CAPUT SUCCEDANELTAI Swellings occurring on the presenting part, as the result of com pression, are constant sequehe of parturition.
The presenting part, during its passage, is tightly squeezed by the soft parts, especially by the pelvic diaphragm (Stumpf) and the external os of the uterus; this ligature of the presenting part causes disturbance in the circulation of blood and lymph, and thereby a stasis arises, with outpouring of blood and serum into the tissues. The whole of the child's body except the part in front of the ligature is under an increased pressure, possibly thus producing suction on the presenting part. When the vertex presents, there is a swelling of a doughy con sistency, brought about by oedema of the soft parts, usually over one parietal bone and in fact usually over its hinder portion or else over the upper part of the tabular portion of the occipital bone. This con sists of a sero-lucinorrhagic infiltration of all the tissues, the greater part of the transudation being between the galea and the periosteum (Lonnberg). Countless small 'hemorrhages are always present in the tissues, likewise in the periosteum; at times there is hypertumia of the substance of the bone and even of the meninges beneath the swelling. In cases where the labor is of short duration the swellings are only slightly developed. The factors determining the size of a caput succe daneum are the size of the foetal head, the dimensions of the maternal pelvis and the duration of the labor. A caput succedaneum can hardly be confused with a eephaltumatoma, as the former is not limited by the suture bones; it is also, as a rule, more diffuse and pits on pressure with the finger.
With breech presentations there exists a swelling of the scrotum and penis, or, in the female, of the labia or Pates. This swelling is also not entirely made up of serous effusion but contains many small hremor rhages.
Birth-swellings occur in a similar manner on the face or on the extremities, if these are the presenting parts.
CEPHALiEMITOMA Hreinorrhage under the galea, aponeurotica in the newborn was given this name by Naegele.
Cephalrematomata occasionally develop during labor, usually, however, some time after birth as a consequence of subperito-osteal 'hemorrhage. They usually develop between the second and fourth
day of life, rarely as late as the second week.
Cephalrematomata were encountered 99 times in 20,000 births at the Munich Lying-in Hospital (F. Beck). They have their seat of predilection over the parietal bone, are usually unilateral and are moreover on the right side in the majority of instances. They occur at times over both parietal bones or over other cranial such as the frontal, occipital and temporal; occasionally several subperiosteal hrumatomata are found in the same child.
On examination, a rounded mass, varying in its degree of convexity, is found over the diseased bone; the skin over the tumor is movable and either normal or, in the first days of life, edematous. At times there are 'hemorrhages or pressure marks.
During the first days the skin is usually tense; this tension, how ever, gradually diminishes and the tumor shows distinct fluctuation. It occupies a larger or smaller part of the parietal bone but nerer over steps the boundaries set by the sutures of the bone; inasmuch as the peri osteum is especially adherent at the sutures, the extravasated blood is unable to separate the pericranium from the bone at these points. The swelling varies in size from that of a nut to that of a goose egg and larger. It grows during the first clays after birth, attaining its maxi mum at the end of the first week.
On palpating the tumor, by passing the finger over it from periph ery to dome, the impression of a groove or defect in the cranium can be felt. This impression comes from the tumor being surrounded by a hard wall-like ring of newly-formed bony tissue. In its further course the tumor becomes flatter, the wall-like ring which grows from the edge towards the centre becomes broader until the whole mass is covered with a shell of newly-formed bony tissue, more or less dense. Then the tumor acquires a parchment-like sensation, distinctly crepitating on pressure over the bony shell.