How are caput and moulding assessed and graded, and what do they indicate?

Caput is scalp oedema (0/+/++/+++). Moulding is overlapping of the fetal skull bones, graded: 0 = bones separated (sutures felt easily); + = bones just touching; ++ = bones overlapping but reducible; +++ = bones overlapping, not reducible (severe).

Increasing caput and moulding (especially +++) suggest obstructed labour / cephalopelvic disproportion.

Clinical relevance. Increasing caput and severe (+++) moulding with slow progress signal obstructed labour needing caesarean.

More Detail

Caput and moulding

These are recorded on the partogram and signal obstruction when marked.

Caput succedaneum

• Diffuse scalp oedema from pressure during labour; graded 0, +, ++, +++.

Moulding

• Overlapping of the fetal skull bones at the sutures as the head adapts to the pelvis.
• Grades:
  • 0 - bones separated, suture lines felt easily.
  • + - bones just touching each other.
  • ++ - bones overlapping but reducible with gentle pressure.
  • +++ - bones overlapping and not reducible (severe).

Significance

• Mild moulding is normal, but increasing caput and moulding (especially +++) together with slow progress suggest obstructed labour / cephalopelvic disproportion and the need to reassess and consider caesarean.