Skip to main content Accessibility help
×
Hostname: page-component-7c8c6479df-24hb2 Total loading time: 0 Render date: 2024-03-29T12:04:42.285Z Has data issue: false hasContentIssue false

Chapter 63 - Fetal Compromise in Labor (Content last reviewed: 15th December 2018)

from Section 6 - Late Prenatal – Obstetric Problems

Published online by Cambridge University Press:  15 November 2017

David James
Affiliation:
University of Nottingham
Philip Steer
Affiliation:
Imperial College London
Carl Weiner
Affiliation:
University of Kansas
Bernard Gonik
Affiliation:
Wayne State University, Detroit
Stephen Robson
Affiliation:
University of Newcastle
Get access

Summary

For many years it was taken to indicate the presence of hypoxia, leading to fetal acidosis. However, we have become more aware of the importance to the fetus of variables such as maternal/fetal temperature, chorioamnionitis, passage of meconium into the amniotic fluid (which can lead to meconium aspiration syndrome), and trauma, including events such as cord prolapse and head compression (which can occur from excessive molding even in spontaneous labor, but is more commonly associated with forceps and difficult cesarean deliveries).

Type
Chapter
Information
High-Risk Pregnancy
Management Options
, pp. 1788 - 1809
Publisher: Cambridge University Press
First published in: 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Greenwell, EA, Wyshak, G, Ringer, SA, et al. Intrapartum temperature elevation, epidural use, and adverse outcome in term infants. Pediatrics 2012; 129: e447–54.Google Scholar
Hulthen, V,I, Petersson, K, Kublickas, M, Papadogiannakis, N. Both acute and chronic placental inflammation are overrepresented in term stillbirths: a case-control study. Infect Dis Obstet Gynecol 2012; 2012: 293867.Google Scholar
Balchin, I, Whittaker, JC, Lamont, RF, Steer, PJ. Maternal and fetal characteristics associated with meconium-stained amniotic fluid. Obstet Gynecol 2011; 117: 828–35.CrossRefGoogle ScholarPubMed
Singh, M, Varma, R. Reducing complications associated with a deeply engaged head at caesarean section: a simple instrument. Obstetrician & Gynaecologist 2008; 10: 3841.CrossRefGoogle Scholar
Steer, P. Has the expression “fetal distress” outlived its usefulness? Br J Obstet Gynaecol 1982; 89: 690–3.Google Scholar
Addy, DP. Birth asphyxia. Br Med J 1982; 284: 1288–9.Google Scholar
Towell, M. Fetal acid base physiology and intrauterine asphyxia. In Goodwin, JW, Godden, JO, Chance, GW (eds), Perinatal Medicine, the Basic Science Underlying Clinical Practice. Baltimore, MD: Williams & Wilkins, 1976, pp. 187208.Google Scholar
Beard, RW, Morris, ED, Clayton, SG. pH of foetal capillary blood as an indicator of the condition of the foetus. J Obstet Gynaecol Br Commonw 1967; 74: 812–22.Google Scholar
American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 348, November 2006: Umbilical cord blood gas and acid–base analysis. ACOG Committee on Obstetric Practice. Obstet Gynecol 2006; 108: 1319–22.Google Scholar
Sykes, GS, Molloy, PM, Johnson, P, et al. Do Apgar scores indicate asphyxia? Lancet 1982; i: 494–5.Google Scholar
Lissauer, TJ, Steer, PJ. The relation between the need for intubation at birth, abnormal Cardiotocograms in labour and cord artery blood gas and pH values. Br J Obstet Gynaecol 1986; 93: 1060–6.Google Scholar
Bennet, L, Westgate, JA, Liu, YC, Wassink, G, Gunn, AJ Fetal acidosis and hypotension during repeated umbilical cord occlusions are associated with enhanced chemoreflex responses in near-term fetal sheep. J Appl Physiol 2005; 99: 1477–82.Google Scholar
Westgate, JA, Wibbens, B, Bennet, L, et al. The intrapartum deceleration in center stage: a physiologic approach to the interpretation of FHR changes in labor. Am J Obstet Gynecol 2007; 197: 236.e1–11Google Scholar
National Institute for Health and Care Excellence. Intrapartum Care for Healthy Women and Babies. NICE Clinical Guideline CG190. London: NICE, 2017. www.nice.org.uk/guidance/CG190 (accessed September 2018).Google Scholar
American College of Obstetricians and Gynecologists. Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation and General Management Principles. ACOG Practice Bulletin No. 106. Washington, DC: ACOG, 2009.Google Scholar
Steer, PJ, Eigbe, F, Lissauer, TJ, Beard, RW. Interrelationships among abnormal cardiotocograms in labor, meconium staining of the amniotic fluid, arterial cord blood pH and Apgar scores. Obstet Gynecol 1989; 74: 715–21.Google Scholar
