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Updated: Jun 25, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
Severe chronic morbidity following childbirth
Tak Yeung Leung1, Tony Kwok Hung Chung
1Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China SAR. tyleung@cuhk.edu.hk
Insights
This review covers critical childbirth morbidities: obstetric fistulas, brachial plexus palsy, and birth asphyxia. Effective management requires addressing social barriers and utilizing advanced neonatal therapies like hypothermia for brain injury.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Surgical Neurology
Background:
- Childbirth complications present significant physical, psychosexual, and social challenges.
- Obstetric fistulas, brachial plexus palsy, and birth asphyxia are key morbidities with lasting impacts.
- Current knowledge and management strategies for these conditions are continually evolving.
Purpose of the Study:
- To review the latest knowledge on three significant chronic morbidities of childbirth.
- To highlight the complexities in managing obstetric fistulas, brachial plexus palsy, and birth asphyxia.
- To discuss current and innovative therapeutic approaches for these conditions.
Main Methods:
- Literature review of current scientific knowledge on obstetric fistulas, brachial plexus palsy, and birth asphyxia.
- Analysis of contributing factors, diagnostic challenges, and treatment modalities for each condition.
- Evaluation of the efficacy of neonatal hypothermic therapy for hypoxic-ischemic brain injury.
Main Results:
- Obstetric fistulas remain prevalent in underdeveloped regions, requiring socio-cultural and financial barriers to be overcome for effective treatment.
- Congenital brachial plexus palsy, linked to shoulder dystocia and macrosomia, often resolves but may necessitate micro-neurosurgery in severe cases.
- While not the primary cause of cerebral palsy, birth asphyxia-induced brain injury can be mitigated by early neonatal hypothermic therapy.
Conclusions:
- Comprehensive management of childbirth morbidities necessitates addressing underlying social determinants and improving access to care.
- Proactive training for shoulder dystocia management and early intervention for severe brachial plexus palsy are crucial.
- Neonatal hypothermia represents a promising neuroprotective strategy for infants suffering intrapartum hypoxic-ischemic insults.
Abstract:
Three special, chronic morbidities of childbirth are reviewed with the most up-to-date knowledge in this article. Firstly, obstetric fistulas secondary to prolonged obstructed labour are still prevalent tragedies in underdeveloped countries. The damage is not only physical but psychosexual and social. The surgical skill and technology required to prevent and to treat obstetric fistulas are simple, but culture-social antagonism, geographic distance, political instability and financial constraint have to be overcome before effective management can take place. Congenital brachial plexus palsy is associated with shoulder dystocia and macrosomia, and both excessive exogenous traction and strong endogenous pushing forces contribute to its occurrence. As shoulder dystocia and macrosomia are not easily predictable, regular training and drill is essential to ensure proper management of shoulder dystocia. Most of the babies with brachial palsy will recover in 3 months but a minority of patients will suffer a more severe degree of damage, requiring early micro-neurosurgical intervention. Finally, although birth asphyxia is not the major cause of cerebral palsy, brain injury resulting from acute intrapartum hypoxic-ischemic insult is potentially alleviated by early neonatal hypothermic therapy. Both clinical and radiological assessments are essential in selecting suitable candidates for this innovative neuroprotective strategy.
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