Four infants delivered after full-term pregnancies presented with large, diffuse, fluctuant swelling of the scalp, which was diagnosed as cephalohematoma in three and as severe caput in one. All infants had signs of hypovolemia at birth; one infant died of irreversible shock. Obstetrical instrumentation was used at birth for all infants. Figure 1 shows a computed tomogram of patient 1, and Fig 2, clinical appearance of patients 2 and 3.
Denouement and Discussion
Unrecognized Subaponeurotic Hemorrhage
At birth, the infrequent, but potentially disastrous, subaponeurotic hemorrhage may go undiagnosed. When present, this epicranial injury may be confused with the more common cephalohematoma or caput succedaneum.In each infant, a fluctuant scalp swelling that crossed suture lines was described on initial physical examination immediately after delivery. Nevertheless, neither the volume of the swelling nor its subaponeurotic location was appreciated. Instead, a diagnosis of a large caput was made in one infant and