Which delivery scenario increases risk of neonatal spinal injury due to neck hyperextension during delivery?

• A. Vertex presentation
• B. Breech presentation with intrauterine neck hyperextension
• C. Face presentation
• D. Transverse lie

Answer: (B)

Neonatal cervical spine injury risk rises when the neck is placed into excessive extension with traction during delivery. This risk is highest with breech delivery when the body is delivered first and the head is delivered last, requiring maneuvers that extend and pull on the neck to release the head. If the neck is already hyperextended inside the uterus, these forces are amplified, making injury to the cervical vertebrae or spinal cord more likely.

In vertex presentations, the head is typically flexed as it descends, reducing the amount of neck extension and associated traction. Transverse lie changes the delivery mechanics to the side, not predominantly stressing the neck in extension during head delivery. Face presentation involves neck extension to deliver the face, but the specific combination of breech delivery with preexisting intrauterine neck hyperextension creates a situation where the risk of cervical spine injury during extraction is especially elevated.