Neurological Morbidity of Term Infants as an Indicator of Safe Obstetrical Practice
The Stresses of a “Normal” Delivery Have Been a Long-standing Source of Anxiety Among Obstetricians. Lacomme wrote in 1960: “I do not know what a ‘normal delivery’ is; I only know of an ‘optimal’ labor, i.e. labor where minimal stress is exerted on the fetus.” Later on, with fetal heart rate (FHR) monitoring and acid base balance measurements during labor, the definition of an “optimal labor” was refined by taking into account: mechanical forces related to uterine contractions, hemodynamic changes associated with uterine contractions, and secondary fetal changes, as reviewed in 1974 by Sureau. However, the obstetrical anxiety not only persisted but increased with each new method of evaluating the risk of fetal asphyxia. In 1973, Valkeakari offered the first echoencephalographic demonstration of changes in the fetal brain as the result of a normal cephalic delivery. These changes were midline shifts depending on the fetal position during the vaginal delivery (significant with p less than 0.05 from 6 to 12 h postnatally) which were probably related to cerebral edema (normal up to 3 h and back to normal at 24 h). At the same time, it appeared clinically (Amiel-Tison et al. 1977 a) that mild signs of cerebral dysfunction linked with the birth process were often observed in the absence of overt fetal distress and therefore with Apgar scores of 8 or more at 1 and 5 min, particularly in occipito posterior presentations.
KeywordsCesarean Section Fetal Heart Rate Cesarean Section Rate Birth Asphyxia Cerebral Dysfunction
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