Caput Succedaneum

Caput succedaneum is a neonatal birth complication involving localized swelling or edema that may be present on the newborn’s head after a vaginal delivery. The edema (swelling due to excess fluid trapped under the baby’s scalp) is usually benign resulting from the compression and pressure on the baby’s head as they pass through the birth canal.

This can occur when there is prolonged labor or if the baby’s head is stuck due to cephalopelvic disproportion, improper vacuum extractor delivery or other common birth complications. Sometimes caput succedaneum can lead to more serious birth complications, such as newborn jaundice.

Some babies with jaundice will require treatment, such as blood transfusion, phototherapy, or treatment of any underlying causes. When newborn jaundice is not diagnosed on time or properly treated, it may result in a serious neonatal birth complication known as kernicterus. This is a life threatening and permanent form of neonatal brain damage, which occurs when excess levels of bilirubin cause toxicity in the brain tissue. Babies with kernicterus may eventually develop cerebral palsy or other lifelong disabilities.

Caput succedaneum may occur before the baby’s birth (prenatal) or during delivery.

Prenatal Causes

Caput succedaneum may occur due to PROM (premature rupture of membranes) in the mother’s womb. When the amniotic sac is unable to support the head of the fetus due to rupture of membranes, it will cause more pressure on the head from the pelvic bones and fluid build-up may occur under the baby’s scalp.

Causes of Caput Succedaneum During Delivery

Caput succedaneum is swelling (edema) that affects a newborn's scalp. It most commonly occurs from pressure on the head as the baby moves through the birth canal during a prolonged or difficult vaginal delivery. In caput succedaneum (kuh-PUT sec-seh-DAY-knee-um), fluid builds underneath the scalp, causing swelling.

A vaginal delivery after prolonged labor where the baby’s head experiences significant pressure (from the vaginal wall, cervix, or uterus) is the most common cause of caput succedaneum. The typical delivery will involve pushing the baby head-first through the birth canal, which makes the baby’s head the primary pressure zone during birth.

Although caput succedaneum during delivery may develop in any baby, medical providers should be alert to the following risk factors, which increase the risk:

• Premature rupture of membranes (PROM)
• Fetal macrosomia (the baby’s head is much larger than average)
• Cephalopelvic Disproportion
• Oligohydramnios (low levels of amniotic fluid)
• Braxton Hicks contractions (false labor)
• Assisted delivery (use of vacuum extraction or forceps)

A key symptom of caput succedaneum is a soft, puffy, and swollen spot (typically 1-2 cm deep) primarily on the part of the head which first went through the birth canal. But sometimes the spot may extend to both sides of the scalp. Noticeable changes to the skin color or bruising may also be present in the affected area.

For correct diagnosis, the medical provider should be able to differentiate between the symptoms of caput succedaneum and other more serious medical conditions, such as skull fracture, brain bleeds or hydrocephalus (which also causes swelling in the baby’s head, but generally in a different area.)

The medical provider should also be mindful to distinguish caput succedaneum from newborn cephalohematoma (buildup of ruptured blood vessels in the tissue that covers the baby’s skull.) Swelling caused by caput succedaneum is subcutaneous (under the skin), while the swelling caused by cephalohematoma is within the skin tissue.

Depending on the condition, the medical provider may be able to reliably diagnose caput succedaneum as early as the first stage of labor using an ultrasound and a digital vaginal examination of the baby’s scalp. When assessing the edema on the baby’s scalp, the medical provider must note whether the swelling crosses the midline (a specifically indicative finding for caput succedaneum.)

After birth, an experienced doctor or medical provider should be able to identify a case of caput succedaneum immediately upon the baby’s birth. They will usually confirm it by performing a differential diagnosis (comparing the common symptoms of two or more conditions to determine the actual underlying cause.)

The most important part in newborn assessment for caput succedaneum is to physically examine the swelling distribution and palpate the swelling (feel with the fingers to assess the location, size, texture, consistency, and tenderness of the swelling.) When palpating the area with swelling and edema, the mass should feel boggy (soft and tender) and fluctuant (fluctuating in a wave-like motion due to the fluid-filled mass.)

According to the Academy of Neonatal Nursing recommendations, medical professionals should always compare the potential symptoms of caput succedaneum with those of newborn cephalohematoma. Making this distinction is vital because undiagnosed caput succedaneum may lead to kernicterus, while newborn cephalohematoma may lead to complications, such as anemia and blood clotting.

