Prenatal incarceration of caput succedaneum: A case report

Abstract

Caput succedaneum is relatively common at birth but infrequently diagnosed in utero. We report the first case of a prenatal incarcerated caput succedaneum after cervical cerclage in a patient with premature rupture of the membranes (PPROM). A 41-year-old woman was referred and admitted to our hospital due to PPROM at 19 wk of gestation. Aggressive therapy, including amnioinfusion, cervical cerclage, and administration of antibiotics and tocolysis, was initiated. At 24 wk of gestation, a thumb tip-sized and polyp-like mass, which was irreducible, was delineated with a vaginal examination, vaginal speculum, and transvaginal ultrasonography, leading to the diagnosis of incarcerated caput succedaneum. Under general anesthesia, the incarcerated caput succedaneum was repositioned with fingers after cutting the string to avoid necrosis, and then, placement of a McDonald cervical cerclage was undertaken again. At 26 wk of gestation, she delivered a 678 g girl through an emergency cesarean section performed due to profuse bleeding and prolonged decelerations. A slight bulge with hair was observed on the head by palpation at birth. Cephalic ultrasonography, X-ray, magnetic resonance imaging and electroencephalogram confirmed no abnormality. Although the baby needed oxygen (0.2 L/min) at the time of hospital discharge, she has grown favorably at three years of corrected age.

Keywords: Caput succedaneum, Cervical cerclage, Patient with premature rupture of the membranes, Ultrasonography, Prenatal

Core tip: Caput succedaneum is relatively common at birth but infrequently diagnosed in utero. Furthermore, no case of incarceration of antenatal caput succedaneum has been reported in the literature. This is the first report of prenatal and incarcerated caput succedaneum after cervical cerclage in a patient with premature rupture of the membranes (PPROM). The presenting case makes obstetricians recognize that cerclage placement, especially in a patient with PPROM, may result in unusual caput succedaneum in utero. When it develops to incarceration, earlier release should be considered to prevent the serious complication of necrosis.