During childbirth, fetal injuries caused by factors such as malposition of the fetus, cephalopelvic disproportion, and forceps are referred to as birth injuries (产伤). In recent years, with advancements in obstetric techniques and the increased rate of cesarean sections, the incidence of birth injuries has significantly declined. The injuries are categorized by affected areas as follows.

1. **Soft Tissue Injuries** (1) **Abrasions and Bruises**: Commonly seen in cases of prolonged labor, difficult delivery, or abnormal fetal positions. These often occur on the presenting part. In breech presentations, there may be edema and discoloration of the vulva and external genitalia. In face presentations, the face may appear swollen and discolored with petechiae. No special treatment is required, as these resolve spontaneously within a week. (2) **Subcutaneous Fat Necrosis**: Usually caused by birth trauma, hypoxia, or extreme cold. It typically appears 3–4 days after birth on the back, buttocks, cheeks, or thighs, presenting as localized hardening with red or normal skin color. The affected area may feel warm and tender with clearly defined edges. It should be differentiated from scleredema neonatorum and cellulitis. Generally, no treatment is needed, and it resolves gradually over 6–8 weeks. Secondary infections require prompt control. (3) **Sternocleidomastoid Muscle Injury**: Often results from excessive traction during breech extraction or excessive rotation of the fetal head. A hematoma forms within the muscle, followed by fibrosis. A palpable lump of 1–2 cm may develop, potentially leading to torticollis. To prevent torticollis, the infant’s head should be gently tilted toward the unaffected side and stretched in the opposite direction 15–20 times per session, 4–6 times daily. Follow with local massage or warm compress. If the lump persists after 2–3 months, surgical correction may be necessary.
2. **Head Injuries** (1) **Caput Succedaneum**: Caused by pressure on the fetal head during passage through the birth canal. The swelling is not confined by cranial sutures and resolves spontaneously within 2–3 days. (2) **Cephalohematoma**: Results from excessive compression of the fetal head, causing traction between the skull and periosteum, leading to subperiosteal hemorrhage due to ruptured blood vessels. The hematoma may occur on one or both parietal bones, feels fluctuant, and does not cross suture lines. Most resolve within 6–8 weeks, though some may leave behind ossified tissue. No treatment is needed, and aspiration should be avoided to prevent secondary infection. (3) **Skull Fracture**: Often occurs in forceps-assisted deliveries and may be linear or depressed. Mild cases are asymptomatic; severe depressed fractures may compress brain tissue, and vascular injury can lead to intracranial hemorrhage. X-rays confirm the diagnosis. Linear fractures require no intervention and usually heal in 6–8 weeks. Depressed fractures may require neurosurgical reduction or vacuum extraction. Close monitoring for bleeding is essential.
3. Peripheral nerve injury (1) Facial nerve palsy is often caused by forceps injury to the facial nerve during delivery, manifested as shallow nasolabial folds on the affected side, the corner of the mouth deviating to the healthy side, widened palpebral fissure, and inability to close the eye. Generally, no treatment is required. If there is no recovery after two weeks, acupuncture, tuina, physical therapy, and vitamin B1, B12 can be used. Care should be taken to protect the unclosed eye to prevent corneal ulcers. (2) Brachial plexus nerve injury is caused by excessive traction of the head or arm during fetal delivery. Depending on the site of injury, it can be divided into: 1. Upper arm type (Erb paralysis) involving the muscles innervated by the C5 and C6 nerve roots. The affected limb droops and adducts, the shoulder internally rotates, the elbow pronates, and the wrist and finger joints flex, with an asymmetric embrace reflex. 2. Lower arm type (Klumpke paralysis) involving the C8 to T1 nerve roots, with weakness in the wrist flexors and hand muscles, and a weak grasp reflex. 3. Total arm type, which is rare, combines symptoms of the above two types. If the cervical sympathetic nerve is damaged, ptosis of the upper eyelid, miosis, and Horner syndrome may occur. For brachial plexus nerve injury, the child's shoulder should rest to avoid movement, and most cases recover within 2–3 weeks. Parents should be instructed to perform passive exercises to abduct the shoulder, externally rotate the arm, and extend the wrist. Regular electromyography should be conducted to assess the injury severity and prognosis. If there is no improvement after six months, an abduction brace may be needed to prevent shoulder contracture. Severe cases may require nerve bundle anastomosis. (3) Phrenic nerve injury often occurs during breech childbirth, involving the C3, C4, and C5 nerve roots. The affected diaphragm is paralyzed, presenting as dyspnea, cyanosis, limited abdominal breathing, absence of diaphragmatic movement on the affected side, and reduced breath sounds. Fluoroscopy may show weakened diaphragmatic movement, and the affected side may be complicated by atelectasis. There is no specific treatment. If recovery is slow or pneumonia recurs, surgical intervention may be necessary. (4) Spinal injury often occurs in the cervical or thoracic region, presenting as flaccid paralysis of distal muscles, drooping of the upper eyelid (blepharoptosis), miosis, and urinary incontinence. X-rays may reveal spinal fracture or dislocation. Mild cases may recover spontaneously, while severe cases can be fatal.
4. Fractures often occur in cases of breech presentation, macrosomia, or difficulty in delivering the shoulders or limbs, and are most commonly seen in the clavicle and long bones. (1) Clavicle fracture can be detected during routine physical examination, presenting with localized swelling or tenderness. Palpation of the fractured ends may reveal bone crepitus, and the Moro reflex may be absent. X-ray examination can confirm the diagnosis. If dislocation is present, an 8-shaped bandage should be used to immobilize the shoulder. Callus formation typically occurs within 2–3 weeks. In recent years, no intervention is usually required, as it can heal spontaneously. (2) Long bone fractures (humerus, femur) are most commonly seen in the midshaft of the humerus or femur, manifesting as localized swelling, shortening of the affected limb, pseudoparalysis, and bone crepitus. X-ray examination can confirm the diagnosis. The affected limb can be reduced by traction and then immobilized in a functional position. For femur fractures, bilateral lower limb suspension traction may be used. Healing generally takes 3–8 weeks.
5. Abdominal organ injury Among abdominal organ injuries, the liver is most susceptible, though the adrenal glands, gastrointestinal tract, and spleen may also be affected. The most common complication is hemorrhage, which may initially present with subtle symptoms but can lead to shock or even death in severe cases.