• Clinical science

Birth traumas


Birth trauma is an injury to the newborn caused by mechanical forces during birth. Risk factors include macrosomia, abnormal fetal presentation, prolonged or rapid labor, and forceps or vacuum deliveries. Soft tissue injuries of the scalp include benign cephalohematoma and caput succedaneum, as well as subgaleal hemorrhages, which are associated with a high risk of significant blood loss and require monitoring. The most common skeletal injury is the clavicle fracture, which is often asymptomatic and heals spontaneously within 7–10 days. Skeletal or muscular birth injuries may cause torticollis, a unilateral contraction of the sternocleidomastoid muscle with a resulting head tilt. Other birth injuries include nerve damage, such as brachial plexus injury and facial nerve palsy, which may cause temporary muscle weakness or paralysis. The prognosis of birth traumas is usually favorable, with most injuries resolving spontaneously within weeks to months.

Risk factors


Neonatal soft tissue injuries

Soft tissue injuries of the scalp in infants are mostly caused by shearing forces during vacuum or forceps delivery. Whereas caput succedaneum and cephalohematoma are benign conditions and resolve spontaneously, subgaleal hemorrhages require close monitoring and fluid replacement to prevent hemorrhagic shock.

  • Head molding: a transient deformation of the head into an elongated shape due to external compression of the fetal head as it passes through the birth canal during labor; typically resolves within a few days after the birth
  • Caput succedaneum: benign edema of the scalp tissue that extends across the cranial suture lines
  • Cephalohematoma: subperiosteal hematoma that is limited to cranial suture lines
  • Subgaleal hemorrhage: rupture of the emissary veins and bleeding between the periosteum of the skull and the aponeurosis; that may extend across the suture lines; associated with a high risk of significant hemorrhage and hemorrhagic shock


Birth-related clavicle fracture

  • Epidemiology: most common fracture during birth (∼ 2% of deliveries)
  • Clinical features
    • Usually asymptomatic
    • Possible pseudoparalysis
    • Bone irregularities, crepitus, and tenderness over the clavicle possible on palpation
    • Possible brachial plexus palsy
  • Diagnostics: : clinical diagnosis; X-ray; only indicated in cases of gross bone deformation
  • Treatment
    • Reassurance and promote gentle handling of the arm (e.g., while dressing)
    • To avoid discomfort, pin shirt sleeve to the front of the shirt with the arm flexed at 90 degrees
    • Consider analgesics
    • Follow-up 2 weeks later to confirm proper healing: via clinical findings of a callus formation, and possibly an x-ray
    • Usually self-resolves within 2–3 weeks without surgical intervention or long-term complications


Infant torticollis


Facial nerve palsy due to birth trauma

  • Epidemiology: most common cranial nerve injury during birth
  • Pathomechanism
    • Injury occurs during forceps-assisted delivery (most common)
    • Prolonged birth in which the head is pressed against the maternal sacral promontory
  • Clinical features
  • Treatment: eye care with artificial tears and ointment
  • Prognosis: spontaneous recovery in 90% of cases within several weeks


Neonatal brachial plexus palsy

Shoulder dystocia

Shoulder dystocia maneuvers
McRoberts maneuver
  • The patient should stop bearing down and lie supine with the buttocks on the edge of the bed.
  • Abduct, externally rotate, and hyperflex the maternal hips (with the maternal legs pulled towards the head).
Internal maneuvers Rubin maneuver*
Woods maneuver*
Delivery of posterior arm
Zavanelli maneuver

* May be performed with the McRoberts maneuver and may require episiotomy.

Most cases of shoulder dystocia occur in the absence of identifiable risk factors!

Do not pull the fetal head! Doing so may cause brachial plexus injury (Erb palsy). References:[11][12][13][14]