Newborn Penile Trauma in Delayed Breech Presentation: A Case Study

Breech presentation occurs in a small number of term pregnancies and can result in increased neonatal morbidity. Genital trauma, although uncommon, is a possible complication of footling breech presentation, especially when maternal presentation for cesarean section is delayed. One such case is that of a suspected 35-week gestational-age male neonate born via emergency cesarean section for footling breech. The mother had a history of polysubstance abuse and received no prenatal care due to her unawareness of the pregnancy until a delayed presentation at labor and delivery. At delivery, the neonate was seen to have superficial penile trauma with sloughing of the scrotal skin in addition to bruising of the prepuce. Further evaluation confirmed that injuries were limited to the superficial dermis, and deeper genitourinary structures were spared. The neonate's injuries were treated conservatively with topical bacitracin and supportive care, with complete resolution seen in the neonatal intensive care unit by the seventh day of life. Recovery was complicated by neonatal abstinence syndrome and gram-positive sepsis, both of which were managed appropriately. This case highlights a rare but preventable complication of footling breech presentation. Mechanical compression and friction with uterine contractions during labor likely played a role in the genital injury. Conservative management proved adequate for mild superficial injuries such as this one, and no long-term complications are expected. This case reaffirms the importance of prenatal care. With routine prenatal care, footling breech presentation would have been identified, a cesarean section would have been planned, and mechanical trauma during labor avoided. Early recognition and consistent follow-ups are necessary for uncomplicated deliveries.