During childbirth, injuries to the fetus 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 their location as follows.

1. Soft tissue injuries (1) Abrasions and bruising: 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 be swollen and discolored with petechiae. No special treatment is required, as these resolve on their own within a week. (2) Subcutaneous fat necrosis: Often caused by childbirth injury, hypoxia, or extreme cold. 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 and tender with clear 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: Commonly caused by excessive traction during breech extraction or excessive rotation of the fetal head. A hematoma forms in 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 antagonistic direction, 15–20 times per session, 4–6 times daily, followed by local massage or heat application. 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 limited by suture lines and resolves on its own 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. Most resolve within 6–8 weeks after birth, occasionally leaving a raised calcified area. 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 from the fracture can cause intracranial hemorrhage. X-rays confirm the diagnosis. Linear fractures require no treatment 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 by shallow nasolabial fold on the affected side, mouth corner deviating to the healthy side, widened palpebral fissure, and inability to close the eye. Generally, no treatment is needed. If recovery does not occur after two weeks, acupuncture, tuina, physical therapy, and vitamin B1, B12 may be used. Care should be taken to protect the unclosed eye to prevent corneal ulcer. (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 classified into: 1. Upper arm type (Erb paralysis) involving the C5 and C6 nerve roots. The affected limb hangs down and adducts, with internal rotation of the shoulder, pronation of the elbow, and flexion of the wrist and finger joints. The embrace reflex is asymmetrical. 2. Lower arm type (Klumpke paralysis) involving the C8 to T1 nerve roots, with weakness in the wrist flexors and hand muscles, and weakened grasp reflex. 3. Total arm type, which is rare and exhibits symptoms of both 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, rotate the arm backward, and extend the wrist. Regular electromyography should be conducted to assess the injury severity and prognosis. If no improvement occurs after 6 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, restricted abdominal breathing, loss 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, palpable bone crepitus at the fracture site, and loss of the Moro reflex. X-ray examination confirms the diagnosis. If dislocation is present, a figure-of-8 bandage should be applied to immobilize the shoulder. Callus formation occurs within 2–3 weeks. In recent years, no treatment is typically required as it heals spontaneously. (2) Long bone fractures (humerus, femur) most commonly involve the midshaft of the humerus or femur, manifesting as 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, followed by the adrenal glands, gastrointestinal tract, and spleen. The most common complication is hemorrhage, which may initially present with subtle symptoms but can lead to shock or even death in severe cases.