A Systematic Review of Intrapartum Fetal Head Compression: What Is the Impact on the Fetal Brain?

Heyborne, Kent

doi:10.1055/s-0037-1602658

Cited by 18 publications

(4 citation statements)

References 28 publications

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“…This is not consistent with the observation of clinicians who had experience of the British system for almost four decades before 2007 (Figures 4-6) [3,[24][25][26][27]. Headcompression decelerations are not associated with cerebral ischemia or anoxia and hence are due to benign reflex mechanisms [33]. The claim that early decelerations must be "gradual" has been shown to be posttruth ideology [3].…”

Section: Myth No 2 Myth: "True" Early Decelerations Are Very Rarementioning

confidence: 89%

Myths at the core of Intrapartum Cardiotocography Interpretation – Risks of false Ideology, Prospect theory and way forward

Sholapurkar¹

2019

Clin Obstet Gynecol Reprod Med

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Meaningful and scientific cardiotocography (CTG) interpretation is vital to minimise intrapartum fetal asphyxia and its serious consequences. This paper analyses myths at the heart of cardiotocography viz. the majority 'rapid' fetal heart rate (FHR) decelerations are variable (from cord-compression), early decelerations must be 'gradual', shoulders are indicative of cord-compression, true early decelerations are extremely rare etc. The burgeoning scientific knowledge about human cognitive biases in the last few decades helps us to understand these myths and to find a way forward. Importantly, this paper demonstrates that the current unscientific untruthful framework of pattern-recognition of FHR decelerations based on misconceived ideology (rapid vs gradual) is not just semantics, but is posing a serious risk to the unborn babies because of dysfunctional interpretation. The commonest cause of fetal hypoxemia in labor is contraction induced drop in uteroplacental perfusion and not cord-compression at all. There is 'false-alarm fatigue' due to overburden of atypical variable decelerations. Concurrently, deep late decelerations are increasingly misinterpreted as 'variable' in UK, leading to confusion, complacency and dangerous procrastination. Nobel prize winning Prospect theory of decision making informs us that the British obstetricians and British guideline-groups are in the best position to discard these myths and put CTG interpretation on a sound scientific basis. This is because they have the 'reference point' of primarily timing-based scientific categorization of FHR decelerations (majority early) for four decades before 2007. Without this reform, the cardiotocography and its computerized interpretation will remain blighted. Obstetricians, midwives and guideline-groups need to overcome the inertia and urgently address these unsafe myths.

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Section: Myth No 2 Myth: "True" Early Decelerations Are Very Rarementioning

confidence: 89%

Myths at the core of Intrapartum Cardiotocography Interpretation – Risks of false Ideology, Prospect theory and way forward

Sholapurkar¹

2019

Clin Obstet Gynecol Reprod Med

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“…There is considerable controversy about the role of head compression as a cause of FHR decelerations and of adverse perinatal outcome, as one would expect when any new approach is introduced that challenges embedded dogma or recalls neglected science. Some doubt its existence [94]; others reject its pertinence to clinical outcomes, except perhaps in the most extreme circumstances [38]; others focus on its medico-legal implications [95] [96], and some advise caution before rejecting the notion [97].…”

Section: The Head Compression Controversymentioning

confidence: 99%

Fetal Head Compression: Its Possible Role in Neurologic Injury

Schifrin,

Koos,

Cohen

2024

OJOG

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It is widely assumed that fetal ischemic brain injury during labor derives almost exclusively from severe, systemic hypoxemia with marked neonatal depression and acidemia. Severe asphyxia, however, is one of several causes of perinatal neurological injury and may not be the most common; most neonates diagnosed with hypoxic-ischemic encephalopathy do not have evidence of severe asphyxia. Sepsis, direct brain trauma, and drug or toxin exposure account for some cases, while mechanical forces of labor and delivery that increase fetal intracranial pressure sufficiently to impair brain perfusion may also contribute. Because of bony compliance and mobile suture lines, the fetal skull changes shape and redistributes cerebrospinal fluid during labor according to constraints imposed by contractions, and bony and soft tissue elements of the birth canal as the head descends. These accommodations, including the increase in intracranial pressure, are adaptive and necessary for efficient descent of the head while safeguarding cerebral blood flow. Autonomic reflexes mediated through central receptors normally provide ample protection of the brain from the considerable pressure exerted on the skull. On occasion, those forces, which are transmitted intracranially, may overcome the various adaptive anatomical, cardiovascular, metabolic, and neurological mechanisms that maintain cerebral perfusion and oxygen availability, resulting in ischemic brain injury. Accepting the notion of a potentially adverse impact of fetal head compression suggests that avoidance of excessive uterine activity and of relentless pushing without steady progress in descent may offer protection for the fetal brain during parturition. Excessive head compression should be considered in the differential diagnosis of ischemic encephalopathy.

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“…Light and moderate configurations do not lead to pathological changes but expressed (pathological) degree leads to compression hypoxia of the fetal brain [7] and birth trauma. Clinical and experimental studies have shown that head compression leads to deceleration of cardiac activity [8][9][10]. When does a pathological head configuration occur?…”

Section: Types and Degree Of Configurationmentioning

confidence: 99%

The Importance of Configuration for Understanding Birth Trauma

2021

BJSTR

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Mini ReviewConfiguration (molding) is an evolutionarily formed process that ensures the adaptation of the size and shape of the head to the birth canal of the mother and also prevents birth trauma (ВТ) to the mother and fetus. It is known that the configuration prevents birth trauma [1], but the pronounced configuration leads to traumatic injuries to the skull and brain. A pronounced head configuration is observed with cephalopelvic disproportion, prolonged or dysfunctional labor, difficult delivery, operative delivery (vacuum extraction and forceps delivery), excessive use of oxytocin, excessive uterine contractions and other reasons. However, how do these conditions and complications of childbirth lead to birth damage? All causes are mediated by head configuration. The configuration of the head is a mediated link in the interaction of pathology during childbirth and birth injuries, so it can explain the cause and mechanisms of these injuries. The configuration can be diagnosed by vaginal examination and sonography during labor. All causes of obstructed labor are mediated by configuration mechanisms that both neutralize the effect of these causes, and can become pathological for the fetus, leading to birth traumatic injuries. That is, compensation mechanisms become insufficient to prevent traumatic injuries.

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A Systematic Review of Intrapartum Fetal Head Compression: What Is the Impact on the Fetal Brain?

Cited by 18 publications

References 28 publications

Myths at the core of Intrapartum Cardiotocography Interpretation – Risks of false Ideology, Prospect theory and way forward

Myths at the core of Intrapartum Cardiotocography Interpretation – Risks of false Ideology, Prospect theory and way forward

Fetal Head Compression: Its Possible Role in Neurologic Injury

The Importance of Configuration for Understanding Birth Trauma

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