A collection of blood between the periosteum and the bone of the skull, usually unilateral & over a parietal… - MNS 2024

MNS 2024

Child Health Nursing (Pediatrics)

Easy

Appeared in: MNS 2024

Explanation

Cephalohaematoma is defined as a subperiosteal hemorrhage, which is a collection of blood between the skull bone and its periosteum.
This type of hemorrhage is confined to a single cranial bone because the periosteum adheres firmly to the suture lines, meaning the swelling does not cross them.
The description in the question—a unilateral collection of blood over a parietal bone between the periosteum and bone—is the classic definition of a cephalohaematoma.
It typically appears hours after birth and resolves over weeks, posing a risk for hyperbilirubinemia as the blood breaks down.

Option B: Caput succedaneum is an edematous swelling of the scalp tissue itself (above the periosteum), not a collection of blood beneath it. It is soft, pits on pressure, and characteristically crosses suture lines.
Option C: A chignon is a specific, localized swelling caused by the application of a vacuum extractor cup during delivery. While it's a scalp swelling, it's defined by its iatrogenic cause.
Option D: A subdural hematoma is an intracranial hemorrhage, meaning it is bleeding inside the skull, between the dura and arachnoid mater. The question describes an extracranial collection of blood.

Clinical Relevance

Nursing practice connection: Knowing Differentiation of neonatal scalp and cranial birth injuries helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses must accurately differentiate between cephalohaematoma and caput succedaneum during the initial newborn assessment. This is done by palpating the swelling to determine if it is firm or soft and whether it crosses suture lines.
A key nursing intervention for a newborn with a cephalohaematoma is to monitor for the development of jaundice (hyperbilirubinemia). The breakdown of the collected red blood cells releases bilirubin, which can accumulate.
Parents often need reassurance about the nature of a cephalohaematoma. The nurse should explain that it is a common birth injury that usually resolves on its own without treatment, though it may take several weeks.

How to Approach the Question

First, break down the question into its key defining features: 1) a collection of blood, 2) located between the periosteum and skull bone, 3) usually unilateral, and 4) over a parietal bone.
Next, evaluate each option against these features.
Recall that 'Cephalohaematoma' is by definition a subperiosteal hemorrhage, which perfectly matches the location described.
Remember that because it is subperiosteal, a cephalohaematoma is limited by suture lines, making it unilateral.
Contrast this with 'Caput succedaneum,' which is scalp edema (not purely blood) that is superficial to the periosteum and crosses suture lines.
Eliminate 'Chignon' as it refers specifically to swelling from a vacuum device.

Concept Tested & Keywords

Concept Tested: Differentiation of neonatal scalp and cranial birth injuries.
Stem keywords: collection of blood, periosteum, bone of the skull, unilateral, parietal bone
Lead-in keywords: is

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E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1065-1067

E6 Obstetrics Williams p. 18-34