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.

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 गर्भस्थस्यापप जायते|
सवर्णो नीरुजः शोफस्तं पवद्यादुपशीर्भकम्||२१||
ARUNADATTA
कपाले पवने दुष्टे गर्भस्स्थतस्यापप नीरुजः शोफस्तत्सवर्णभः-कायसमानवर्णो,
जायते| तमुपशीर्भकाख्यं रोगं जानीयात्|

5. Charaka: Chikitsa: 12:74
• दोर्ास्त्रयः स्वः क
ु पपता पनदानवः क
ु वभस्ि शोफ
ं पशरसः सुघोरम्|७५|
• Chakrapani :
• पशरसः सुघोरपमत्यत्र लक्षर्णं पत्रदोर्क
ृ तं, नाम च ‘पशरःशोथ’ इपत
पवज्ञेयं, तन्त्रािरेऽयम् ‘उपशीर्भक’ इत्युक्तः||७५|
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6. TREATMENT
Ashtanga :
नवे जन्मोत्तरं जाते योजयेदुपशीर्भक
े ||१९||
वातव्यापिपियां, पक्व
े कमभ पवद्रपिचोपदतम्|
आमपक्व
े यथायोग्यं पवद्रिीपपपिकार्ुभदे||२०||
Charaka:
तेर्ां पसराकायपशरोपवरेका िूमः पुरार्णस्य घृतस्य पानम्|
स्याल्लङ्घनं वक्त्रर्वेर्ु चापप प्रघर्भर्णं स्यात् कवलग्रहश्च||८०||
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7. Correlates with
20XX presentation title 7

8. 20XX presentation title 8

9. CAPUT SUCCEDANEUM
ONSET
SWELLING PRESENT OVER THE SCALP AT THE TIME OF BIRTH, EVEN AS EARLY
AS THE FIRST STAGE OF LABOUR -SO CAN FEEL WITH A DIGITAL
EXAMINATION
CONTENTS SEROSANGUINOUS , HEMORRAGIC FLUID COLLECTION
LIES AT
SUPERIOR TO THE CRANIAL SUTURE LINE & SUPERIOR TO THE
PERIOSTEUM- CROSSES THE MIDLINE /SUTURE LINES
NATURE SOFT , BOGGY , PITTING AND FLUCTUANT
RESOLVES 48-72 HRS OF LIFE
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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
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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 .
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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
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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
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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
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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
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16. Complications
• Anaemia
• Infection
• Jaundice
• Hypotension
• Intracranial haemorrhage
• Underlying linear skull fractures
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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
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18. CEPHALO HEMATOMA
ONSET ASSOCIATED WITH BIRTH TRAUMA .Eg: INSTRUMENTAL – ASSISTED
DELIVERIES
CONTENTS HEMORRAGHIC
LIES AT
INFERIOR TO THE PERIOSTEUM- DON’T CROSSES THE MIDLINE
/SUTURE LINES
NATURE
FIRM AND FLUCTUANT, MASS SIZE GROWS DURING THE FIRST DAY
OF LIFE
RESOLVES BETWEEN 2 WEEKS – 6 MONTHS { ANEMIA / HYPERBILIRUBINEMIA}
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19. 20XX presentation title 19

20. Thank you