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BIRTH TRAUMA – OBSTETRIC VIEW

Birth trauma still remains an unavoidable and very actual obstetric issue. Nobody in delivery rooms can be completely protected from this obstetric complication. The focused meaning of the term that will be discussed here represents only physical injuries to the fetus / newborn and the mother. Those birth injuries usually happen as a consequence of an extreme intrapartal mechanical forces acting directly to bony and soft connective tissues of fetal or maternal organisms. All obstetric interventions are at some degree risky and there are no absolutely accurate solutions. Although birth traumas are most often connected with vaginal deliveries, children delivered by cesarean section are not totally protected from those injuries. The incidence of some birth traumas did not change significantly during time, while some other forms of injuries appear more rarely. There are several classifications of birth traumas as well as their main causes, but a new basic classification into objective and subjective causes of intrapartal injuries is very important from both the obstetrical and medico-legal points of view. The causes could be defined as objective, if they are commonly associated with an increased risk of fetal and maternal injuries, if the injuries are usually more frequent or almost always result from those specific delivery situations, and if they are independent or modestly dependent of obstetrician’s experience. All intrapartal unfortunate events associated with rare and prenatally undetected diseases or pathological fetal conditions that are directly attributable to development of injuries despite correctly performed obstetric interventions, are also included in the same group of causes. Subjective causes of birth injuries most often involve birth injury incidents as consequence of incorrect, negligent and superficial obstetric procedures in otherwise low-risk clinical situations. Birth injuries can be mild and transitory with a good outcome, but also tragic and devastating events with lethal consequences. Apart from perinatological significance, which comes from its influence on peripartal mortality and morbidity, birth trauma is very important from medico-legal aspects. Medico-legal and financial consequences are important to those children, their parents, medical staff, and the whole society. That is why the effective primary and secondary prevention of birth injuries are needed unconditionally. Obstetrician’s correct and timely decisions and measures can greatly reduce birth traumas and their serious consequences.

birth trauma ; vaginal delivery ; operative deliveries ; perinatal care ; professional responsibility

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