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Comprehensive Overview of Neonatal Birth Injury: Causes, Classification, and Management

Detailed insights into birth injury types, predisposing factors, recognition, and management strategies for neonatal birth trauma during labor and delivery.

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Birth Injury PREDISPOSING FACTORS ,CLASSIFICATION , RECOGNITION , INVESTIGATION AND MANAGEMENT OF NEONATAL BIRTH TRAUMA PRESENTED BY:- SHASHANK PANDEY BAMS FINAL PROFF GAMC REWA
Definition and Terminology:- Birth injury (birth trauma) is any structural destruction or functional deterioration of fetal tissues/organs resulting from mechanical forces (compression, traction, shear) or hypoxic insult sustained during labor and delivery. EASY UNDERSTANDING:- • Compression – Pressure on fetal tissue • Traction-Pulling force • Shear- Opposite forces causing tissue damage • Hypoxic insult: Reduced oxygen supply
Avoidable Birth injury:- Avoidable birth injuries are injuries that occurs due to preventable factors such as improper obstetric care , delayed intervention or inadequate intrapartum care , these injuries an be minimized or prevented with skilled obstetric management. COMMON CAUSES:- Excessive traction during delivery Improper use of forceps and vaccum extractor Delay in recognizing fetal distress Delayed caesarean section when indicated. Inappropriate management of shoulder dystocia.
Avoidable Birth injury:- EXAMPLES:- Brachial plexus injury{ Erb’s palsy}. Facial nerve injury due to Forceps. Skull fracture from improper instrumental delivery.
Unavoidable Birth Injury:- Unavoidable birth injuries are injuries that occur despite appropriate and timely obstetric care they result from unavoidable maternal or fetal factors and cannot always be protected. COMMON CAUSE:-  Macrosomia{large body} Shoulder dystocia despite correct management Breech presentation Prolonged or obstructed labour Prematurity and fragile fetal issue
Unavoidable Birth Injury:- EXAMPLE:- Clavicle fracture during difficult delivery. Minor cephalohematoma after prolonged labour. Soft tissue bruising in a difficult vaginal delivery. NOTE:-  Birth injury is Distinct from 'birth asphyxia', though the two can frequently coexist.  Birth Injury Distinct from congenital malformation, which predates labor entirely.
EPIDEIMOLOGY &INCIDENCE OF BIRTH INJURY OVERALL INCIDENCE: 2-7 per 1000 live births and incidence varies with obstetrics practice, mode of delivery and reporting methods. COMMON BIRTH INJURIES:- Soft tissue injury is among the most frequent birth injuries which include caput succedaneum, bruises , abrasions and cephalohematoma, these injuries are usually self limiting and resolv without treatment. Clavicle fracture is most common bone injury ; incidences increases in macrosomia and shoulder Dystocia {up to 1.5–3% of vaginal deliveries with shoulder dystocia} Brachial plexus injury occurs in approximately 0.1 -0.3% of live births commonly associated with shoulder dystocia and excessive lateral traction{recovery is spontaneous} Trend over time:Overall incidence has fallen with improved intrapartum monitoring, but instrumental-delivery-related injury persists
PREDISPOSING FACTORS-MATERNAL Maternal factors increase the risk of difficult labour and may expose the fetus to excessive compression ,traction or hypoxia, thereby increasing the likelihood of birth injury. PELVIC FACTORS- Abnormal maternal pelvic anatomy may interfere with the normal passage of the fetus through the birth canal , resulting in difficult delivery and increased mechanical trauma Contracted or android pelvis. Cephalopelvic disproportion Pelvic tumors and uterine abnormalities obstruvting the birth canal
PREDISPOSING FACTORS-MATERNAL LABOUR PATTERN:- Abnormal labour increases the duration or force of delivery, predisposing the fetus to compression ,traction and hypoxic injury Prolonged first and second stage of labour Precipitate {very rapid} labour Obstructed labour Hypertonic or uncoordinated uterine contractions.
PREDISPOSING FACTORS-MATERNAL PARITY & OBSTETRIC HISTORY:- Certain maternal characteristics and previous obstetrics events increase the likelihood of difficult delivery and birth trauma. Primigravida {first pregnancy} and Elderly primigravida [pregnancy>30 years} Previous difficult labour and instrumental delivery Previous birth injury Maternal diabetes with Fetal macrosomia Previous obstetric complications.
