Whats cephalohemetoma

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Cephalohematoma

A cephalohematoma is a subperiosteal collection of blood in a newborn - blood accumulates between the periosteum and the outer surface of the skull bone, caused by tearing of the diploic and/or emissary veins during mechanical birth trauma.

Anatomy - Why it doesn't cross suture lines

The periosteum is firmly attached at every suture line, so the blood collection is physically confined to a single bone. This is the single most important distinguishing feature.

Diagram showing layers of the neonatal skull and the location of cephalohematoma vs. caput succedaneum vs. subgaleal hemorrhage

(Harriet Lane Handbook, 23rd ed.)

Key Features

Feature	Detail
Location	Between periosteum and skull bone; usually over the right parietal bone
Crosses sutures?	No - strictly confined by suture lines
Cause	Rupture of diploic/emissary veins from birth trauma or vacuum extraction
Size	1-5 cm; swelling may increase for the first 12-24 hours after birth
Feel on exam	Initially firm; becomes more fluctuant after 48 hours; distinct, well-defined margins
Timing	Not apparent at birth, grows over hours; resolves over weeks
Incidence	Less than 1% of newborns

Causes / Risk Factors

Instrumental delivery (vacuum extraction, forceps)
Higher birth weight
Prolonged or difficult labor

Complications

Neonatal jaundice - the breaking down of the accumulated blood increases the bilirubin load
Skull fracture - an underlying linear fracture may be present (reported in up to 25% of cases)
Calcification - if the hematoma does not fully reabsorb, the periphery can calcify
Rarely: superinfection (if the overlying skin is breached, e.g., after fetal scalp electrode use)
Association with hemophilia - spontaneous cephalohematoma can be the presenting sign of an underlying coagulopathy

Comparison with Similar Conditions

	Caput Succedaneum	Cephalohematoma	Subgaleal Hemorrhage
Tissue layer	Subcutaneous (above aponeurosis)	Subperiosteal	Below epicranial aponeurosis
Crosses sutures	Yes	No	Yes (can be massive)
Present at birth	Yes, maximal at birth	Grows after birth	Progressive after birth
Resolution	48-72 hours	Weeks	Weeks
Severity	Minimal	Rarely severe	Can be life-threatening

(Harriet Lane Handbook, 23rd ed. - Table 18.3)

Management

Most cases resolve spontaneously - no intervention needed
Do not aspirate (increases infection risk)
Monitor bilirubin levels for jaundice
X-ray or skull US if fracture is suspected
If calcification occurs, it usually remodels over months to years; surgical removal is rarely needed
The Essentials of Forensic Medicine and Toxicology, 36th ed., p. 429
Fitzpatrick's Dermatology, Vol. 1
Harriet Lane Handbook, 23rd ed.
Rosen's Emergency Medicine

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