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 the advancement of obstetric techniques and the increased rate of cesarean sections, the incidence of birth injuries has significantly decreased. The injuries are described below based on their locations.

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 deliveries, 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 usually resolve on their own 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, presenting as localized hardening with red or normal skin color. The affected area may feel warm and tender with clear borders. It should be differentiated from sclerema neonatorum and cellulitis. Generally, no treatment is needed, and it gradually disappears within 6–8 weeks. If secondary infection occurs, prompt infection control is necessary. (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 develop, 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. After stretching, local massage or warm compresses can be applied. If the lump persists for 2–3 months, surgical correction may be required.
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 cranial sutures and usually resolves 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 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 after birth, 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 may be asymptomatic; severe depressed fractures can compress brain tissue, and vascular injury may lead to intracranial hemorrhage. X-rays can 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 signs of bleeding is essential.
3. Peripheral nerve injury (1) Facial nerve palsy is mostly caused by forceps injury to the facial nerve during delivery, manifested as 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 required. If there is no recovery after two weeks, acupuncture, tuina, physiotherapy, and vitamin B1, B12 can be used. Pay attention to protecting 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 divided into: 1. Upper arm type (Erb paralysis) involving the muscles innervated by 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 asymmetrical embrace reflex. 2. Lower arm type (Klumpke paralysis) involving C8 to T1 nerve roots, with weakness of wrist flexors and hand muscles, and weakened grasp reflex. 3. Total arm type, which is rare, presents with 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 for the child, such as shoulder abduction, arm external rotation, and wrist extension. Regular electromyography reviews are needed to determine the extent of injury and estimate prognosis. If there is no improvement after 6 months, an abduction brace should be used to prevent shoulder contracture. For severe injuries, nerve bundle anastomosis may be considered. (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, limited 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 treatment is required. (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 on their own, 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 examinations, 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 confirms the diagnosis. If there is {|###|}dislocation{|###|}, 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 the fracture heals spontaneously. (2) **Long bone fractures** (humerus, femur) most commonly occur in 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 {|###|}fracture of femur{|###|}, bilateral lower limb suspension traction may be used. Healing generally takes 3–8 weeks.
5. **Abdominal organ injury** Abdominal organ injury most frequently involves the liver, 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.