The Blues have failed to win any of their last 13 matches and are two points above the dropzone ahead of this final-day clash with Derby, who can finish no higher than 10th.
A poor campaign for Birmingham that led to the departure of Pep Clotet two weeks ago could yet get even worse should results go against them on Wednesday.
City lost for a fourth time in five matches last time out, going down 2-0 to Preston North End, and are now left sweating on their place in the second tier.
Three of eight teams can still be relegated, with 13th-placed Wigan Athletic included in the equation given they are set to be hit with a 12-point deduction.
Taking their superior goal difference into account, a point against Derby will be enough for the Blues to stay in the division for another season.
On their longest winless run since 1994, however, and without a win in six home matches against Derby, the picture looks pretty bleak for Birmingham heading into this final match.
Derby will take great joy in furthering their city rivals' misery, but they themselves are badly out of form following a run of four defeats in a row.
Four successive wins either side of the three-month shutdown had Derby in playoff contention, but they have fallen way off the pace since then and are down in 12th place.
The Rams have kept just one clean sheet on the road in the Championship this season - two fewer than any other side in the division - and have lost their last two away matches.
Philip Cocu will use the shortened summer break to work out what went wrong for his side in his debut campaign, which has been full of more lows than highs.
Following a run of five successive games against teams in the top six, the Dutchman will very much be eager to ensure that 2019-20 does not end with a fifth defeat on the spin.
Birmingham City's Championship form: LLLLDL
Derby County's Championship form: WDLLLL
Borussia Dortmund completed the signing of Jude Bellingham on Monday, but the talented midfielder will make one more appearance for Birmingham before departing.
Derby are without Tom Lawrence after the Wales international picked up an injury early on in the loss to Leeds United on Sunday.
Birmingham City possible starting lineup:
Camp; Colin, Roberts, Dean, Pedersen; Crowley, Sunjic, Bellingham, Bela; Hogan, Jutkiewicz
Derby County possible starting lineup:
Roos; Bogle, Clarke, Davies, Lowe; Rooney, Bird; Waghorn, Sibley, Knight; Martin
We say: Birmingham City 1-1 Derby County
Birmingham supporters will be wondering just how their survival fight has gone down to the last game. Derby have also been in poor form, albeit without the threat of relegation, and we are expecting this one to finish all square.