Obstetrics and Gynecology - A.M. Gromova 2000

Neonatal Diseases
Birth Injuries of the Newborn
Soft Tissue Birth Trauma

Caput succedaneum refers to soft tissue injury of the fetal presenting part, characterized by edema and occasionally hematoma. It most frequently occurs on the fetal HEAD in the parietal and occipital regions; the edema may extend across cranial suture lines. When other fetal parts present, the caput succedaneum develops accordingly on the face, buttocks, or Perineum. In facial presentation, it is located in the region of the forehead, orbits, and Mouth, sometimes accompanied by marked conjunctival and labial mucosal edema, petechial hemorrhages, and potentially concurrent traumatic Brain injury. Edema of the Lips impairs suckling, necessitating tube feeding.

In breech presentation, the caput succedaneum forms in the genital region (Labia Majora and minora in female infants, and the Scrotum and Testes in male infants). Hemorrhage into the scrotum and testes may be accompanied by painful Shock.

Cephalohematoma (subperiosteal hemorrhage) is a hematoma formed beneath the periosteum On the surface of a cranial bone. The overlying Skin is unchanged and mobile, and examination reveals an elastic, fluid-filled Swelling that slightly increases in size During the first few days of life. Unlike caput succedaneum, the swelling is strictly limited by the BOUNDARIES OF THE affected bone and has distinct margins.

Small caput succedaneums require no Treatment and resolve spontaneously by the 2nd to 3rd day of life. For large lesions, cold compresses are applied locally, along with hemostatic agents (calcium chloride, vikasol, rutin). For cephalohematomas, needle aspiration of the Blood is performed followed by the application of a pressure bandage.

Suppuration of the hematoma may occur as a complication; in such cases, wide incision and drainage are performed, followed by standard management of an abscess.

Injuries to the skin and subcutaneous tissue result from compression and are localized to areas where fetal tissue is pressed against the maternal bony pelvis, as well as sites of application of obstetric or scalp traction forceps. Damaged skin areas are treated with a 0.5% alcoholic iodine solution, and a dry aseptic dressing is applied. If hemorrhagic blisters form, ointment dressings with 1% synthomycin emulsion and antibacterial therapy are indicated.