O&G · Neonatal care — birth trauma
Birth injuries
Also known as Birth trauma · Subgaleal haemorrhage · Cephalohaematoma · Caput succedaneum · Brachial plexus birth palsy · Erb's palsy · Neonatal birth injury
Exam-exhaustive FRANZCOG fellowship reference on birth injuries — the three extracranial scalp swellings (caput, cephalohaematoma, subgaleal haemorrhage) with the differentiating table, RANZCOG C-Obs 28 subgaleal haemorrhage tiered surveillance protocol, brachial plexus birth palsy natural history, clavicular fracture, facial nerve palsy, and the documentation requirements after instrumental birth. ANZ-primary, globally tagged to MRCOG and ABOG.
Practise this topic
On this page
Study tools
Your progress
Saved on this device.
Target exams
Red flags
- A baby after a difficult vacuum gets your attention for the first six hours, not the first six minutes — subgaleal bleeds over hours, not minutes
- Boggy scalp swelling that crosses suture lines, with tachycardia and pallor, is a subgaleal haemorrhage until proven otherwise — call for help and crossmatch now
- A normal early haematocrit in suspected SGH is the pre-equilibration lie — the number falls as the bleed continues
- Asymmetric Moro after a shoulder dystocia or instrumental birth is a brachial plexus injury until proven otherwise
- An asymmetric crying face that does not close the eye on the affected side is a facial nerve palsy — protect the cornea
- A palpable clavicular click or crepitus in a macrocosmic infant after a difficult delivery is a clavicular fracture — analgesia, careful handling, and the parents need to know it heals
The baby is four hours old and the vacuum cup came off twice during delivery. The midwife calls you because his scalp looks "a bit puffy". Most of the time that sentence is a caput or a cephalohaematoma and the parents go home reassured. Sometimes it is the opening of a subgaleal haemorrhage that will exsanguinate a term neonate over the next six hours. Birth injuries reward the registrar who examines the scalp systematically and punishes the one who glances and walks away.[1][4]
Overview and definition
Birth injury is tissue damage sustained during the birth process. The spectrum runs from the benign and self-limiting (caput succedaneum, mild clavicular fracture) through the serious (cephalohaematoma, brachial plexus palsy, facial nerve palsy) to the lethal (subgaleal haemorrhage). Birth trauma spans a wide range of reported rates across settings, with the serious end concentrated in instrumental births, macrosomia, malpresentation, and prolonged or precipitate labour — your unit's audit sets the local figure.[7][8]
The skill the FRANZCOG examiner is testing is not the recognition of a clavicle fracture — it is the disciplined bedside examination and structured surveillance after every instrumental birth, especially the vacuum. That is what RANZCOG C-Obs 28 codifies, and that is the spine of this topic.[1][2]
Numbers that anchor the topic
References14ShowHide
- [1]Colditz MJ, Lai MM, Cartwright DW, Colditz PB Subgaleal haemorrhage in the newborn: A call for early diagnosis and aggressive management J Paediatr Child Health, 2015.PMID 25109786
- [2]Babata K, Vadlamudi G, Bailey NA, et al. Subgaleal hemorrhage in neonates: a comprehensive review and summary recommendations J Perinatol, 2025.PMID 39284927
- [3]Reid J Neonatal subgaleal hemorrhage Neonatal Netw, 2007.PMID 17710955
- [4]Uchil D, Arulkumaran S Neonatal subgaleal hemorrhage and its relationship to delivery by vacuum extraction Obstet Gynecol Surv, 2003.PMID 14515066
- [5]Doumouchtsis SK, Arulkumaran S Head injuries after instrumental vaginal deliveries Curr Opin Obstet Gynecol, 2006.PMID 16601472
- [6]Bahl R, Hotton E, Crofts J, Draycott T Assisted vaginal birth in 21st century: current practice and new innovations Best Pract Res Clin Obstet Gynaecol, 2024.PMID 38462263
- [7]Hughes CA, Harley EH, Milmoe G, et al. Birth trauma in the head and neck Int J Pediatr Otorhinolaryngol, 1999.PMID 10037286
- [8]Parker LA Part 1: early recognition and treatment of birth trauma: injuries to the head and face Adv Neonatal Care, 2005.PMID 16338668
- [9]Oppenheim WL, Davis A, Growdon WA, et al. Clavicle fractures in the newborn Clin Orthop Relat Res, 1990.PMID 2293927
- [10]Van der Looven R, Le Roy L, Tanghe E, et al. Risk factors for neonatal brachial plexus palsy: a systematic review and meta-analysis Dev Med Child Neurol, 2020.PMID 31670385
- [11]Doumouchtsis SK, Arulkumaran S Are all brachial plexus injuries caused by shoulder dystocia? BJOG, 2009.PMID 19691859
- [12]Levidy MF, Azer A, Shafei J, et al. Global trends in surgical approach to neonatal brachial plexus palsy: a systematic review Childs Nerv Syst, 2024.PMID 39840269
- [13]Galimberti L, Garbetta G, Poloniato A, et al. Ultrasound Diagnosis of Clavicle Fractures in Newborns: A Systematic Review Diagnostics (Basel), 2024.PMID 39334614
- [14]Hale HB, Bae DS, Waters PM Current concepts in the management of brachial plexus birth palsy J Hand Surg Am, 2010.PMID 20141905