Caput Succedaneum

Causes, incidence, and risk factors
A caput succedaneum is caused by the mechanical trauma of the initial portion of scalp pushing through a narrowed cervix. The swelling may be on any portion of the scalp, may cross the midline (as opposed to a cephalhematoma), and may be discolored because of slight bleeding in the area. There may also be molding of the head, which is common in association with a caput succedaneum.

Symptoms
Soft, puffy swelling of the scalp in a newborn infant
Swelling may or may not have some degree of bruising
Swelling may extend over the midline of the scalp
Most often seen on the portion of the head which presented first
May be associated with increased molding of the head
Signs and tests
Physical examination confirms that the swelling is a caput succedaneum. No testing is necessary.

Treatment
No treatment is necessary, and it usually heals spontaneously within a few days.

Expectations (prognosis)
Complete recovery can be expected, with the scalp regaining its normal contour.

Complications
Jaundice can result as the bruise breaks down into bilirubin.


Prevention
A caput succedaneum is more likely to form during a prolonged or difficult delivery. This is especially true after the membranes have ruptured, thus removing the protective cushion of the amniotic sac. Vacuum extraction can also increase the chances of a caput succedaneum.

However, a caput succedaneum is sometimes identified by prenatal ultrasound even before labor or delivery begins. It has been found as early as 31 weeks of gestation. More often than not, this is associated with either premature rupture of the membranes or too little amniotic fluid (oligohydramnios). All other things being equal, the longer the membranes are intact, the less likely a caput is to form.

Nevertheless, a caput succedaneum can form before or during birth even in the absence of any identifiable risk factor. Good prenatal care and management of labor and delivery can reduce the chances of this minor problem, but the formation of a caput succedaneum is often unpredictable and unavoidable.


References
Stoll, **, Kliegman, RM. Nervous System Disorders. In: Behrman, RE., Kliegman, RM, Jenson, HB, eds. Nelson Textbook of Pediatrics. 17th ed., Philadelphia, PA: Saunders; 2004:562