Wheeler, T, Murrills, A. Patterns of FHR during normal pregnancy. Br J Obstet Gynaecol 1978; 85: 1827.Google Scholar
Westgate, JA, Bennet, L, Gunn, AJ. FHR variability changes during brief repeated umbilical cord occlusion in near term fetal sheep. Br J Obstet Gynaecol 1999; 106: 664–71Google Scholar
Badawi, N, Kurinczuk, JJ, Keogh, JM, et al. Intrapartum risk factors for newborn encephalopathy: the Western Australian case-control study. BMJ 1998; 317: 1554–8.Google Scholar
McNamara, H, Johnson, N. The effect of uterine contractions on fetal oxygen saturation. Br J Obstet Gynaecol 1995; 102: 644–7Google Scholar
Simpson, KR, James, DC. Effects of oxytocin-induced uterine hyperstimulation during labor on fetal oxygen status and FHR patterns. Am J Obstet Gynecol 2008; 199: 34.e1–5CrossRefGoogle Scholar
Peebles, DM, Spencer, JA, Edwards, AD, et al. Relation between frequency of uterine contractions and human fetal cerebral oxygen saturation studied during labour by near infrared spectroscopy. Br J Obstet Gynaecol 1994; 101: 44–8Google Scholar
Skupski, DW, Rosenberg, CR, Eglinton, GS. Intrapartum fetal stimulation tests: a meta-analysis. Obstet Gynecol 2002; 99: 129–34Google Scholar
Vintzileos, AM, Nochimson, DJ, Guzman, ER, et al. Intrapartum electronic FHR monitoring versus intermittent auscultation: a meta-analysis. Obstet Gynecol 1995; 85: 149–55.Google Scholar
Thacker, SB, Stroup, DF. Continuous electronic heart rate monitoring for fetal assessment during labor. Cochrane Database Syst Rev 2000; (2): CD000063.Google Scholar
Alfirevic, Z, Devane, D, Gyte, GM Cuthbert, A. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev 2017; (2): CD006066.Google Scholar
East, CE, Leader, LR, Sheehan, P, Henshall, NE, Colditz, PB. Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of a non-reassuring FHR trace. Cochrane Database Syst Rev 2010; (3): CD006174.Google Scholar
Briozzo, L, Martinez, A, Nozar, M, et al. Tocolysis and delayed delivery versus emergency delivery in cases of non-reassuring fetal status during labor. J Obstet Gynaecol Res 2007;33: 266–73.CrossRefGoogle ScholarPubMed
Neilson, JP. Fetal electrocardiogram (ECG) for fetal monitoring during labour. Cochrane Database Syst Rev 2015; (12): CD000116.Google Scholar
Olofsson, P, Ayres-de-Campos, D, Kessler, J, et al. A critical appraisal of the evidence for using cardiotocography plus ECG ST interval analysis for fetal surveillance in labor. Part II: the meta-analyses. Acta Obstet Gynecol Scand. 2014; 93: 571–86Google Scholar
Doria, V, Papageorghiou, AT, Gustafsson, A, et al. Review of the first 1502 cases of ECG-ST waveform analysis during labour in a teaching hospital. BJOG 2007; 114: 1202–7.CrossRefGoogle ScholarPubMed
Chandraharan, E. Foetal electrocardiograph (ST-analyser or STAN) for intrapartum foetal heart rate monitoring: a friend or a foe? J Matern Fetal Neonatal Med 2017 Jan 23: 1–8. doi: 10.1080/14767058.2016.1276559. [Epub ahead of print]Google Scholar
Mozurkewich, E, Wolf, FM. Near-infrared spectroscopy for fetal assessment during labour. Cochrane Database Syst Rev 2000; (3): CD002254.Google Scholar
Belfort, MA, Saade, GR, Thom, E, et al. A randomized trial of intrapartum fetal ECG ST-segment analysis. N Engl J Med 2015; 373: 632–41.Google Scholar
Xodo, S, Saccone, G, Schuit, E, Amer-Wåhlin, I, Berghella, V. Why STAN might not be dead. J Matern Fetal Neonatal Med 2016 Nov 2:1–3. [Epub ahead of print]Google Scholar
Bhide, A, Chandraharan, E, Acharya, G. Fetal monitoring in labor: implications of evidence generated by new systematic review. Acta Obstet Gynecol Scand 2016; 95: 58.Google Scholar
Blix, E, Brurberg, KG, Reierth, E, Reinar, LM, Øian, P. ST waveform analysis vs. cardiotocography alone for intrapartum fetal monitoring: a systematic review and meta-analysis of randomized trials. Acta Obstet Gynecol Scand 2015; 95: 1627.CrossRefGoogle Scholar
Nickelsen, C, Thomsen, SG, Weber, T. Continuous acid-base assessment of the human fetus during labour by tissue pH and transcutaneous carbon dioxide monitoring. Br J Obstet Gynaecol 1985; 92:220225.Google Scholar
East, CE, Begg, L, Colditz, PB, Lau, R. Fetal pulse oximetry for fetal assessment in labour. Cochrane Database Syst Rev 2014; (10): CD004075.Google Scholar
Ennis, M, Vincent, CA. Obstetric accidents: a review of 64 cases. BMJ 1990; 300: 1365–7.Google Scholar