When medical providers fail to follow medical standards that should lead to the differentiation between caput succedaneum and cephalohematoma and a birth injury or brain injury occurs a medical malpractice lawsuit may be available for the family of the injured baby.

A majority of cases of caput succedaneum will self-resolve within 48 hours. Attempting to drain the fluid from the baby’s scalp can cause infections, so it should be avoided. All babies diagnosed with caput succedaneum should be monitored for the risk of newborn jaundice. Bruising of the skin over the swollen area may lead to increased bilirubin levels in the blood, which may cause neonatal jaundice or make it worse.

Failure to properly monitor and treat newborn jaundice may cause kernicterus, which is a dangerous and life-threatening birth complication. Kernicterus develops when excess levels of bilirubin invade the brain tissue, leading to permanent brain damage. Failure to diagnose and treat jaundice and kernicterus is one of the most common bases for a medical malpractice lawsuits arising during the neonatal time period.

Caput succedaneum is also a key indicator to show that the baby when through a stressful and difficult delivery, and their head was subjected to considerable external pressure at the time of birth. This should alert the medical provider to the possibility of a more serious brain injury, such as hypoxic-ischemic encephalopathy (HIE) resulting from oxygen deprivation, which can lead to cerebral palsy.

Parents whose children suffer from caput succedaneum related birth injuries or birth complications are entitled to answers as to the cause of their child’s injury and whether mistakes by the doctors and nurses contributed to the injury.

• Were there signs of birth injuries or birth complications during the pregnancy, labor, and delivery process, or presence of risk factors, which were either not recognized or properly treated?
• During the labor and delivery, were there clear indications that their baby was suffering from fetal distress, but appropriate actions were not taken by the obstetrician or nurses?
• Did the medical team fail to recognize a common caput succedaneum birth complication like jaundice?
• Did your baby suffer a serious brain injury as a result of kernicterus due to improper neonatal treatment?

Our national birth injury attorneys have extensive experience in this and all areas of birth injury medical malpractice. The lawyers and nurses at Miller Weisbrod Olesky will help you determine if mistakes of the medical providers caused a birth injury to your child, including Hypoxic-Ischemic Encephalopathy (HIE) or cerebral palsy.

Our award-winning birth injury attorneys have represented families all over the United States in their time of need after a birth injury. We use our experience and expertise to obtain for you and your child a medical malpractice settlement that will help provide specialized medical therapy in order to maximize the quality of life and independence of your child throughout their life.

Sometimes families are reluctant to contact a medical malpractice lawyer. It’s also not uncommon for parents to feel overwhelmed by the responsibilities they encounter in caring for their injured child and worried that they will not be able to help out in a lawsuit involving their child’s birth injury. Our birth injury attorneys and nursing staff will address these hesitations and concerns, so you can focus on your child and maximizing their care.

Most birth injury law firms will employ one or two nurses to assist the review of cases and medical research. But Miller Weisbrod Olesky offers an unmatched number of nurses and nurse-attorney employees support to both the birth injury attorneys and our clients.

Our team of registered nursing staff and nurse-attorneys bring a deep level of medical and personal insight to every client’s case. Our nursing team includes both an experienced labor and delivery nurse as well as an ICU nurse. Working closely with the rest of the team, they investigate the reasons behind a birth injury and how medical professionals breached their standard of care.

The only way to find out if you have a birth injury case is to talk to a lawyer experienced in birth injury lawsuits. It’s not uncommon that a birth related complication results in a preventable birth injury, including cerebral palsy, but it takes a detailed expert review by a birth injury attorney of the medical records from your child’s birth to determine if the birth injury was the result of medical malpractice.

At Miller Weisbrod Olesky, a team of committed lawyers, nurses and paralegals uses our detailed medical negligence case review process to assess your child’s potential birth injury case. We start by learning more about you and your child and the status of meeting/missing developmental milestones. Then we gather medical records to determine what happened before, during, and after your delivery. We call in skilled medical experts who review your records and let us know if they think medical errors could have caused your child’s injuries.

If we feel medical negligence caused or contributed to your child’s injuries, we meet with you to discuss how you can receive compensation from the medical professionals who made the errors. Our birth injury attorneys have recovered millions of dollars in settlements for families of children that have suffered a birth injury.

At no point in our legal intake process will we ask you to pay anything. The medical review of your case and the consultation are free. We only receive payment when you do.