Caput Succedaneum
Overview
Caput succedaneum describes oedema of the scalp resulting in a swelling at the presenting part of the head with poorly-defined margins that spreads over the suture lines and the midline. It is typically present at birth.
It is common after prolonged labour or secondary to the use of ventouse delivery.
Management
Caput succedaneum does not require any treatment and usually resolves within a few days.
Cephalohaematoma
Overview
A cephalohaematoma describes a collection of blood (a haematoma) between the skull and periosteum and presents as a swelling on the neonate’s head. It is due to the damage of the blood vessels crossing the periosteum, which is usually caused by traumatic, prolonged, or instrumental delivery.
In contrast to caput succedaneum, it is usually seen a few hours after birth and the swelling does not cross the suture lines of the skull.
Management
Cephalohaematoma usually resolves within a few months, however, anaemia may develop if the cephalohaematoma is severe, and jaundice may develop as blood is broken down and bilirubin is released.
Chignon
Overview
A chignon is a temporary swelling that is seen after a ventouse suction cap has been used for delivery. This usually resolves within 48 hours.
Brachial Plexus Injury
Overview
Stretching of the cervical nerve roots during delivery can result in brachial plexus injuries. Risk factors include:
- Macrosomia
- Shoulder dystocia
- Breech position
- Traumatic, difficult, or instrumental delivery
- Multiparity
Erb’s palsy is more commonly seen than Klumpke’s paralysis.
Erb’s palsy
- Due to damage to C5-C6
- Arm held in “waiter’s tip” position – adducted and internally rotated with the forearm pronated, with the hand and wrist flexed
Klumpke’s paralysis
- Due to damage to C8-T1
- Weak intrinsic hand muscles
- Associated with Horner’s syndrome if T1 damage occurs
Management
Most brachial plexus injuries are stretch injuries and resolve spontaneously within a few months with conservative management and sometimes physiotherapy. Severe brachial plexus injuries can lead to lasting weakness and may require neurosurgical input.
Fractured Clavicle
Overview
Fractured clavicles are the most common bone fracture during delivery. Risk factors include:
- Shoulder dystocia
- Macrosomia
- Traumatic, difficult, or instrumental delivery
Features include:
- Reduced movement or apparent paralysis in the affected arm
- Asymmetric shoulders – the affected shoulder is lower down
- Pain and distress when moving the affected arm
Management
A fractured clavicle is confirmed using an X-ray and management is conservative with the use of immobilisation. Other injuries should be sought.
Facial Nerve Injury
Overview
Overstretching of the facial nerve may lead to facial nerve palsy, characterised by an asymmetrical face when crying and drooping on the affected side.
Most cases recover within a few weeks to months in most infants, however, if there is no improvement after 7-10 days, further assessment is required as complete nerve transection may have occurred.
