Causes of birth asphyxia and trauma.

Causes of birth asphyxia and trauma were determined in the 208 most severely affected infants of 10,995 consecutive live births; 159 infants had cerebral disturbances, 39 had fractures and palsies, and 10 had fractures or palsies in addition to cerebral disturbances. Most frequent causes of birth asphyxia and trauma were: prolonged labour, midforceps or breech delivery in full-term infants; abruption placentae, difficult breech delivery, and maternal sedation in premature infants; and unattended precipitate deliveries in immature infants. Asphyxia following normal labour and delivery usually occurred in infants with fetal malnutrition.Improved obstetrical management with more frequent use of Cesarean section delivery might have been of value in preventing much of this fetal injury.Asphyxia and trauma due to complications of delivery were twice as frequent on the ward as on the private service. This may have been due in part to a lower Cesarean section rate on the ward service. A monthly review of birth asphyxia and trauma is recommended to help maintain a high standard of obstetrical practice.