Obstetrics and Gynaecology · MU Sofia

33. Birth canal injuries and fetal trauma - types, diagnosis, management, prevention

Covers maternal birth canal injuries, starting with a table of perineal tears from first to fourth degree, with the structures involved and repair approach for each, then risk factors and prevention including episiotomy angle. It then lists cervical tears, vaginal haematoma, uterine rupture and pelvic floor damage. Fetal injuries follow in a comparison table of scalp and skull lesions, brachial plexus, clavicle and facial nerve injuries, with a closing section on shoulder dystocia management and a note contrasting caput with cephalhaematoma.

Inside: 2 sections · 2 tables · 15 flashcards · 2 min

Topic 33 of 61 in the MU Sofia syllabus for Obstetrics and Gynaecology (Dental Medicine, Year 4). The free AceMed note covers it in 2 sections, about 208 words (2 min of reading), with 15 flashcards.

In this note

  1. Maternal birth injuries
  2. Fetal birth injuries

Maternal birth injuries

Perineal tears

Risk factors: first vaginal birth, birth weight > 4 kg, forceps, occipito-posterior position, long second stage, shoulder dystocia. Prevention: controlled delivery of the head, perineal support and warm compresses, mediolateral episiotomy (at 60° from the midline) when an instrumental delivery is needed. Missed sphincter injury causes anal incontinence.

Other maternal injuries

  • Cervical tears: bleeding with a well-contracted uterus; inspect and suture.
  • Vaginal and vulval haematoma: severe pain, a tense swelling, shock; drain and ligate if large.
  • Uterine rupture: mostly after a previous caesarean (≈ 0.5% in a trial of labour), also obstructed labour, oxytocin misuse, trauma. Signs: fetal bradycardia (first sign), sudden pain, loss of contractions, the presenting part moves up, shock. Treatment: laparotomy, delivery, repair or hysterectomy.
  • Pelvic floor damage (prolapse and incontinence later), symphysis separation, obstetric fistula after obstructed labour.

Fetal birth injuries

Shoulder dystocia

The anterior shoulder sticks behind the symphysis after the head is born ("turtle sign"). Risk factors: macrosomia, diabetes, obesity, prolonged labour, instrumental delivery. Management: call for help, no pulling or fundal pressure, McRoberts position (thighs flexed onto the abdomen) and suprapubic pressure, then internal manoeuvres (Rubin, Woods screw, delivery of the posterior arm) or all-fours position.

Caput crosses the sutures and is there at birth; cephalhaematoma respects the sutures and appears later.

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