UPASHEERSHAKA - caput succedaneum / cephalohematoma

Upa- near /secondary; sheershaka - small head.
Upasheershaka refers to swelling very close to or on the head which appears like another small head. Painless scalp swelling due to vitiated vata in kapala pradesha (scalp bones) of the foetus which is of same colour of the skin. this can be either caput succedaneum or cephalohematoma or subgaleal hematoma. The uterine inertia is the main reason says vagbhata acharya and causes an edematous painless swelling on skull of savarna , neeruja with abnormal colour , as it is the collection of blood and looks normal bloody red called upsheershaka

1. UPASHEERSHAKA Dr. ASWATHY .P .S Final year post graduate scholar Department of KAUMARABRITHYA SDMCAH, HASSAN

2. CONTENTS INTRODUCTION 3 REFERENCES 4 CHIKITSA 5 CAPUT SUCCEDANEUM 10 CEPHALO HEMETOMA 13

3. Introduction PRASAVAKAALEENA ABHIGHATA / BIRTH INJURIES UNDER SHIRO ROGA 20XX DR.ASWATHY.P.S 3

4. ASHTANGA HRIDAYA : UTTARA STANA : BALAMAYA PRATHISHEDHAM : 21 कपाले पवने दुष्टे गर्भस्थस्यापि जायते| सवर्णो नीरुजः शोफस्तं विद्यादुपशीर्षकम्||२१|| ARUNADATTA कपाले पवने दुष्टे गर्भस्थितस्यापि नीरुजः शोफस्तत्सवर्णः-कायसमानवर्णो, जायते| तमुपशीर्षकाख्यं रोगं जानीयात्|

5. Charaka: Chikitsa: 12:74 दोषास्त्रयः स्वैः कुपिता निदानैः कुर्वन्ति शोफं शिरसः सुघोरम्|७५| Chakrapani : शिरसः सुघोरमित्यत्र लक्षणं त्रिदोषकृतं, नाम च ‘शिरःशोथ’ इति विज्ञेयं, तन्त्रान्तरेऽयम् ‘उपशीर्षक’ इत्युक्तः||७५| 20XX presentation title 5

6. treatment Ashtanga : नवे जन्मोत्तरं जाते योजयेदुपशीर्षके||१९|| वातव्याधिक्रियां, पक्वे कर्म विद्रधिचोदितम्| आमपक्वे यथायोग्यं विद्रधीपिटिकार्बुदे||२०|| Charaka: तेषां सिराकायशिरोविरेका धूमः पुराणस्य घृतस्य पानम्| स्याल्लङ्घनं वक्त्रभवेषु चापि प्रघर्षणं स्यात् कवलग्रहश्च||८०|| 20XX presentation title 6

7. Correlates with ​ ​ 20XX presentation title 7

8. 20XX presentation title 8

9. CAPUT SUCCEDANEUM 20XX presentation title 9

10. Cephalohematoma Accumulation of blood under the scalp ,specially in the sub periosteal space Most common site – occipital /parietal region Etiology – a prolonged second stage of labor Macrosomia / increase size of the infant relative to the birth canal Weak / ineffective uterine contractions Abnormal fetal presentation Instrument assisted delivery with forceps / vacuum extractor Multiple gestations Presentation of occiput in transverse or posterior position during delivery cesarean section was initiated following the first stage of labor 20XX presentation title 10

11. Pathophysiology : most common – during birthing process rarely – in juveniles & adults – following trauma / surgery External pressure on the fetal head is increased when the head is compressed against the maternal pelvis during labor or from additional applied external forces from instruments ( forceps / vacuum extractor) – results rupture of small blood vessels between the periosteum and calvarium Shearing action between the periosteum and the underlying calvarium causes slow bleeding As the bleeding continues and fills the subperiosteal space , pressure builds and the accumulated blood acts as a tamponade to stop further bleeding . 20XX presentation title 11

12. Physical examination Slow nature of subperiosteal bleeding – CH usually not present at birth but instead become noticeable within first 1-3 days following birth Repeated inspection and palpation of newborn’s head – necessary to identify the presence of CH Once CH is present – assessing and documenting change in size is continued Initially present with a firm but increasingly fluctuant area of swelling over which the scalp moves easily Characteristics of CH – firm , enlarged unilateral/ bilateral bulge on top one or more bones Raised area cannot be transluminated ,and the overlying skin is usually not discoloured / injured Cranial sutures define the boundaries of the cephalohematoma 20XX presentation title 12

13. Evaluation Skull x rays concern for underlying haemorrhage CT scan Head USG concern for intracranial haemorrhage Newborn should be monitors closely for neurologic deficit, as this could suggest intra cranial bleed is present and requires further investigation Infants should be evaluated for bleeding diathesis , such as Von Willebrand disease , which may have predisposed the infant to develop CH Needle aspiration of CH , is discouraged due to the risk of introducing infection and is only indicated if an infection is suspected Escherichia coli is the primary pathogen associated with infected CH 20XX presentation title 13

14. TREATMENT & MANAGEMENT Primarily OBSERVATIONAL Takes weeks to resolve as the clotted blood is slowly absorbed Usually CH don’t present any problem to a newborn Increased risk of neonatal jaundice in the first days after birth – carefully assessed for yellowish discoloration of skin ,sclera – non invasive measurements with a transcutaneous bilirubin meter can be used . And serum bilirubin level should be obtained if the newborn exhibits of jaundice Calcification /ossifications – may occurs in cases that do not resolve Skull x ray /CT scan of the head – indicated ( haven’t absorbed within 6 weeks ) Ossified CH, has hardened and has clearly outer and inner layer of bone surrounding the lesion – treated safely surgically with craniotomy / craniectomy and cranioplasty 20XX presentation title 14

15. prognosis Majority CH , Resorb within the first month of life (80%) Children typically don’t have an associated neurologic deficit as the CH is superficial to the calvarium and not in contact with the brain parenchyma 20XX presentation title 15

16. Complications Anaemia Infection Jaundice Hypotension Intracranial haemorrhage Underlying linear skull fractures 20XX presentation title 16

17. Advise for parents Prior to discharge, educate the parents on the importance of monitoring the infant for the first week Observed for any behavioural changes , feeding difficulties , emesis , failure to thrive Majority of infants have an uneventful recovery 20XX presentation title 17

18. CEPHALO HEMATOMA 20XX presentation title 18

19. 20XX presentation title 19

20. T hank you