During childbirth, injuries to the fetus caused by factors such as malposition of the fetus, cephalopelvic disproportion, and forceps are called birth injuries. In recent years, with the advancement of obstetric techniques and the increased rate of cesarean sections, the incidence of birth injuries has significantly decreased.

bubble_chart Type

Injuries are described according to the affected parts as follows:

1. Soft tissue injury
   1. **Abrasions and bruises**: Commonly seen in prolonged labor, difficult delivery, or abnormal fetal positions. They mostly occur in the presenting part. In breech presentations, there may be edema and discoloration of the vulva and external genitalia. In face presentations, the face may be swollen and discolored with petechiae. No special treatment is needed, as these resolve spontaneously within a week.
   2. **Subcutaneous fat necrosis**: Often caused by childbirth injury, hypoxia, or extreme cold. It typically appears 3–4 days after birth on the back, buttocks, cheeks, or thighs as localized hardening, with red or normal skin color. The area may feel warm to the touch and be tender, with clear borders. It should be differentiated from neonatal scleredema and cellulitis. Usually, no treatment is required, and it gradually disappears in 6–8 weeks. If secondary infection occurs, prompt infection control is needed.
   3. **Sternocleidomastoid muscle injury**: Commonly caused by 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 be felt, potentially leading to torticollis. To prevent torticollis, the infant’s head can be gently tilted toward the unaffected side and stretched in the opposite direction, 15–20 times per session, 4–6 times daily, followed by local massage or warm compress. If the lump persists for 2–3 months, surgical correction may be necessary.
2. Head injury
   1. **Caput succedaneum**: Caused by pressure on the fetal head during passage through the birth canal. The swelling is not limited by cranial sutures and resolves spontaneously within 2–3 days.
   2. **Cephalohematoma**: Results from excessive compression of the fetal head, causing traction between bones and membranes, leading to subperiosteal hemorrhage due to vessel rupture. The hematoma may occur on one or both parietal bones, feels fluctuant, and does not cross suture lines. It usually resolves within 6–8 weeks, though occasionally leaves a raised calcified area. No treatment is needed, and puncture 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 may cause intracranial hemorrhage. X-rays confirm the diagnosis. Linear fractures require no treatment and usually heal in 6–8 weeks. Depressed fractures may need neurosurgical reduction or vacuum extraction. Close monitoring for bleeding is essential.
3. Peripheral nerve injury
   1. **Facial nerve palsy**: Usually caused by forceps injury to the facial nerve. Manifestations include flattening of the nasolabial fold on the affected side, deviation of the mouth to the unaffected side, widened palpebral fissure, and inability to close the eye. Most cases resolve without treatment. If no improvement occurs after two weeks, acupuncture, massage, physiotherapy, and vitamin B1/B12 may be used. Protect the unclosed eye to prevent corneal ulcers.
   2. **Brachial plexus nerve injury**: Caused by excessive traction on the head or arm during delivery. It can be classified based on the affected area:
      1. - **Upper arm type (Erb’s palsy)**: Involves the C5 and C6 nerve roots. The affected limb hangs limp, adducted, with internal rotation of the shoulder, pronation of the elbow, and flexion of the wrist and fingers. The Moro reflex is asymmetrical.
      2. - **Lower arm type (Klumpke’s palsy)**: Involves the C8 to T1 nerve roots, causing weakness in wrist flexors and hand muscles, with a weak grasp reflex.
      3. - **Total arm type**: Rare, combining features of both types. If the cervical sympathetic nerves are injured, ptosis, miosis, and Horner’s syndrome may occur. For brachial plexus injury, the shoulder should rest, and movement should be avoided. Most cases recover in 2–3 weeks. Parents should be guided to perform passive exercises, such as shoulder abduction, arm external rotation, and wrist extension. Regular electromyography can assess injury severity and prognosis. If no improvement occurs after 6 months, an abduction splint may be used to prevent shoulder contracture. Severe cases may require nerve anastomosis.
   3. Phrenic nerve injury: Often occurs during breech childbirth, involving C3, C4, and C5 nerve roots, leading to paralysis of the diaphragm on the affected side. Symptoms include dyspnea, cyanosis, restricted abdominal breathing, loss of diaphragmatic movement on the affected side, and diminished breath sounds. Fluoroscopy may reveal weakened diaphragmatic movement, and the affected side may be complicated by atelectasis. There is no specific treatment. If recovery is slow or recurrent pneumonia occurs, surgical intervention is necessary.
   4. Spinal injury: Often occurs in the cervical or thoracic region. Manifestations include flaccid paralysis of distal muscles, drooping of the upper eyelid (blepharoptosis), constriction of the pupils, and severe incontinence of urine, among others. X-ray imaging may reveal spine fracture or dislocation. Mild cases may recover on their own, while severe cases can be fatal.
4. Fracture: Commonly seen in cases of breech presentation, large infants, or difficult delivery of shoulders or limbs, often occurring in the clavicle and long bones.
   1. Clavicle fracture: Can be detected during routine physical examination, presenting with localized swelling or tenderness, and palpable bone crepitus at the fracture site with loss of the embrace reflex. X-ray examination confirms 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 heals spontaneously.
   2. Long bone fracture (humerus, femur): Most commonly seen in the midshaft of the humerus and femur, presenting with localized swelling, shortening of the affected limb, pseudoparalysis, and bone crepitus. X-ray examination confirms 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 occurs within 3–8 weeks.
5. Abdominal organ injury: Among abdominal organ injuries, the liver is most frequently affected, though the adrenal glands, gastrointestinal tract, and spleen may also be involved. The most common complication is hemorrhage, which may present with subtle early symptoms but can lead to shock or even death in severe cases.