A Systematic Review of Intrapartum Fetal Head Compression: What Is the Impact on the Fetal Brain?
17. Januar 2017
20. März 2017
26. April 2017 (online)
Objective During labor the fetal head is subjected to pressure related to uterine contractions and maternal pushing. Here we systematically review what is known about fetal head compression and its effects on fetal intracranial pressure, oxygenation, blood flow and cerebral function, and the plausibility that it might cause isolated fetal brain injury.
Study Design Systematic review of intrapartum fetal head compression and fetal brain injury in accordance with the MOOSE methodology. The PubMed database was searched using a combination of the terms “fetal,” “head,” “cranial,” “extracranial,” “pressure,” and “compression.” Additional references were obtained using multiple strategies. Results were evaluated, and relevant studies encompassing animal and human data using several approaches are summarized in this review.
Results Studies support a significant increase in fetal extracranial pressure with contractions and pushing. However, available data do not support a concomitant significant relative increase in intracranial pressure, a reduction in cerebral circulation or oxygenation, or an impact on cerebral function.
Conclusion A review of the literature indicates that fetal intracranial pressure is well protected from extracranial forces. Available data do not support intrapartum fetal extracranial pressure as a cause of fetal brain injury.
Precis The fetal brain is relatively unaffected by intrapartum fetal head compression.
Keywordsmechanical forces of labor - fetal head compression - fetal brain injury - fetal intracranial pressure
- 1 Kelly JV. Compression of the fetal brain. Am J Obstet Gynecol 1963; 85: 687-694
- 2 Smellie W. Treatise of the Theory and Practice of Midwifery. Vol 1. London, UK: New Sydenham Society; 1752
- 3 Amiel-Tison C. Cerebral damage in full-term new-born. Aetiological factors, neonatal status and long-term follow-up. Biol Neonat 1969; 14 (03) 234-250
- 4 Schifrin BS, Deymier P, Cohen WR. Cranial compression ischemic encephalopathy: fetal neurological injury related to the mechanical forces of labor and delivery. In: Zhang L, Longo LD. , eds. Stress and Developmental Programming of Health and Disease: Beyond Phenomenology. Hauppauge, NY: Nova Scientific Publishers; 2014: 651-688
- 5 Stroup DF, Berlin JA, Morton SC. , et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283 (15) 2008-2012
- 6 Lindgren L. The influence of pressure upon the fetal head during labour. Acta Obstet Gynecol Scand 1977; 56 (04) 303-309
- 7 Rempen A, Kraus M. Measurement of head compression during labor: preliminary results. J Perinat Med 1991; 19 (1-2): 115-120
- 8 Schwarcz R, Strada-Saenz G, Althabe O, Fernandez-Funes J, Alvarez LO, Caldeyro-Barcia R. Compression received by the head of the human fetus during labor. In: Angle CR. , ed. Physical Trauma as an Etiologic Agent in Mental Retardation. Omaha, NE: 1970
- 9 Schwarcz R, Strada-Saenz G, Althabe O, Fernandez-Funes J, Caldeyro-Barcia R. Pressure exerted by uterine contractions on the head of the human fetus during labor. Perinatal Factors Affecting Human Development, Scientific Publication 185. Washington, DC: Panamerican Health Organization; 1969: 115-126
- 10 Svenningsen L, Jensen O. A method for objective measurement of fetal head compression during the second stage of labor. Gynecol Obstet Invest 1988; 26 (03) 219-224
- 11 Svenningsen L, Lindemann R, Eidal K. Measurements of fetal head compression pressure during bearing down and their relationship to the condition of the newborn. Acta Obstet Gynecol Scand 1988; 67 (02) 129-133
- 12 Antonucci MC, Pitman MC, Eid T, Steer PJ, Genevier ES. Simultaneous monitoring of head-to-cervix forces, intrauterine pressure and cervical dilatation during labour. Med Eng Phys 1997; 19 (04) 317-326
