Пт, 27 окт 2017 Автор: врач терапевт ЕленаKornilov
Childbirth, being a natural process, often leads
to injuries to the mother and child. A child passing through the birth canal
overcomes strong bone resistance in the presence of the mother
narrow pelvis. At the same time, the development of cefalohematoma is possible – between
the bone of the newborn’s skull and the periosteum accumulates
blood.
According to statistics, cephalohematoma occurs with a frequency of: 2 per 100
childbirth. This is considered to be the most commonly encountered generic
injury.
Contents
Education cefalohematoma
Anatomically, the periosteum is a thin plate consisting of
connective tissue. It is attached to the bone strictly on its edge.
Therefore, cefalohematoma does not exceed the limits of one bone of the skull:
frontal, occipital, temporal, parietal. During childbirth may occur
several such hematomas – but within different bones. At the same time
two cephalohematomas do not appear above one of the bones of the skull.
This hemorrhage is diagnosed 24-48 hours after
of birth. Looks like a soft – elastic swelling on the parietal
(much less often – on the occipital or frontal) bones. Palpation
there is a transfusion of fluid. Education can be painful and
cause a negative reaction of the child due to arising under it
bone fracture. If this does not happen – the pain does not appear.
The skin over the formation is not changed. KefaloHematome sizes
vary:
• up to 4cm – first degree;
• 4.1 – 8 cm – second degree;
• more than 8cm – 3 degree.
Hemorrhage can reach 20 cm. If there are several –
summarizes the entire joint area. One hematoma contains from 5 to
200 ml of blood, which due to the lack of clotting factors in
newborns do not fold for a long time. In this regard, on
During the first days of education may increase.
Cephalohematomas, as mentioned, may be followed.
tissue damage.
These include:
• fractures of the skull bones;
• cerebral edema, cerebral hemorrhage.
Such complications, according to statistics, are observed in 5 newborns
out of 1000.
Cefalohematoma in the newborn – causes
Cefalohematoma occurs in the generic process, when, overcoming
pelvic resistance, cranial bones, skin
moves, vessels are damaged.
The reasons for it may be different. From the side
mothers:
• narrow pelvis;
• maternity allowance with traumatic medical
tools (forceps or vacuum extractor);
• fast or prolonged labor;
• age after 35 years;
• first birth.
Causes of newborn cefalohematoma:
• large weight (more than 4 kg);
• pathological presentation;
• malformations of organs (hydrocephalus);
• pregnancy more than 40 weeks (bone consolidation occurs
fetus, making it difficult to change
childbirth);
• increased bleeding (hemophilia).
Rare causes of cefalohematoma
newborn:
• entanglement with umbilical cord, recession of the tongue, leading to hypoxia
fetus;
• aspiration of amniotic fluid.
Differential diagnostics
When detecting cephalohematoma, despite the simple process
diagnostics, differentiate with:
• aponeurotic hemorrhage;
• generic tumor;
• brain hernia.
Hemorrhage under aponeurosis has no clear boundaries, may
spread to the area of several bones at once, more dense
to the touch.
A generic tumor is, in fact, edema of the subcutaneous tissue.
May occupy an area of more than one bone, without
clear boundaries, with a jelly-like consistency, passes over 3 days.
Hernia is a protrusion of the meninges (and in some cases
– and brain tissue) through the seams of the skull or fontanel.
Cefalohematoma in the newborn – consequences
The prognosis for this pathology is favorable: cefalohematoma does not
affects the development of the child and his intellect.
The consequences that may arise from
newborn:
• ossification;
• anemia;
• jaundice;
• suppuration.
Ossification
One week after birth, hematoma grows at the site
плотной connective tissue. As a result, the bone is deformed.
skull, because the formed tissue has a high density. But
it is only a cosmetic defect that does not affect
health status. It will be completely invisible in an adult.
person
Anemia
If the hematoma is large or if there are several
formations may develop post-hemorrhagic anemia. It’s related
with a small amount of blood in the newborn, which significantly
any loss is reflected. Treatment for such anemia is not carried out: as
typically, hemoglobin recovers to normal over time without
taking special drugs.
With the breakdown of red blood cells hemolytic anemia develops with
its external manifestation in the form of jaundice.
Jaundice
In cases where cefalohematoma is huge and
quickly absorbed – the decomposition of red blood cells. Level
blood bilirubin increases, hemolytic anemia develops.
Since the metabolic processes are slow, for some time the skin
integuments and mucous membranes have a slight icteric staining. Special
therapy in such cases is not assigned, the state is normalized
on their own.
Suppuration
One of the rare but terrible complications is suppuration, which
occurs when damage to the integrity of the hematoma and its infection.
It is dangerous because the inflammatory process can go to the tissue
the brain. If suppuration has occurred, the condition of the newborn
worsens: body temperature, the child becomes sluggish and
restless. The skin over the hematoma becomes inflamed, becomes red,
edematous, painful. Palpation вызывает беспокойство и
cry.
If such a complication develops, an emergency
operation: opening, drainage, later – course
anti-inflammatory topical therapy. With timely detection
pathology everything goes without consequences for the health of the child.
What to do when newborn cefalohematome
Cefalohematoma, if its integrity is not compromised, threats to
Health and life of the newborn does not represent. It is believed that
hematoma size of 8 cm does not require medical intervention itself
resolves over time.
Therapeutic treatment
In the presence of such a hematoma, the pediatrician may prescribe vitamins.
(vitamin K) to strengthen the walls of blood vessels and reduce
bleeding and calcium supplements. Sometimes for local
application attributed to Troxevasin – gel. It is allowed for
application to the newborn, applied to the scalp twice in
day.
Puncture
For sizes larger than 8 cm, puncture is performed;
sucked away, in place puncture superimposed tight, crushing
bandage. Observe the child pediatric surgeon and neonatologist. Puncture
проводится на 10 – 20 day. To puncture there is another
indication: no cephalhematoma size reduction to 10
day.
Some experts advise puncturing the hematoma after
childbirth, without waiting for complications. There is no consensus on this.
The question of therapeutic tactics is solved individually. Puncture
still needed by strict indications. If you can do without
it is better to refrain from unnecessary intervention. But и
You can not refuse it if the need is justified.
Carrying out a puncture will prevent the development of serious complications in
form of suppuration.
Excision
If necessary, the ossified hematoma is also treated.
surgically – excision of the ossified part is performed,
after which the edges of the wound are sutured.
Every mom needs to know:
• it is impossible to rock a child with a hematoma up to 6 months – this is
slows down the resorption process;
• bathe the baby very carefully to prevent damage
skin and its infection;
• if necessary, surgery from surgery is not
refuse – it is safe;
• in case of available indications for caesarean section
It is necessary to leave the choice of management of labor for the doctor and
agree.
Completely eliminate the formation of cefalohematoma in labor
is impossible. But сделать так, чтобы ребёнок правильно развивался
intrauterine and born healthy, according to the strength of any woman. For this
you need to eat right, take vitamins for pregnant women,
give up bad habits, rest and sleep, a lot
to walk outside. If these conditions are met, the child will
well developed, and the generic process will take place without complications.