PREDISPOSING FACTORS- FETAL Certain fetal characterstics increase the suspectibility to birth injuries by making labor and vaginal delivery more difficult orby increasing the fragility of fetal tissues SIZE & GROWTH:- Excessive fetal size or immature tissues increase the likelihood of mechanical trauma during birth. Macrosomia{Bt wt. >4kg} Large fetal head circumference Prematurity [Fragile bones and blood vessels] IUGR/low birth weight
PREDISPOSING FACTORS- FETAL PRESENTATION AND LIE:- Abnormal fetal presentation or lie may lead to difficult labor and increase the need for instrumental or operative delivery. Breech presentation Face or brow presentation Transverse lie Persistent Occipito posterior position Shoulder dystocia
BROW PRESENTATION
PREDISPOSING FACTORS- FETAL STRUCTURAL AND MEDICAL FACTORS:- Congenital abnormalities and certain fetal disorders predispose the new born to trauma even during uncoplicated delivery. Congenital anomalies {hydrocphalus} Multiple gestation Skeletal Dysplasia Bleeding disorders [haemophilia ,thrombocytopenia] Connective tissue disorder
PREDISPOSING FACTORS – INTRAPARTUM AND INSTRUMENTAL Obstetric interventions and difficult intrapartum events acan increase the risk ofbirth injury , particularly when excessive traction or improper techniques are required INSTRUMENTAL DELIVERY:- Instrument assisted vaginal delivery may cause fetal trauma,especially when difficult extraction or repeated attempts are needed. Forceps delivery[particularly mid cavity forceps] Vaccum vent house extraction Combined use of forceps and vacuum
PREDISPOSING FACTORS – INTRAPARTUM AND INSTRUMENTAL MANIPULATIVE PROCEDURE:- Certain obstetrics maneuvers performed to correct fetal position or facilitate delivery may increase the risk of injury. Internal or External Cephalic Version Breech extraction Manual rotation of fetal head
PREDISPOSING FACTORS – INTRAPARTUM AND INSTRUMENTAL EMERGENCY SITUATIONS: Emergency deliveries often require rapid intervention ,increasing the possibility of fetal trauma Shoulder dystocia requiring obstetric maneuvers. Rapid delivery due to fetal distress. Excessive traction or inexperienced operator.
PATHOPHYSIOLOGY OF BIRTH INJURY Birth injury occurs due to mechanical trauma during labour and delivery , often worsened by fetal hypoxia .The main mechanisms are: Compression: Pressure on fetal tissues causes edema , ischemia and nerve injury. Traction : Excessive pulling stretches or tears nerves , muscles and blood vessels. Rotation: Forceful twisting may injure the cervical spine or intracranial structures. Hypoxia: Reduced oxygen supply weakens tissues and increases the severity of injury.
CLASSIFICATION OF BIRTH INJURIES Soft tissues Injuries Skeletal Injuries Nerve Injuries Intracranial Injuries Visceral Injuries
SOFT TISSUE INJURY Soft tissue injury — scalp edema DEFINITION: Diffuse edematous swelling of the scalp from pressure of the presenting part against the dilating cervix LOCATION: Scalp, over the presenting part — often crosses the midline Borders: Crosses suture lines (extraperiosteal / subcutaneous plane) Onset : Present at birth; may enlarge slightly over first hours Consistency: Soft, pitting edema; may show overlying petechiae or bruising Resolution: Spontaneous, within 2–3 days Management: Reassurance only — no active intervention needed
CEPHALHEMATOMA DEFINITION: Subperiosteal collection of blood over one (occasionally both) cranial bones, most often parietal BORDERS: Strictly LIMITED by suture lines — periosteum is firmly attached at sutures. Onset: Appears hours after birth (absent at birth); enlarges over 1–2 days Complications: Hyperbilirubinemia from RBC breakdown; rarely infection or underlying linear fracture Resolution: Weeks to months; may leave a firm calcified rim palpable for months Management : Conservative — AVOID aspiration/incision (introduces infection risk); monitor serum bilirubin subperiosteal hemorrhage
CEPHALOHEMATOMA
Subgaleal Hemorrhage Bleeding into the potential space between the galea aponeurotica and periosteum — a large, distensible space with no anatomical boundary, allowing blood to spread across the entire scalp and track into the neck. Cause: Strongly associated with vacuum (ventouse) extraction — shearing of emissary veins connecting scalp and dural sinuses Extent: NOT limited by sutures — diffuse, boggy swelling that can extend from eyebrows to the nape of the neck. Volume risk: The subgaleal space can accommodate a newborn's ENTIRE circulating blood volume Onset: Typically apparent within the first 6 hours after a difficult/instrumental delivery, progressively enlarging