Vincent, CA, Martin, T, Ennis, M. Obstetric accidents: the patient’s perspective. Br J Obstet Gynaecol 1991; 98: 390–5.Google Scholar
Maternal and Child Health Research Consortium. Confidential Enquiry Into Stillbirths and Deaths in Infancy (CESDI) 6th Annual Report. London: MCHRC, 1999.Google Scholar
NHS Litigation Authority. Study of Stillbirth Claims. London: NHSLA, 2009. http://www.nhsla.com/Safety/Documents/NHS%20Litigation%20Authority%20Study%20of%20Stillbirth%20Claims.pdf (accessed March 2007).Google Scholar
Keith, RD, Beckley, S, Garibaldi, JM, et al. A multicentre comparative study of 17 experts and an intelligent computer system for managing labour using the cardiotocogram. Br J Obstet Gynaecol 1995; 102: 688700.Google Scholar
INFANT Collaborative Group. Computerised interpretation of fetal heart rate during labour (INFANT): a randomised controlled trial. Lancet 2017; 389: 1719–29.Google Scholar
MacDonald, D, Grant, A, Sheridan-Pereira, M, Boylan, P, Chalmers, I. The Dublin randomized controlled trial of intrapartum fetal heart rate monitoring. Am J Obstet Gynecol 1985; 152: 524–39.Google Scholar
Nunes, I, Ayres-de-Campos, D, Ugwumadu, A, et al. Central fetal monitoring with and without computer analysis: a randomized controlled trial. Obstet Gynecol 2017; 129: 8390.Google Scholar
Royal College of Obstetricians and Gynaecologists. Each Baby Counts. www.rcog.org.uk/eachbabycounts (accessed September 2018).Google Scholar
Balchin, I, Whittaker, JC, Patel, RR, Lamont, RF, Steer, PJ. Racial variation in the association between gestational age and perinatal mortality: prospective study. BMJ 2007; 334: 833.Google Scholar
Balchin, I, Whittaker, JC, Lamont, RF, Steer, PJ. Timing of planned cesarean delivery by racial group. Obstet Gynecol 2008; 111: 659–66.CrossRefGoogle ScholarPubMed
Patel, RR, Steer, P, Doyle, P, Little, MP, Elliott, P. Does gestation vary by ethnic group? A London-based study of over 122,000 pregnancies with spontaneous onset of labour. Int J Epidemiol 2004; 33: 107–13.Google Scholar
Davis, RO, Philips, JB, Harris, BA, Wilson, ER, Huddleston, JF. Fatal meconium aspiration syndrome occurring despite airway management considered appropriate. Am J Obstet Gynecol 1985; 151: 731–6.Google Scholar
Cunningham, AS, Lawson, EE, Martin, RJ, Pildes, RS. Tracheal suction and meconium: a proposed standard of care. J Pediatr 1990; 116: 153–4.Google Scholar
Kelleher, J, Bhat, R, Salas, AA, et al. Oronasopharyngeal suction versus wiping of the mouth and nose at birth: a randomised equivalency trial. Lancet 2013; 382: 326–30.CrossRefGoogle ScholarPubMed
Frey, HA, Tuuli, MG, Shanks, AL, Macones, GA, Cahill, AG. Interpreting category II FHR tracings: does meconium matter? Am J Obstet Gynecol 2014; 211: 644–8.Google Scholar
Geenes, V, Chappell, LC, Seed, PT, et al. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective population-based case-control study. Hepatology 2014; 59: 1482–91.Google Scholar
Hofmeyr, GJ, Xu, H, Eke, AC. Amnioinfusion for meconium-stained liquor in labour. Cochrane Database Syst Rev 2014; (1): CD000014.Google Scholar
Task Force on Joint Assessment of Prenatal and Perinatal Factors Associated with Brain Disorders. National Institutes of Health report on causes of mental retardation and cerebral palsy. Pediatrics 1985; 76: 457–8.Google Scholar
Gaffney, G, Sellers, S, Flavell, V, Squier, M, Johnson, A. Case–control study of intrapartum care, cerebral palsy, and perinatal death. BMJ 1994; 308: 743–50.Google Scholar
Nelson, KB. Perspective on the role of perinatal asphyxia in neurologic outcome: its role in developmental deficits in children. Can Med Assoc J 1989; 141 (Suppl.): 310.Google Scholar
NHS Resolution. Annual Report and Accounts 2017/18. London: NHS, 2018. https://resolution.nhs.uk/wp-content/uploads/2018/08/NHS-Resolution-Annual-Report-2017-2018.pdf (accessed September 2018).Google Scholar
Berglund, S, Grunewald, C, Pettersson, H, Cnattingius, S. Severe asphyxia due to delivery-related malpractice in Sweden 1990–2005. BJOG 2008; 115: 316–23.Google Scholar
Beckley, S, Stenhouse, E, Greene, K. The development and evaluation of a computer-assisted teaching programme for intrapartum fetal monitoring. BJOG 2000; 107: 1138–44.Google Scholar
Barrett, JM. Funic reduction for the management of umbilical cord prolapse. Am J Obstet Gynecol 1991; 165: 654–7.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×