Congenital Vault Depression in an Infant Requiring Manual Pelvis Disengagement During Delivery

Congenital vault depression (CVD) is a rare neonatal cranial finding that typically results from chronic intrauterine pressure and remodeling rather than acute delivery trauma. To the best of our knowledge, this report is the first that describes CVD in a term infant delivered via Caesarean section requiring manual pelvic disengagement due to a significantly impacted fetal head. Upon delivery, a 4 x 3 cm depression was noted in the right temporoparietal bone; however, the infant remained neurologically intact, and imaging via X-ray and computed tomography confirmed a concave deformity without evidence of fracture or intracranial injury. While neonatal skull depressions are typically attributed to either obstetric trauma or faulty fetal packing, another term for CVD, this report describes such a deformity occurring in the context of the manual pelvic disengagement maneuver. Managed conservatively through watchful waiting rather than surgical intervention, the infant demonstrated complete resolution of the skull depression by four months of age, supporting the efficacy of non-surgical management for asymptomatic presentations of suspected CVD.