Subgaleal Hemorrhage : Recognition and Management Subgaleal hemmorhage is a life threatning neonatal emergency caused by bleeding into the subgaleal space . Early recognition and prompt management are essential to prevent hypovolemic shock and reduce mortality. RECOGNITION: Rapidly enlarging boggy , fluctuant scalp swelling that crosses suture lines and shift with head movement Signs of Hypovolemic shock include pallor , tachycardia, prolonged capillary refill , hypotensionand poor peripheral perfusion Head circumference should be measured every 15-30 minutes to detect progressive bleeding. Laboratory findings may show falling haemoglobin/hematocrit and coagulopathy{prolonged PT/APTT thrombocytopenia}
Subgaleal Hemorrhage : Management Immediate ABC stabilization with oxygen and intravenous access Start fluid Resuscitation followed by packed red blood cell transfusion if significant blood loss is present. Correct coagulopathy using fresh frozen plasma[FPP],Platelets or other blood products as indicated Continuous monitoring of vital signs ,head circumference , urine output and hemoglobinin the NICU until the infant is haemodynamically stable.
Note:-
OTHER SOFT TISSUE INJURIES Bruising & Petechiae:- Superficial ecchymoses over the presenting part (face in face presentation, buttocks in breech). Petechiae may follow a tight nuchal cord. Usually resolve within a week without treatment; extensive bruising warrants a bilirubin check. Abrasions & Lacerations:- Superficial scalp lacerations from fetal scalp electrodes, scalp pH sampling, or scalpel injury during Cesarean section. Manage with simple wound care; rarely need suturing. Subcutaneous Fat Necrosis:- Firm, well-circumscribed, erythematous/violaceous nodules or plaques appearing days to weeks after a traumatic delivery, typically over pressure points. Can rarely cause hypercalcemia — monitor calcium if extensive.
SKELETAL INJURIES:- CLAVICLE FRACTURE: The most common significant bony birth injury Clinical Features: Mechanism: compression of the shoulder against the pubic symphysis during shoulder dystocia, or excessive traction on the shoulder  • Asymmetric / decreased Moro reflex on affected side • • Crepitus and irregularity palpable over the clavicle • • Pseudoparalysis — infant avoids moving the arm • • Local tenderness, swelling, occasional visible deformity • • Often initially missed; picked up on day 2–3 as a palpable callus
CLAVICULAR FRACTURE IN NEONATE
Management & Prognosis Excellent prognosis — heals rapidly with abundant callus formation within 7–10 days. • • Gentle handling; avoid traction on the affected arm • • Pin the sleeve to clothing or apply a figure-of-8 bandage for comfort in select cases • • Analgesia rarely required beyond gentle handling • • Reassure parents — remodels completely, no long-term deformity • • Always examine for an associated brachial plexus injury
Humerus & Femur Fractures Humerus fracture: Occurs with a trapped/extended arm during breech extraction or during difficult delivery of the arm in cephalic presentation Femur fracture:Occurs during breech extraction, particularly with a footling breech or excessive traction on the leg Clinical signs Pain on passive movement, swelling, deformity or angulation, pseudoparalysis of the limb, palpable crepitus. Management: Splinting / immobilization (e.g., Velpeau bandage for humerus, splint/traction for femur) Prognosis: Excellent — neonatal bones heal rapidly with abundant callus; remodeling is complete even with child angulation
Neonatal humeral fracture
FEMUR SHAFT FRACTURE IN NEWBORN
Skull Fractures Linear Fracture Most common type of skull fracture at birth. • • Usually asymptomatic, incidental finding • • Often discovered on skull X-ray done for another indication • • Underlies some cephalhematomas — always suspect if the swelling is unusually large or tense • • No treatment necessary in the vast majority of cases • • Heals spontaneously with normal bone remodeling
Skull Fractures Depressed ('Ping-Pong Ball') Fracture: Caused by forceps blade pressure or in-utero compression against the maternal pelvis/sacral promontory. • • Visible/palpable indentation of the skull, resembling a dented ping-pong ball • • Neuroimaging (CT) to assess for underlying hemorrhage • • Many resolve spontaneously or with gentle manual/vacuum elevation • • Neurosurgical elevation reserved for significant depression or neurological signs
LINEAR FRACRURE IN SKULL PING PONG BALL FRACTURE
SKULL FRACTURE :NEONATE HEMATOMA IN SKULL FRACTURE
RareSkeletalInjuries Uncommon fractures encountered in difficult deliveries Rib Fractures: Occasionally seen after difficult manual extraction or vigorous chest compressions during resuscitation. Usually asymptomatic; heal without intervention. Rarely, may cause respiratory distress if multiple/flail segment. Vertebral Injury: Rare, associated with excessive traction/hyperextension in breech delivery. May coexist with spinal cord injury — always assess neurological function of all four limbs when suspected. Facial Bone / Mandible Fracture: Extremely rare; associated with severe forceps trauma. May cause feeding difficulty or asymmetry. Usually managed conservatively with close feeding support.