- 13 Aldrich CJ, D'Antona D, Spencer JA, Delpy DT, Reynolds EO, Wyatt JS. Fetal heart rate changes and cerebral oxygenation measured by near-infrared spectroscopy during the first stage of labour. Eur J Obstet Gynecol Reprod Biol 1996; 64 (02) 189-195
- 14 Aldrich CJ, D'Antona D, Spencer JA. , et al. The effect of maternal pushing on fetal cerebral oxygenation and blood volume during the second stage of labour. Br J Obstet Gynaecol 1995; 102 (06) 448-453
- 15 Aldrich CJ, D'Antona D, Wyatt JS, Spencer JA, Peebles DM, Reynolds EO. Fetal cerebral oxygenation measured by near-infrared spectroscopy shortly before birth and acid-base status at birth. Obstet Gynecol 1994; 84 (05) 861-866
- 16 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 (01) 44-48
- 17 Wilson PC, Philpott RH, Spies S, Ahmed Y, Kadichza M. The effect of fetal head compression and fetal acidaemia during labour on human fetal cerebral function as measured by the fetal electroencephalogram. Br J Obstet Gynaecol 1979; 86 (04) 269-277
- 18 Rosen MG, Scibetta J, Chik L, Borgstedt AD. An approach to the study of brain damage. The principles of fetal electroencephalography. Am J Obstet Gynecol 1973; 115 (01) 37-47
- 19 O'Brien WF, Davis SE, Grissom MP, Eng RR, Golden SM. Effect of cephalic pressure on fetal cerebral blood flow. Am J Perinatol 1984; 1 (03) 223-226
- 20 Mann LI, Carmichael A, Duchin S. The effect of head compression on FHR, brain metabolism and function. Obstet Gynecol 1972; 39 (05) 721-726
- 21 Mocsáry P, Gaál J, Komáromy B, Mihály G, Pohánka O, Surányi S. Relationship between fetal intracranial pressure and fetal heart rate during labor. Am J Obstet Gynecol 1970; 106 (03) 407-411
- 22 Harris AP, Helou S, Traystman RJ, Jones Jr MD, Koehler RC. Efficacy of the Cushing response in maintaining cerebral blood flow in premature and near-term fetal sheep. Pediatr Res 1998; 43 (01) 50-56
- 23 Harris AP, Koehler RC, Gleason CA, Jones Jr MD, Traystman RJ. Cerebral and peripheral circulatory responses to intracranial hypertension in fetal sheep. Circ Res 1989; 64 (05) 991-1000
- 24 Harris AP, Koehler RC, Nishijima MK, Traystman RJ, Jones Jr MD. Circulatory dynamics during periodic intracranial hypertension in fetal sheep. Am J Physiol 1992; 263 (1 Pt 2): R95-R102
- 25 Gonik B, Zhang N, Grimm MJ. Prediction of brachial plexus stretching during shoulder dystocia using a computer simulation model. Am J Obstet Gynecol 2003; 189 (04) 1168-1172
- 26 Graham EM, Adami RR, McKenney SL, Jennings JM, Burd I, Witter FR. Diagnostic accuracy of fetal heart rate monitoring in the identification of neonatal encephalopathy. Obstet Gynecol 2014; 124 (03) 507-513
- 27 Clark SL, Hankins GD. Temporal and demographic trends in cerebral palsy—fact and fiction. Am J Obstet Gynecol 2003; 188 (03) 628-633
- 28 Graham EM, Adami RR. Response: diagnostic accuracy of fetal heart rate monitoring in the identification of neonatal encephalopathy. Obstet Gynecol 2014; 124 (06) 1211
- 29 Towner D, Castro MA, Eby-Wilkens E, Gilbert WM. Effect of mode of delivery in nulliparous women on neonatal intracranial injury. N Engl J Med 1999; 341 (23) 1709-1714
- 30 Grobman WA, Bailit J, Lai Y. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Association of the Duration of Active Pushing with Obstetric Outcomes. Obstet Gynecol 2016; 127 (04) 667-673
- 31 Freeman RK, Garite TJ, Nageotte MP. Fetal Heart Rate Monitoring. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2003
- 32 Mooij PN, Nijhuis JG, Jongsma HW, Menssen JJ. Intracranial pressure and fetal heart rate in a hydrocephalic fetus during labor. Eur J Obstet Gynecol Reprod Biol 1992; 43 (02) 161-165
- 33 McCrann Jr DJ, Schifrin BS. Heart rate patterns of the hydrocephalic fetus. Am J Obstet Gynecol 1973; 117 (01) 69-74