The author - Sozinova AV practicing obstetrician-gynecologist. Experience in the specialty since 2001.
Cephalohaematoma relates to a generic injury newborn and represents a hemorrhage that is located between the bones of the skull, and the periosteum (connective tissue).
Externally cephalohematoma looks like swelling in the head.
kefalogematomy frequency is 3-5 cases per 1000 births.
The process of formation of the skin associated with kefalogematomy displacement together with the periosteum during the passage of the head of the fetus through the birth canal. When displacement occurs periosteum vessels gap arranged between it and the bone, and the bleeding portion formation - pocket filled with fluid blood.
The amount of blood in cephalohematoma varies from 5 to 150 ml. The blood remains liquid for a long time and does not clot, due to the lack of clotting factors in the newborn.
Kinds
In size subperiosteal hemorrhages are three degrees kefalogematomy:
- 1 degree - hemorrhage diameter of 4 cm or less;
- 2nd stage - kefalogematomy diameter of 4.1 - 8 cm;
- 3 degree - hemorrhage diameter of more than 8 cm (in the case of multiple cephalhaematoma estimated total area of ​​hemorrhage).
According kefalogematomy combination with other possible lesions are distinguished:
- cephalohematoma with a fractured skull;
- cephalohematoma brain damage (epidural hematoma, cerebral edema or cerebral hemorrhage);
- kefalogematomy combination with neurological manifestations (alopecia and general cerebral symptoms).
Localization hemorrhage isolated kefalogematomy parietal (the most common), the frontal, occipital (less common), and the temporal bone (a very rare localization).
Causes
The causes which lead to the formation kefalogematomy may be associated with the fetus and the mother.
On the part of the fetus:
- large fruit, diabetic fetopathy;
- incorrect position and fetal presentation (pelvic, transverse, pictorial presentation);
- fetal malformations (hydrocephalus);
- prolonged pregnancy (Too tight fetal bones do not give head configured in childbirth);
Mother's side:
- forceps or vacuum extraction fetus (now rarely used);
- mismatch fetal head and the mother pelvis sizes (anatomically and clinically narrow pelvis);
- Delayed or rapid childbirth;
- discoordination labor forces;
- exostosis of the pelvic bones, pelvis trauma history;
- the woman's age (over 35 years).
Also cephalohematoma may be hypoxic origin: entanglement or trapped by the umbilical cord at birth, the child's tongue retraction, the presence of large amounts of mucus in the airways of the fetus.
symptoms kefalogematomy
Kefalogematomy manifestations become apparent in the 2 - 3 day generic swelling subsides.
Dimensions hemorrhage from the first day of birth tend to increase, due to a deficiency of coagulation factors newborn - the blood for a long time remains liquid, so there is no possibility of blood clots zatrombirovat damaged blood vessels.
Cephalohematoma resilient to the touch, a pressure on the bleeding region can feel the movement of the liquid.
If cephalohematoma is small in size, it begins to decrease by 7 - 8 day passes without a trace. In the event of a significant size hemorrhage resorption process it can take several months. Often in kefalogematomy localization observed fracture (crack) bone.
Cephalohaematoma always has clear limits in the form of roller compacted hemorrhage circumference.
Delimitation kefalogematomy due to the coalescence of dense periosteum of the skull bones in joints, so hemorrhage is located in one bone.
Diagnostics
Differential diagnosis includes generic tumor, hemorrhage under the aponeurosis (a testovatoy consistency flat and intersects the joints), cerebral hernia (protrusion meninges through fontanelle).
Kefalogematomy diagnosis is not difficult. Examination of the head with the characteristics of 99% of the permit to establish a diagnosis.
In addition, ultrasound is used kefalogematomy, which allows you to specify its size, presence or absence of a fracture of the cranial bones or brain herniation.
Possible to use X-ray examination for suspected fracture.
kefalogematomy treatment
The treatment involved kefalogematomy neonatologist and pediatric surgeon (if indicated). For small sizes hemorrhage child prescribed calcium preparations (calcium gluconate) and vitamin K for 3 - 5 days in order to stop bleeding and stimulation of clotting factors.
Cephalhaematoma with dimensions of 8 cm or more is necessary punktirovat (puncture engaged pediatric surgeon), and suck liquid blood. Then applied compressive bandage.
Mothers need to remember that a child with cephalohematoma can not rock.
In the case of festering hematoma (fever, inflammation of the skin over the hemorrhage) should reveal it, remove the pus and blood clots. After that, drain the wound, prescribe dressings with antiseptics and antibiotics.
Inpatient uncomplicated kefalogematomy lasts 7 - 10 days, and complicated - a month or more. Later the child during the year is registered in the pediatric surgeon and a neurologist.
Complications and prognosis
Possible complications kefalogematomy:
- anemia (due to bleeding);
- jaundice (permeated the surrounding tissue to the blood breaks down bilirubin and enters the bloodstream);
- suppuration;
- ossification kefalogematomy (changing the shape of the skull).
The prognosis for children with cephalohematoma in most cases favorable.
Effects
Rarely, but cephalohematoma does not pass without leaving a trace. The following consequences:
- baby lag in speech and mental development;
- cerebral palsy;
- the appearance of neurological symptoms;
- common health problems.