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There is a very tough tissue covering that encapsulates bones, called the periosteum. It adheres tenaciously to the outer and inner surfaces of all the bones of the body, including the skull. If you have ever boiled a soup bone long enough, you have probably noticed this covering.
A cephalohematoma is a collection of blood under the periosteum. It is almost always a complication of childbirth. It most commonly occurs when the fetal head is forced through the birth canal; the head is propelled forward while the cervix grips the scalp tenaciously. This sliding, tearing force can tear tiny veins that nourish the periosteum from the bone side. This tearing of vessles causes bleeding (hemorrhage) under the tough covering of each bony plate (the periosteum), and a tense pocket of blood collects. This is apparently a painless process.
The result is a squishy swelling with distinct borders that feels just as if there were a tiny water-filled balloon under the scalp. It is differentiated from caput succedaneum in that the caput is a more generalised and very temporary swelling of the scalp and disappears in a day or two, but the cephalohematoma becomes more distinct to see and feel over the first few days of life.
Cephalohematomas are more common with forceps delivery or vacuum extraction, and in the case of forceps delivery, can indicate the presence of a skull fracture. An underlying skull fracture is especially suspected if the cephalohematoma crosses suture lines in the skull.
The course of a newborn's uncomplicated cephalohematoma in itself is benign. The trapped blood cells break down and the component parts are reabsorbed into the system for recycling or disposal. The heme becomes bilirubin, the iron is recycled into new red blood cells. Calcium is deposited in the resolving cephalohematoma, especially around the edge where the dura mater has been lifted up. As the swelling begins to resolve, you will feel a distinct hard ridge around the edge of the swelling, with a soft, balloon-like center.
Eventually, the entire remaining mass of the cephalohematoma becomes hard and calcified, and then it too is reabsorbed and disappears. Within a few months there will be no physical or xray detectable trace of the swelling.
Obviously, there is no treatment necessary or ever warranted for an uncomplicated cephalohematoma. By no means should they ever be drained or needled, because of the risk of introducing infection into the space.
Problems related to cephalohematomas are related to underlying skull fracture or trauma to the brain. Such problems are rare. See leptomeningeal cyst.