, and there are treatments to help round out the head if it doesn’t occur naturally.
Other signs and symptoms of caput succedaneum include puffiness and tenderness under the scalp. This is due to excess fluids at the area of incidence. Similarly, swelling is common due to this as well.
Finally, you may notice bruising or color alterations on the scalp itself. This is due, once again, to the pressure put on the head of the baby during delivery. The baby may also display signs of discomfort such as excess crying, as the condition may cause pain.
Caput succedaneum is typically temporary and resolves on itself within a few days post-delivery. It’s important to note that caput succedaneum may lead to jaundice, or the yellowing of the skin and eyes due to excess bilirubin in the blood, which should be treated medically with phototherapy4.
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