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Intrapartum Neurologic Injury Analysis

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scoring systems may be useful in the management of low-risk parturients continuous monitoring during labor (Koong et al., 1997). In European centers, an additional strategy for identifying high-risk parturients is the analysis of a fetal heart rate (FHR) tracing at the time of admission; if the FHR tracing is normal, they may receive less monitoring, and if the tracing is abnormal, patients receive intensive monitoring (Gourounti & Sandall, 2007).
The magnitude of risk for intrapartum fetal neurologic injury is controversial. In 2003, the American College of Obstetricians and Gynecologists (ACOG) Task Force on Neonatal Encephalopathy and Cerebral Palsy concluded that 70% of these types of fetal neurologic injuries result from events that occur before the onset of labor (American College of Obstetricians and Gynecologists, 2004; American College of Obstetricians and Gynecologists Task Force on Neonatal Encephalopathy and Cerebral Palsy, 2003). Examples of antepartum events that may cause fetal …show more content…

A uterine contraction can result in a decreased uteroplacental blood flow. A placenta with borderline function before labor may be unable to maintain gas exchange adequate to prevent fetal asphyxia during labor. The healthy fetus may compensate for the effects of hypoxia during labor (Parer & Livingston, 1990; Court & Parer, 1984). The compensatory response includes (1) decreased oxygen consumption, (2) vasoconstriction of nonessential vascular beds, and (3) redistribution of blood flow to the vital organs (e.g., brain, heart, , placenta adrenal glands) (Peeters et al., 1979; Cohn et al., 1974). Humoral responses (e.g., release of vasopressin and endogenous opioids, release of epinephrine from the adrenal medulla) may enhance fetal cardiac function during hypoxia (Parer, 1997). Prolonged or severe hypoxia overwhelms these compensatory mechanisms, resulting in fetal injury or

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