Birth Trauma, Perinatal Asphyxia, and Iatrogenic Respiratory Distress

Abstract

Birth injuries are customarily defined as injuries associated with mechanical forces producing hemorrhage, edema, tissue disruption, or alteration of organ function during the intrapartum period.1 It is unfortunate that the term birth injury has often been used to connote avoidable injury caused by negligence; in the vast majority of cases this implication is unjustified. Virtually all forms of birth trauma can occur in spontaneous, uncomplicated full-term deliveries as well as from obstetric interventions.2 The risk is increased by various maternal and fetal factors, e.g., macrosomia, cephalopelvic disproportion, dystocia, fetal malformations or masses, prematurity, prolonged labor, abnormal presentation, as well as the obstetric techniques needed to manage complicated deliveries, including forceps applications (rotations and midforceps) and version and extraction. Of these, breech extraction is associated with the greatest potential for morbidity (until recently, approximately fourfold greater than that associated with cephalic presentations). Although forceps or vaccuum extraction per se may not cause injury in a given case, the indications for which they are used may predispose to the occurrence of the injury.