Cephalohematoma is a type of birth injury to the head usually caused by the use of certain tools to assist with delivery. It affects about 2 out of every 100 babies born each year. It usually clears up in a few weeks.
Our law firm handles birth injury cases around the country. The child in many of these lawsuits had a cephalohematoma. But in the vast majority of cases, a cephalohematoma is a benign injury that quickly resolves.What Is Cephalohematoma?
A cephalohematoma is an abnormal accumulation or pooling of blood in the area between the baby's skull and the skin of the scalp. Cephalohematoma is the collection of blood under the skin but above the bones of the skull.
This collection of blood is derived from one suture to another, which is where the layers and the skin that covers the skull are attached. This characterizes a venous or a collection of blood from the venous system. There is another kind of hematoma that is deeper and is rooted in the arterial system. But this hematoma is not a cephalohematoma.
A cephalohematoma is caused by excessive pressure on a baby's skull during delivery resulting in a rupture of the small blood vessels and capillaries that cross a baby's head underneath the scalp. The pressure or force on the baby's head causing these small blood vessels to rupture can occur in several ways.
For example, if the fetal head is too large for the birth canal or it gets pressed against the mother's pelvis. A prolonged second stage of labor can also cause excessive pressure on the head. However, a cephalohematoma is most frequently caused by the use of birth assistance devices such as forceps and vacuum extractors.
- Obstetric Forceps: forceps are a tool for assisting with vaginal deliveries. Obstetric forceps look like a pair of hinged spoons. The spoons of the forceps are designed to fit into the birth canal and cup around the head of the baby to aid in delivery. The use of forceps in vaginal delivery requires a very high level of skill and training on the part of the obstetrician.
- Vacuum Extractor: a vacuum extractor has a special suction cup with a handle attached to a vacuum pump. The cup is fitted over the baby's head and sealed using the vacuum pump. Once attached to the baby's head the doctor uses the handle to maneuver the baby through the birth canal. Effective use of the vacuum requires far less care and skill on the part of the doctor.
If used correctly and with the appropriate level of skill and care, forceps and vacuum extractors can be perfectly safe delivery tools. However, when these instruments are not used correctly they can easily result in excessive head pressure and cause injuries such as a cephalohematoma.Does Cephalohematoma Cause Jaundice?
A cephalohematoma can cause jaundice. Abnormally high levels of bilirubin in the blood cause jaundice. A cephalohematoma causes infant jaundice because the pooling of the blood in the head lowers the baby's red blood cell levels.
Babies born with a cephalohematoma are always are a higher risk for developing jaundice and their jaundice may be harder to treat. Still, like a cephalohematoma itself, jaundice is typically very treatable. But in extreme cases, neonatal jaundice can cause kernicterus and brain damage.Can Cephalohematoma Cause Death?
Cephalohematoma itself is not a life-threatening condition. If not properly managed, however, this brain bleed can lead to other serious health conditions including brain damage and death.
When cephalohematoma is not properly managed, it can lead to complications. In rare cases, a cephalohematoma can lead to serious infection. If the blood accumulation is drained the risk of infection increases dramatically and can result in a very dangerous bone infection in the skull.
A more common complication from cephalohematoma is anemia. Anemia is a condition in which the body does not have enough healthy red blood cells. The loss of blood from infant cephalohematoma can frequently lower a baby's red blood cell counts.
If a baby becomes severely anemic they will be unable to deliver adequate levels of oxygen to their organs and must be treated immediately.
Cephalohematoma is usually a minor condition and babies are sent home after delivery. The healing time for cephalohematoma is usually a few weeks, by which time the blood mass should disappear.Are There Different Types of Cephalohematoma?
There are not "different types" of cephalohematoma. However, there are other types of blood-related swelling or "brain bleeds" in the head after birth that are similar to cephalohematoma but with different names. These include caput succedaneum and subgaleal hematoma.
There usually is no course of treatment for cephalohematoma and management is limited to observation. The normal healing time for cephalohematoma is several weeks. So while there is no active cephalohematoma treatment, the doctors should monitor carefully for complications such as jaundice and anemia.
Cephalohematoma and caput succedaneum are both typically benign brain bleeds but they are important differences between the two. Caput succedaneum is also a swelling of the baby's head caused by trauma during the birth process. It differs from cephalohematoma in that a caput succedaneum is edema (swelling caused by fluids) and a cephalohematoma is like a blood clot where the swelling is caused by ruptured blood vessels.
How do doctors know the difference? CT scan is excellent means of diagnosing and differentiating between cephalohematoma and subgaleal hemorrhage. Both are readily apparent on CT and differentiated based upon their relationship to the bony sutures. While hemorrhage associated with a cephalohematoma is confined by these sutures, hemorrhage within the subgaleal space is not.
The caput vs. cephalohematoma question is very common and the subject of confusion.Cephalohematoma Settlements and Verdicts
You do not see a large number of cephalohematoma birth injury cases because this injury usually does not cause real harm and the healing time is typically measured in days or weeks.
But like any birth injury case, the settlement value of the average cephalohematoma lawsuit is quite high if there is a birth injury. Often, cephalohematoma is a co-traveler with another more serious complications.
The settlements and verdicts summarized below are from cases in which cephalohematoma was listed as one of the primary birth injuries.
- Harker v. Chan (Pennsylvania 2018) $47 Million Verdict: A newborn girl is diagnosed with cephalohematoma based on a CT scan. As we say above, a CT scan is very good at making this diagnosis. The doctor treats the child as having a probable subgaleal hematoma and wraps her head with a bandage. No other doctor treats children with a suspected subgaleal hematoma this way. The doctor ignores signs the child is suffering tissue damage from the bandage. Plaintiff files a lawsuit alleging that child was treated for a subgaleal hemorrhage even without evidence that the child had one. But even if the child had a subgaleal hemorrhage, the standard of care is to close observation with serial blood counts and blood transfusions if necessary. The child has permanent partial baldness and a deformed head. The jury awarded $43.7 million in pain and suffering damages and $3.3 million in future medical expenses.
- Barretto v. St. Luke's Hosp. (New York 2016) $575,000 Settlement: The doctors and hospital were accused of negligently failing to diagnose and deal with shoulder dystocia and fetal macrosomia during the birth process resulting in and stressful vaginal delivery with excessive head pressure. The baby suffered birth injuries including brain damage, hypoxia, and cephalohematoma. A structured settlement was reached for $575,000.
- A.B. Pro Ami v. Sherwin (New York 2015) $1.7 Million Verdict: Doctors made 3 forceful attempts at vaginal delivery with the use of a vacuum extractor. Plaintiff alleged that the vacuum extractor was negligently used causing bay to suffer a cephalohematoma and bruising which led to significant neurologic damage with permanent speech and language problems. A jury in Suffolk County found that doctor's use of the vacuum was negligent and awarded $1.7 million in damages.
If your baby was born with cephalohematoma or another type of birth injury contact the birth injury attorneys at Miller & Zois today at 800-553-8082 for a free case evaluation. We will obtain all the relevant medical records, confer with medical experts and determine whether or not you have a potential malpractice case. You can also get a free online case evaluation.