Caput succedaneum

Commonly observed after prolonged labor

Secondary to accumulation of blood or serum above the periosteum

Clinical features: poorly demarcated soft tissue swelling that crosses suture lines; accompanying pitting edema and overlying petechiae, ecchymoses and purpura

Treatment: none needed because condition usually resolves within days

Cephalhematoma

Less common than caput succedaneum but may occur after prolonged labor and instrumentation

Secondary to rupture of blood vessels that traverse skull to periosteum

Clinical features: well-demarcated, often fluctuant swelling that does not cross suture lines; no overlying skin discoloration; possibly, skull fractures; sometimes, elevated ridge of organizing tissue

Complications: intracranial hemorrhage with resultant shock; hyperbilirubinemia

Treatment: none recommended for uncomplicated lesions, which usually reabsorb in 2 weeks to 3 months; for suspected or detected fracture, radiographs again at 4 to 6 weeks to ensure closure of linear fractures and to exclude formation of leptomeningeal cysts, which can be detected by radiography (if there is doubt, cranial computed tomographic scanning can be helpful)3; for depressed skull fractures, immediate neurosurgical consultation