Peripheral Nerve Injuries BRACHIAL PLEXUS RELEVENT ANATOMY: Brachial plexus is formed by C5–T1 ventral rami. Upper trunk (C5–C6): Supplies shoulder and elbow muscles → injury causes Erb's palsy. Lower trunk (C8–T1): Supplies intrinsic hand muscles → injury causes Klumpke's palsy. T1 sympathetic fibers: Injury may cause Horner's syndrome. Mechanism: Excessive lateral traction between the baby's head/neck and shoulder stretches or tears the plexus. Clinical importance: Site of injury determines the type and severity of paralysis.
BRACHIAL PLEXUS ANATOMY
Erb-Duchenne Palsy (Upper Brachial Plexus Injury) Mechanism Erb-Duchenne palsy is the most common neonatal brachial plexus injury, caused by injury to the C5–C6 nerve roots (upper trunk).  It occurs due to excessive lateral traction between the fetal head and shoulder during difficult delivery, particularly in shoulder dystocia, breech extraction, forceps/vacuum delivery, and fetal macrosomia. The injury may range from neuropraxia to nerve root avulsion.
Clinical Features Characteristic "Waiter's Tip" deformity :Shoulder adducted and internally rotated Elbow extended Forearm pronated Wrist flexed Loss of shoulder abduction and external rotation Weak elbow flexion and forearm supination Absent Moro reflex on the affected side Grasp reflex preserved (C8–T1 intact) Decreased sensation over the lateral aspect of the arm (may be present)--- Erb-Duchenne Palsy (Upper Brachial Plexus Injury)
Erb-Duchenne Palsy:Management and Prognosis:- Management Conservative treatment is the first-line approach. Immobilization of the affected limb for 7–10 days. Gentle passive range-of-motion exercises and physiotherapy to prevent contractures. Regular neurological assessment and follow-up. Microsurgical nerve repair, grafting, or nerve transfer is indicated if there is no biceps function by 3–6 months or evidence of severe nerve injury.
Klumpke's Palsy (Lower Brachial Plexus Injury) Klumpke's palsy is caused by injury to the C8–T1 nerve roots (lower trunk) of the brachial plexus.  It occurs due to excessive upward traction on the infant's arm during difficult delivery, particularly in breech extraction or forceful delivery of the upper limb. The injury may vary from neuropraxia to nerve root avulsion. In severe cases, involvement of T1 sympathetic fibers may lead to Horner's syndrome.
Clinical Features  . Weakness or paralysis of the intrinsic muscles of the hand.  Claw hand deformity due to paralysis of lumbricals and interossei  Weak finger flexion and impaired grip strength.  Grasp reflex absent or weak  Sensory loss over the medial aspect of the forearm and hand.  Horner's syndrome (ptosis, miosis, anhidrosis) if T1 sympathetic fibers are involved.
Management & Prognosis Conservative treatment is the initial approach. Gentle immobilization for 7–10 days. Passive range-of-motion exercises and physiotherapy. Occupational therapy to maintain hand function. Microsurgical nerve repair, grafting, or nerve transfer if there is no neurological recovery by 3–6 months or in severe nerve injury. Prognosis is less favorable than Erb's palsy because lower trunk injuries are more often associated with nerve root avulsion. Mild neuropraxia usually recovers completely.Severe injuries may result in persistent hand weakness, claw hand deformity, and muscle wasting. Presence of Horner's syndrome indicates a poor prognosis.
