Medical Malpractice
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. If you are reading this and concerned about your child, the overwhelming likelihood is that it will amount to nothing. But you want to be informed and you want to communicate with your child’s doctors.
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.
Cephalohematoma Causes
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.
Cephalohematoma Treatment
In most cases, cephalohematoma usually resolves on its own within a relatively short period of time as the body reabsorbs the blood clot naturally. For that reason, treatment is typically limited to observation to ensure that the condition does not trigger any complications. In rare cases, surgical intervention may be necessary in order to remove blood clots or drain excess blood.
Cephalohematoma Healing Time
Cephalohematomas usually take at least a month or two to resolve on their own as the body absorbs the blood clot. During this time, the baby’s doctor should carefully monitor for signs of complications.
Does Cephalohematoma Cause Jaundice?
A cephalohematoma can cause jaundice. Abnormally high levels of bilirubin in the blood cause jaundice.
The connection between cephalohematoma and jaundice is due to the breakdown of red blood cells within the accumulated blood. As these cells break down, they release bilirubin, a yellow pigment. Normally, bilirubin is processed by the liver and excreted. However, the large amount of bilirubin produced from the breakdown of the red blood cells in a cephalohematoma can overwhelm the newborn’s still-maturing liver, leading to higher bilirubin levels in the blood, a condition known as hyperbilirubinemia. When bilirubin levels are high, it leads to jaundice, which is characterized by yellowing of the skin and the whites of the eyes.
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.
One such complication is the risk of jaundice, which we just mentioned. Additionally, if a cephalohematoma becomes infected, it could potentially lead to more serious complications, including osteomyelitis (infection of the bone) or sepsis, both of which could be life-threatening if not treated promptly.
Anemia is also a concern. 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.
In most cases, careful monitoring and appropriate medical care help prevent serious outcomes related to cephalohematoma.
How Long Does a Cephalohematoma Last?
A cephalohematoma usually resolves on its own over a period that can range from a few weeks to a few months. Initially, during the first few weeks, the swelling might appear more pronounced as it reaches its peak.
Over time, usually within several weeks to a few months, the body gradually reabsorbs the accumulated blood, leading to a decrease in swelling and the flattening of the affected area. In most cases, a cephalohematoma completely resolves within three months, although the exact duration will vary depending on the size of the cephalohematoma and the individual’s healing process.
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.
What Is the Treatment for a Cephalohematoma?
There usually is no course of treatment for cephalohematoma and management is limited to observation. The normal healing time for cephalohematoma is several weeks. Needle aspiration is an option for particularly large cephalohematoma.
Cephalohematoma vs. Caput Succedaneum
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 birth injuries.
- S.K. v. Mercy Hospital (Iowa 2022): $97 Million Verdict: A minor, S.K., sustained severe brain damage during childbirth at Mercy Hospital in Iowa City, resulting in permanent disabilities requiring lifelong care. The lawsuit alleged that after the mother was administered an epidural, resulting in hypotension and fetal distress, the nursing staff failed to inform the attending obstetrician and did not advocate for an earlier delivery. The obstetrician used forceps and a vacuum during delivery, causing skull fractures, indentations, and cephalohematoma. S.K. was delivered in respiratory distress with multiple severe conditions, including subarachnoid and subdural hemorrhages, cephalohematoma, and numerous seizures. The plaintiff argued that the medical team should have performed an emergency C-section instead of continuing with vaginal delivery. The jury found the hospital and the obstetrician’s practice equally negligent, resulting in the largest medical malpractice verdict in Iowa’s history. Damages awarded included $43.5 million for pain and suffering, $42.2 million for future medical expenses, and $11.7 million for future lost wages.
- 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.
Contact Miller & Zois About Cephalohematoma Birth Injuries
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.