Fetal and birth trauma
Prem Puri in Newborn Surgery, 2017
Caput succedaneum is a diffuse edematous, occasionally hemorrhagic swelling of the scalp, superficial to the periosteum, occurring secondary to compression of the presenting part during prolonged labor. Usually, caput succedaneum requires no treatment, and the swelling disappears spontaneously in a week or so. Rarely, hemorrhage into soft tissue may cause anemia that requires blood transfusion or may lead to hyperbilirubinemia, or both.18
Paediatrics
Vincent Helyar, Aidan Shaw in The Final FRCR, 2017
Located beneath the outer layer of periosteum; therefore, it does not cross suture lines. Caput succedaneum is oedema/haemorrhage within the skin and therefore does cross sutures. They are seen in the setting of a traumatic delivery.
Birth Injuries, Neonatal
Tony Hollingworth in Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
About 77 per cent of cases follow an instrumental delivery. This condition is highly associated with vacuum-assisted delivery, with an incidence of 4.6 per 1000 vacuum-assisted deliveries. It appears as a boggy swelling usually at the back of the head within 12–72 hours after the delivery, and is not restricted by the suture lines. The mass may expand slowly, resulting in an ongoing blood loss. The subgaleal space is capable of holding up to 50 per cent of a newborn baby’s blood. Therefore, the baby may become progressively anaemic and hypotensive, and possibly die. This condition is associated with a high mortality rate of up to 12–14 per cent. Early recognition of this injury is crucial for survival. Cephalohaematoma is a subperiosteal collection of blood caused by the rupture of vessels beneath the periosteum. It is normally limited to the surface of one cranial bone, usually the parietal or occipital bone (Figs 1 and 3). The swelling is not visible at birth, and there is no discoloration of the overlying scalp. Occasionally it can be associated with underlying skull fracture. Most cephalohaematomas will resolve within a few weeks without any complications. Sometimes they may be calcified. Palpation of an organised cephalohaematoma gives an impression of ‘scalloping’ at the margins. Complications of cephalohaematoma include jaundice due to breakdown of haemoglobin, blood loss, deformity of the skull, infection, sepsis, and rarely osteomyelitis. Erythema, ecchymosis, cuts and abrasions or subcutaneous fat necrosis may occur following instrumental deliveries or vaginal breech delivery. Ecchymosis (subcutaneous collection of blood following rupture of small blood vessels) is common in premature babies. Cuts and abrasions may result during caesarean section due to cutting the baby with the scalpel blade. Subcutaneous fat necrosis may occur on the pressure points on the face, trunk, extremities, and buttocks. It is normally not detected at birth and may take a few days or weeks to develop.
Occiput posterior position diagnosis: vaginal examination or intrapartum sonography? A clinical review
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2014
A. Malvasi, A. Tinelli, A. Barbera, T.M. Eggebø, O.A. Mynbaev, M. Bochicchio, E. Pacella, G.C. Di Renzo
The occiput posterior (OP) position is one of the most frequent malposition during labor. During the first stage of labor, the fetal head may stay in the OP position in 30% of the cases, but of these only 5–7% remains as such at time of delivery. The diagnosis of OP position in the second stage of labor is made difficult by the presence of the caput succedaneum or scalp hair, both of which may give some problem in the identification of fetal head sutures and fontanels and their location in relationship to maternal pelvic landmarks. The capability of diagnosing a fetus in OP position by digital examination has been extremely inaccurate, whereas an ultrasound approach, transabdominal, transperineal and transvaginal, has clearly shown its superior diagnostic accuracy. This is true not only for diagnosis of malpositions, detected in both first and second stage of labor, but also in cases of marked asynclitism.
The feasibility and accuracy of ultrasound assessment in the labor room
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2019
S. Usman, M. Wilkinson, H. Barton, C. C. Lees
Objective: Vaginal examination is widely used to assess the progress of labor; however, it is subjective and poorly reproducible. We aim to assess the feasibility and accuracy of transabdominal and transperineal ultrasound compared to vaginal examination in the assessment of labor and its progress. Methods: Women were recruited as they presented for assessment of labor to a tertiary inner city maternity service. Paired vaginal and ultrasound assessments were performed in 192 women at 24–42 weeks. Fetal head position was assessed by transabdominal ultrasound defined in relation to the occiput position transformed to a 12-hour clock face; fetal head station defined as head-perineum distance by transperineal ultrasound; cervical dilatation by anterior to posterior cervical rim measurement and caput succedaneum by skin-skull distance on transperineal ultrasound. Results: Fetal head position was recorded in 99.7% (298/299) of US and 51.5% (154/299) on vaginal examination (p
Intrapartum sonography for fetal head asynclitism and transverse position: sonographic signs and comparison of diagnostic performance between transvaginal and digital examination
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2012
Antonio Malvasi, Michael Stark, Tullio Ghi, Dan Farine, Marcello Guido, Andrea Tinelli
Objective: The primary goal of this study was to determine the ultrasonographic signs of asynclitic and transverse head positioning. In addition, we compared the performance of intrapartum ultrasound to vaginal digital examination. Material & Methods: 150 women were evaluated by 2D transabdominal and translabial ultrasound (US) to detect the asynclitic and deep transverse positions. Transvaginal sterile digital examinations were performed immediately after each intrapartum US assessments, the examinations were repeated at intervals of 45–90 minutes. Examiners were blinded to each other’s findings (clinical or sonographic). Data were reviewed and analyzed by an independent reviewer. Results: The efficacy of digital examination was significantly lower than US evaluation for the detection of either transverse position or asynclitism. The most frequent transverse position was the left one, while the most frequent asynclitism was the anterior one. Conclusions: Digital pelvic examination for detection of fetal head transverse position during labor is inferior to US, especially in the deep transverse positioning, where caput succedaneum occurs and reduces the diagnostic accuracy of vaginal digital examination. The US examination leads to early detection of persistent transverse position allowing for earlier timing and optimal technique for the operative vaginal delivery. We describe two signs for diagnosing asynclitism. The “squint sign” and the “sunset of thalamus and cerebellum signs” are two simple US signs allowing detection of anterior and posterior asynclitism.
Related Knowledge Centers
- Hematoma
- Tourniquet
- Periosteum
- Scalp
- Subcutaneous
- Head
- Subgaleal Hemorrhage