Intracranial & Spinal Injuries THE MOST SERIOUS BIRTH INJURIES, OFTEN LINKED TO INSTRUMENTAL OR BREECH DELIVERY
Subdural Hemorrhage Subdural hemorrhage (SDH) is the collection of blood between the dura mater and arachnoid mater, caused by tearing of the bridging veins during difficult or traumatic delivery. It is the most common intracranial hemorrhage associated with birth trauma. Etiology / Mechanism Subdural hemorrhage occurs due to rupture of bridging veins caused by excessive compression, traction, or rotational forces on the fetal head during delivery. It is commonly associated with: Instrumental delivery (forceps/vacuum) Prolonged or difficult labor Breech delivery Cephalopelvic disproportion (CPD) Macrosomia
Subdural Hemorrhage Clinical Features Poor feeding and lethargy Irritability or altered consciousness Seizures Apnea or respiratory distress Bulging anterior fontanelle Hypotonia Unequal pupils (late sign) Signs of raised intracranial pressure Diagnosis • Cranial ultrasonography (screening) • CT scan – rapid diagnosis in acute hemorrhage • MRI – most sensitive for defining the extent of injury -Management  Stabilize airway, breathing, and circulation (ABC)Control seizures with anticonvulsants  Maintain adequate oxygenation and fluid balance  Monitor neurological status and intracranial pressure  Neurosurgical evacuation if there is a large hematoma or significant mass effect
Intraventricular Hemorrhage (IVH) Intraventricular hemorrhage is bleeding into the cerebral ventricles arising from the fragile germinal matrix, seen predominantly in preterm infants; it is one of the most important causes of neonatal neurological morbidity. Etiology / Risk Factors  Extreme prematurity (<32 weeks) with fragile germinal matrix vasculature  Fluctuating cerebral blood flow (hypoxia, hypercarbia, rapid volume infusion)  Birth asphyxia and respiratory distress syndrome  Difficult or traumatic vaginal/instrumental delivery  Coagulopathy Clinical Features  May be silent/asymptomatic in mild cases (Grade I-II)  Sudden deterioration - apnea, bradycardia, falling hematocrit in severe bleed (Grade III-IV)  Bulging anterior fontanelle, seizures  Hypotonia and lethargy
Subarachnoid Hemorrhage (SAH) Subarachnoid hemorrhage is bleeding into the subarachnoid space and is the most common type of intracranial hemorrhage in term infants, usually arising from small bridging or leptomeningeal vessels. Etiology  Hypoxic-ischemic injury  Traumatic delivery - instrumental or precipitate labour  Coagulopathy  Extension from an adjoining subdural or intraventricular bleed Clinical Features & Management  Often asymptomatic - an incidental finding on imaging  Classic presentation - seizures on day 2 of life with a well infant in between episodes  Lethargy and poor feeding in some infants  Diagnosis confirmed on CT/MRI; management mainly supportive with anticonvulsants for seizures  Prognosis excellent in the majority of cases
Spinal Cord Injury Spinal cord injury is a rare but serious birth injury caused by excessive traction, hyperextension or rotation of the fetal spine during delivery, most often involving the cervical region. Mechanism Excessive longitudinal traction during breech extraction Hyperextension of the fetal head and neck Forceful rotation while managing shoulder dystocia Most common site - cervico-thoracic junction Clinical Features Flaccid paralysis below the level of injury Absent deep tendon reflexes initially (spinal shock) Diaphragmatic breathing/respiratory distress in high cervical lesions Loss of bladder and bowel control; absent response to pain below the lesion
Spinal Cord Injury: Management Management Immediate stabilization of the spine and cautious, gentle handling Respiratory support where diaphragmatic involvement is present MRI spine is the investigation of choice Multidisciplinary rehabilitation - physiotherapy and long term follow up Prognosis Guarded, and depends largely on the level and severity of injury High cervical lesions carry the poorest outcome due to respiratory compromise
Facial Nerve Palsy Facial nerve palsy is the most common cranial nerve injury at birth, caused by compression of the facial nerve as it exits the stylomastoid foramen. Mechanism Pressure from the forceps blade, particularly with outlet forceps Compression against the maternal sacral promontory in utero Prolonged pressure during a difficult vaginal delivery Clinical Features Facial asymmetry, more obvious on crying Affected side shows a smooth forehead, open eye, flattened nasolabial fold and drooping angle of mouth Forehead wrinkling preserved in peripheral type; absent forehead sparing suggests a central lesion Feeding difficulty with milk dribbling from the angle of the mouth on the affected side
