Birth Injuries

Scalp Swelling (Caput Succedaneum)

Caput succedaneum is a swelling (fluid accumulation) in the presenting part of the scalp during head-first deliveries. It occurs due to pressure from the uterus or birth canal on the baby's head during delivery.

Causes:

• Large fetal size.
• Disproportion between the fetal head and the mother’s pelvis, leading to prolonged head engagement.
• Difficult labor and the use of delivery instruments (forceps or vacuum extraction).

Symptoms:

• A soft, swollen area on the scalp that crosses the skull's suture lines, appearing immediately after birth.

Nurse’s Role:

• Explain the cause of the swelling and reassure the parents.
• Monitor the swelling, which usually resolves within a few days without intervention.

Subgaleal Hematoma (Cephalhematoma)

Cephalhematoma is a blood collection under the last layer of the scalp, directly above the skull bones, caused by the rupture of blood vessels due to difficult labor.

Symptoms:

• A raised area under the scalp that does not cross the suture lines, appearing hours to days after birth.

Treatment:

• The hematoma typically resolves on its own within two weeks to three months.
• Blood transfusion may be needed in cases of severe anemia or shock.
• If jaundice develops, phototherapy or an exchange transfusion may be required, depending on bilirubin levels.

Nurse’s Role:

• Explain the condition to the parents and reassure them.
• Measure and document head circumference daily.
• Notify the doctor immediately if the newborn shows paleness, jaundice, or an increase in head circumference.

Important Note: Never attempt to aspirate or drain the hematoma, as it could lead to septicemia (blood infection).

Intracranial Hemorrhage (Brain Bleeding)

Intracranial hemorrhage occurs in 20-40% of preterm infants weighing less than 1500 grams, while its incidence is lower in full-term babies.

Symptoms:

• Shock symptoms (significant blood loss).
• Pallor.
• Respiratory distress.
• Jaundice.
• Signs of neurological dysfunction.
• Bulging anterior fontanelle.
• Muscle weakness.
• Seizures.
• Unstable body temperature.
• Apnea (breathing pauses).

Required Tests and Investigations:

• Bleeding and clotting time, hemoglobin levels.
• Cranial ultrasound.
• CT scan of the brain.

Nurse’s Role:

• Avoid unnecessary movement of the newborn.
• Administer intravenous fluids and blood products (albumin, plasma, or whole blood) as per the doctor’s instructions.
• Provide vitamin K and plasma if coagulation abnormalities are detected.
• Monitor and manage jaundice with phototherapy if needed.
• Observe for seizures and report them immediately to the physician.