Injury to the fetus during childbirth due to factors such as malposition of the fetus, cephalopelvic disproportion, and forceps is called birth trauma. In recent years, with the advancement of obstetric techniques and the increase in cesarean section rates, the incidence of birth trauma has significantly decreased.

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Injuries are described according to the affected parts as follows.

1. Soft tissue injuries

1. Abrasions and bruises: Commonly seen in cases of prolonged labor, difficult delivery, or abnormal fetal positions. They 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, discolored, and show petechiae. No special treatment is required, as these resolve spontaneously within a week.
2. Subcutaneous fat necrosis: Often caused by childbirth injury, hypoxia, or excessive cold exposure. 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 neonatal leredema neonatorum and cellulitis. Generally, no treatment is needed, as it gradually resolves in 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 within the sternocleidomastoid 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 should be tilted toward the unaffected side, with gentle traction in the antagonistic direction, 15–20 repetitions per session, 4–6 times daily. After traction, local tuina or warm compresses can be applied. If the lump persists for 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 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 aspiration should be avoided to prevent secondary infection.
3. Skull fracture: Often occurs in forceps-assisted deliveries, presenting as linear or depressed fractures. Mild cases may be asymptomatic. Severe depressed fractures may compress brain tissue, and vascular injury may lead to 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 injuries

1. Facial nerve palsy: Often caused by forceps injury to the facial nerve, manifesting as flattening of the nasolabial fold on the affected side, deviation of the mouth toward the unaffected side, widened palpebral fissure, and inability to close the eye. Usually, no treatment is needed. If no recovery occurs after two weeks, acupuncture, tuina, physiotherapy, and vitamin B1/B12 may be used. The unclosed eye must be protected to prevent corneal ulceration.
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 paralysis): 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 paralysis): Involves the C8 to T1 nerve roots, causing weakness in the wrist flexors and hand muscles, with a weak grasp reflex.
   3. Total arm type: Rare, combining symptoms of both types. If the cervical sympathetic nerves are injured, ptosis and miosis may occur, presenting as Horner’s syndrome.
   For brachial plexus nerve injury, the shoulder should be rested, and movement 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 the C3, C4, and C5 nerve roots. The affected side's diaphragm is paralyzed, manifesting as 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 pneumonia recurs, surgical intervention may be required.
4. Spinal injury: Often occurs in the cervical or thoracic region. Manifestations include flaccid paralysis of distal muscles, drooping of the upper eyelid (blepharoptosis), constricted pupils, and severe incontinence of urine. X-rays may reveal spine fracture or dislocation. Mild cases may recover spontaneously, while severe cases can be fatal.

IV. Fracture

Commonly seen in breech presentations, macrosomic infants, or difficult shoulder or limb deliveries, most frequently involving 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 absence of the Moro reflex. X-ray confirms the diagnosis. If dislocation is present, an 8-shaped bandage should be applied to immobilize the shoulder. Callus formation occurs within 2–3 weeks. In recent years, no intervention is typically required as it heals spontaneously.
2. Long bone fracture (humerus, femur): Most commonly involves the midshaft of the humerus or femur, presenting with localized swelling, shortening of the affected limb, pseudoparalysis, and bone crepitus. X-ray confirms the diagnosis. The affected limb can be reduced via traction and immobilized in a functional position. Femur fractures may be treated with bilateral lower limb suspension traction. Healing generally occurs within 3–8 weeks.

V. 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 present with subtle early symptoms but can lead to shock or even death in severe cases.