Facial Nerve Palsy: Management & Prognosis Management Mostly conservative - eye protection with lubricant drops or a patch to prevent corneal drying Gentle feeding support Physiotherapy if recovery is delayed Surgical exploration rarely needed - reserved for cases with no improvement over several weeks Prognosis Peripheral (traumatic) type - excellent, recovers spontaneously within days to weeks in most infants Central type (nuclear agenesis/ CNS injury) - poorer recovery, needs further neurological evaluation Palsy persisting beyond 3 weeks needs nerve conduction studies and specialist referral
Visceral Birth Injuries Visceral injuries are rare but serious birth injuries involving trauma to abdominal or thoracic organs, occurring due to excessive compression or manipulation during a difficult delivery. Organs Commonly Involved Liver - most commonly injured organ (subcapsular hematoma or rupture) Spleen - subcapsular hematoma, especially in breech delivery Adrenal gland - adrenal hemorrhage, more common on the right side Kidney - rare, usually associated with a pre-existing renal anomaly Risk Factors Breech delivery and difficult manual extraction Macrosomia and precipitate labour Hepatosplenomegaly (e.g., due to hemolytic disease) Coagulopathy or bleeding disorder
Visceral Birth Injuries: Recognition & Management Clinical Features Often silent initially - subcapsular hematoma may go unnoticed for 24-48 hours Sudden pallor, tachycardia, abdominal distension and shock if the hematoma ruptures A palpable abdominal mass or flank/scrotal discoloration may be present Falling hematocrit with no obvious external blood loss should raise suspicion Diagnosis High index of suspicion in predisposed infants (breech, macrosomia) Abdominal ultrasound - investigation of choice for hepatic/splenic/adrenal hemorrhage Serial hematocrit and vital sign monitoring Management Conservative management with close monitoring for a stable subcapsular hematoma Correction of coagulopathy and blood transfusion for significant blood loss Emergency laparotomy if free rupture with hemoperitoneum and hemodynamic instability
INVESTIGATION OF BIRTH INJURY A systematic approach combining careful clinical examination with targeted investigations is essential to confirm the diagnosis, assess severity and guide management of birth injury. Imaging Cranial ultrasonography - bedside screening for intracranial/intraventricular hemorrhage X-ray - to confirm suspected fracture of clavicle, humerus, femur or skull CT scan - rapid assessment of acute intracranial bleed MRI - most sensitive for defining extent of nerve, soft tissue and spinal injury Laboratory Complete blood count and hematocrit - to detect significant blood loss/anemia Coagulation profile (PT/APTT, platelet count) if a bleeding disorder is suspected Serum bilirubin - to monitor hemolysis related jaundice with hematoma resorption Nerve conduction studies/EMG for peripheral nerve injury not showing recovery
GENERAL PRINCIPLES OF MANAGEMENT Management of birth injury is largely supportive and individualized, aimed at stabilizing the infant, preventing complications and promoting recovery. Prompt recognition and accurate assessment of the type and severity of injury Stabilization of airway, breathing and circulation in significant injury Gentle handling of the affected part - avoid unnecessary traction or manipulation Correction of anemia/coagulopathy where indicated Close monitoring - vital signs, neurological status and serial imaging as needed Early physiotherapy for nerve and skeletal injuries Referral to specialist (neurosurgery/orthopedics/neurology) for severe or non-resolving injury Parental counselling and reassurance - most birth injuries carry a good prognosis
PREVENTION OF BIRTH INJURY Most avoidable birth injuries can be minimized through careful antenatal assessment, skilled intrapartum care and timely decision making. Accurate antenatal assessment of fetal size, growth and presentation Careful selection of mode of delivery in suspected macrosomia or malpresentation Judicious use of instrumental delivery, performed only by an experienced operator Timely recognition of fetal distress with prompt intervention Adequate management protocol for shoulder dystocia Continuous intrapartum monitoring of maternal and fetal status Avoiding excessive traction or force at every stage of delivery
SUMMARY Birth injury results from mechanical trauma and/or hypoxia sustained during labour and delivery May be avoidable, due to preventable factors, or unavoidable, despite optimal obstetric care Ranges from minor soft tissue injury to major intracranial or spinal cord damage Predisposing factors are broadly maternal, fetal and intrapartum/instrumental Early recognition, targeted investigation and prompt supportive management improve outcome The majority of birth injuries carry a good prognosis with timely and appropriate care
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