Intrapartum Asphyxia and Birth Trauma

  • Jean W. Keeling


There has been a commendable reduction in intrapartum and neonatal deaths associated with birth trauma and asphyxia during the last 40 years. Any death related to intrapartum insult deserves attention. Necropsy and clinical management should be carefully reviewed to identify any avoidable factors. It is particularly important that a good obstetric and neonatal history is available in these cases before necropsy is begun, so that evidence of asphyxia or trauma is not overlooked. A history of intrapartum death or a description of intrapartum difficulties will not be found in all cases. The pathologist should be aware that pallor, shock, hypotonia and difficulty in initiating or maintaining respiration at birth may be the result of intrapartum asphyxia or trauma. These signs do not specifically imply intrapartum insult and may be the presenting features of some major malformations, particularly those accompanied by pulmonary hypoplasia (see Table 17.1, p. 415), congenital heart disease or infection.


Obstet Gynecol Birth Asphyxia Breech Presentation Fetal Head Instrumental Delivery 
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  1. Atkins AJF, Watt JM, Milan P, Davies P, Crawford S (1981) The influence of posture upon cardiovascular dynamics throughout pregnancy. Eur J Obstet Gynecol Reprod Biol 12: 357–372PubMedCrossRefGoogle Scholar
  2. Babyn PS, Chuang SH, Daneman A, Davidson GS (1988) Sonographic evaluation of spinal cord birth trauma with pathologic correlation. Am J Roentgenol 151: 763–766Google Scholar
  3. Barson AJ, Tasker M, Lieberman BA, Hillier VF (1984) Impact of improved perinatal care on the causes of death. Arch Dis Child 59: 199–207PubMedCrossRefGoogle Scholar
  4. Bassell GM, Humayun SG, Marx GF (1980) Maternal bearing down efforts—another fetal risk? Obstet Gynecol 56: 39–41PubMedGoogle Scholar
  5. Beard RW, Morris ED, Clayton SG (1967) pH of foetal capillary blood as an indicator of the condition of the foetus. J Obstet Gynaecol Br Cmwlth 74: 812–822CrossRefGoogle Scholar
  6. Brans YW, Escobedo MB, Hayashi RH, Huff RW, Kagan-Hallet KS, Ramamurthy RS (1984) Perinatal mortality in a large perinatal center: five-year review of 31 000 births. Am J Obstet Gynecol 148: 284–289PubMedGoogle Scholar
  7. Butler NR, Bonham DG (1963) Perinatal mortality. The first report of the 1958 British Perinatal Mortality Survey under the auspices of The National Birthday Trust Fund. Livingstone, Edinburgh.Google Scholar
  8. Cardozo LD, Gibb DMF, Studd JWW, Cooper DJ (1983) Should we abandon Kielland’s forceps? Br Med J 287: 315–317CrossRefGoogle Scholar
  9. Chiswick ML, James DK (1979) Kielland’s forceps: association with neonatal morbidity and mortality. Br Med J 1: 7–9PubMedCrossRefGoogle Scholar
  10. Coard K, Codrington G, Escoffrey C, Keeling JW, Ashley D, Golding J (1991) Perinatal mortality in Jamaica 1986–1987. Acta Paediatr Scand 80: 581–587CrossRefGoogle Scholar
  11. Cohn HE, Sacks EJ, Heymann MA, Rudolph AM (1974) Cardiovascular responses to hypoxemia and acidemia in fetal lambs. Am J Obstet Gynecol 120: 817–824PubMedGoogle Scholar
  12. Crawford JS, Burton M, Davies P (1972) Time and lateral tilt at Caesarean section. Br J Anaesth 44: 477–484PubMedCrossRefGoogle Scholar
  13. Dawes GS (1968) Fetal and neonatal physiology. Year Book Medical Publishers, Chicago, p 97Google Scholar
  14. Dunkerton MC (1989) Posterior dislocation of the shoulder associated with obstetric brachial plexus palsy. J Bone Joint Surg 71: 764–766Google Scholar
  15. Faber-Nijholt R, Huisjes HJ, Touwen BCL, Fidler VJ (1983) Neurological follow-up of 281 children born in breech presentation: a controlled study. Br Med J 286: 9–12CrossRefGoogle Scholar
  16. Fedrick J (1969) Comparison of birth weight/gestation distribution in cases of stillbirth and neonatal death according to lesions found at necropsy. Br Med J 3: 745–748PubMedCrossRefGoogle Scholar
  17. Fox H (1967) The significance of placental infarction in perinatal morbidity and mortality. Biol Neonate 11: 87–105CrossRefGoogle Scholar
  18. Friedman EA, Sachtleben MR (1971) High risk labour. J Reprod Med 7: 28–32Google Scholar
  19. Gresham EL (1975) Birth trauma. Pediatr Clin North Am 22: 317–328PubMedGoogle Scholar
  20. Hanigan WC, Morgan AM, Stahlberg LK, Hiller JL (1990) Tentorial hemorrhage associated with vacuum extraction. Pediatrics 85: 534–539PubMedGoogle Scholar
  21. Healey DL, Quinn MA, Pepperall RJ (1982) Rotational delivery of the fetus: Keilland’s forceps and two other methods compared. Br J Obstet Gynaecol 89: 501–506CrossRefGoogle Scholar
