The Effect of Fetal Head Compression and Fetal Acidaemia During Labour on Human Fetal Cerebral Function as Measured by the Fetal Electroencephalogram

Abstract

We investigated the effect of head compression and acidaemia during labour in 25 African primigravidae. Evidence that head compression had occurred during labour was confirmed by both clinical and radiological means at the end of a trial of labour. No significant difference could be demonstrated in the quantity of fetal electroencephalogram (EEG) abnormality that occurred in the groups with marked head compression as compared to the groups without marked head compression. Deterioration in the fetal EEG to a flat record known as electrocerebral silence (ECS) was associated with the development of acidaemia. As fetal heart rate (FHR) decelerations appeared the percentage of ECS in the fetal EEG record increased significantly (P < 0.05), and likewise, as fetal acidaemia developed a highly significant increase in ECS in the fetal EEG was demonstrated (P < O*OOl). We concluded that in the management of trial of labour there was no significant deleterious change in the fetal EEG as a result of head compression, unless fetal acidaemia supervened. However, in the majority of these cases a significant increase in ECS to more than 20 per cent occurred in association with only moderate acidaemia (pH 7.25 to 7.30).CEPHALOPELVIC disproportion remains a major obstetrical hazard in developing countries and contributes significantly to perinatal death rates. In many cases disproportion and fetal asphyxia co-exist and make the exact cause of death difficult to determine. Perinatal statistics from Harare Hospital, Salisbury reveal that between 15 to 20 per cent of perinatal deaths are due to 269

Intrauterine‐pressure studies in African nulliparae: delay, delivery and disproportion

“…These effects may be due to the effects of hypoxia and acidosis in labour, excessive head compression or intrauterine infection, or any combination of these causes. Recent evidence, however, suggests that compression of the fetal head in labour is safe provided that fetal acidosis does not occur (Wilson et al 1979). Thus, it is safe to conduct a trial of labour until fetal distress occurs, whereupon the trial must be terminated immediately.…”

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

“…The interesting study by Wilson et al argues quite strongly against an adverse effect of fetal head compression 17. In a small study of 25 human high-risk labors with frequent administration of oxytocin, they demonstrated that the fetal EEG was not related to fetal head pressure as assessed by severe head molding but was related to systemic acidosis.…”

Monitoring Fetal Electroencephalogram Intrapartum: A Systematic Literature Review

“…The effect of head compression associated with cephalopelvic disproportion on fetal brain activity was studied and no significant differences in fEEG findings between the group with cephalopelvic disproportion and the group without it were noted (21).…”

“…The information gathered from fEEG, FHR monitoring, scalp pH measurements, Apgar score used as control measures of fetal health, and their relationships with one another were studied and the invaluable information they can provide have been demonstrated in several studies (15,21,23,25,26,31). The 2019 Early Notification scheme progress report of the National Health System identified 70% of perinatal brain injuries as avoidable with continuous CTG monitoring (84).…”

“…normal trace and continuing through birth) is correlated with lower 1 min-and 5 min-Apgar score and the need for post-partum resuscitation(23) Wilson et al, 1979:. Significant correlation between the development of electrocerebral silence in the fEEG and the development of fetal acidosis.…”