  22. Hovatta O, Lipasti A, Rapola J, Karjalainen (1983) Causes of stillbirth: a clinicopathological study of 243 patients. Br J Obstet Gynaecol 90: 691–696PubMedCrossRefGoogle Scholar
  23. Jones CM, Greiss FC (1982) The effect of labor on maternal and fetal circulating catecholamines. Am J Obstet Gynecol 144: 149–153PubMedGoogle Scholar
  24. Lanska MJ, Roessmann U, Wiznitzer M (1990) Magnetic resonance imaging in cervical cord birth injury. Pediatrics 85: 760–764PubMedGoogle Scholar
  25. Lilien AA (1970) Term intrapartum fetal death. Am J Obstet Gynecol 107: 595–603PubMedGoogle Scholar
  26. Löfgren O, Polberger S (1983) Perinatal mortality: changes in the diagnostic panorama 1974–1980. Acta Paediatr Scand 72: 327–332PubMedCrossRefGoogle Scholar
  27. Low JA, MJ, Karchmar EJ, McGrath MJ, Pancham SR, Piercy WN (1981) The effect of maternal, labor, and fetal factors upon fetal heart rate during the intrapartum period. Am J Obstet Gynecol 139: 306–310PubMedGoogle Scholar
  28. Maberry MC, Ramin SM, Gilstrap LC, Leveno KJ, Dax JS (1990) Intrapartum asphyxia in pregnancies complicated by intra-amniotic infection. Obstet Gynecol 76: 351–354PubMedGoogle Scholar
  29. Machin GA (1975) A perinatal mortality survey in southeast London 1970–73: the pathological findings in 726 necropsies. J Clin Pathol 28: 428–434PubMedCrossRefGoogle Scholar
  30. Mcllwaine GM, Howat RCL, Dunn F, Macnaughton MC (1979) The Scottish Perinatal Mortality Survey. Br Med J II: 1103–1106CrossRefGoogle Scholar
  31. Newman B, Smith S (1987) Unusual renal renal mass in a newborn infant. Radiology 163: 193–194PubMedGoogle Scholar
  32. Oppenheim WL, Davis A, Growdon WA, Dorey FJ, Davlin LB (1990) Clavicle fractures in the newborn. Clin Orthop 250: 176–180PubMedGoogle Scholar
  33. Plauché WC (1979) Fetal cranial injuries related to delivery with the Malstrom vacuum extractor. Obstet Gynecol 53: 750–757PubMedGoogle Scholar
  34. Plauché WC (1980) Subgaleal hematoma. A complication of instrumental delivery. JAMA 244: 1597–1598PubMedCrossRefGoogle Scholar
  35. Samms-Vaughan ME, Golding J (1992) Area variation in perinatal mortality in Jamaica: Association with type of hospital services available. In: Perinatal problems of islands in relation to prevention of handicap. INSERM, Paris, pp 90–98Google Scholar
  36. Schwarcz RL, Belizan JM, Cifuentes JR, Cuadro JC, Marques MB, Caldeyro-Barcia R (1974) Fetal and maternal monitoring in spontaneous labors and in elective inductions. A comparative study. Am J Obstet Gynecol 120: 356–362PubMedGoogle Scholar
  37. Scottish Stillbirth and Neonatal Death Report 1989 (1990) Common Serivces Agency for the Scottish Health Service, EdinburghGoogle Scholar
  38. Shankaran S, Elias E, Ilagan N (1991) Subcapsular haemorrhage of the liver in the very low birth weight neonate. Acta Paediatr Scand 80: 616–619PubMedCrossRefGoogle Scholar
  39. Sjöberg I, Erichs K, Bjerre I (1988) Cause and effect of obstetric (neonatal) brachial plexus palsy. Acta Paediatr Scand 77: 357–364PubMedCrossRefGoogle Scholar
  40. Smis B, Thiery M (1980) Fetal heart rate pattern before, during and after amniotomy. Eur J Obstet Gynecol Reprod Biol 11: 163–171PubMedCrossRefGoogle Scholar
  41. Stanley F (1984) Perinatal risk factors in the aetiology of the cerebral palsies. In: Stanley F, Alberman ED (eds) The epidemiology of the cerebral palsies. Clinics in developmental medicine No 87, SIMP, Blackwell, Oxford, pp 98–115Google Scholar
  42. Steer PJ (1985) Fetal distress. In: Crawford JW (ed) Risks of labour. Wiley, Chichester, pp 11–13Google Scholar
  43. Stewart KS, Philpott PH (1980) Fetal response to cephalopelvic disproportion. Br J Obstet Gynaecol 87: 641–649PubMedCrossRefGoogle Scholar
  44. Svenningsen L, Lindemann R, Eidal K (1988) Measurements of fetal head compression pressure during bearing down and their relationship to the condition of the newborn. Acta Obstet Gynecol Scand 67: 129–133PubMedCrossRefGoogle Scholar
  45. Tiwary CM (1989) Testicular injury in breech delivery: possible implications. Urology 34: 210–212PubMedCrossRefGoogle Scholar
  46. Walker CHM (1985) Birth trauma. In: Crawford JW (ed) Risks of labour. Wiley, Chichester, pp 71–93Google Scholar
  47. Wigglesworth JS, Husemeyer RO (1977) Birth trauma in vaginal breech delivery. Br Med J I: 320–321Google Scholar
  48. Wikström I, Axelsson Bergström R, Meirik O (1988) Traumatic injury in large-for-date infants. Acta Obstet Gynecol Scand 67: 259–264PubMedCrossRefGoogle Scholar

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© Springer-Verlag London 1993

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  • Jean W. Keeling

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