Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-5f56664f6-bqpqz Total loading time: 0 Render date: 2025-05-07T13:20:51.191Z Has data issue: false hasContentIssue false

12 - Complications of labor and delivery

from Section 2 - Pregnancy, labor, and delivery complications causing brain injury

Published online by Cambridge University Press:  12 January 2010

By
Yair Blumenfeld  and
Masoud Taslimi
Edited by
David K. Stevenson ,
William E. Benitz ,
Philip Sunshine ,
Susan R. Hintz  and
Maurice L. Druzin
David K. Stevenson
Affiliation:
Stanford University School of Medicine, California
William E. Benitz
Affiliation:
Stanford University School of Medicine, California
Philip Sunshine
Affiliation:
Stanford University School of Medicine, California
Susan R. Hintz
Affiliation:
Stanford University School of Medicine, California
Maurice L. Druzin
Affiliation:
Stanford University School of Medicine, California
Get access

Summary

Introduction

Despite a common misconception among the general public, intrapartum events rarely lead to fetal injury. Approximately 70% of cases of neonatal encephalopathy are secondary to events arising prior to the onset of labor. Moreover, the overall incidence of neonatal encephalopathy attributable to intrapartum hypoxia, in the absence of any other potential preconceptional or antepartum causes, is estimated to be approximately 1.6/10,000. Despite this, the practice of obstetrics is rapidly evolving as a reaction to both extrinsic and intrinsic factors. Today, cesarean section rates are at all-time highs, operative vaginal delivery rates are decreasing, and evidence-based obstetrics is threatened to be replaced by defensive, anecdotally based medicine.

In this chapter, we shall review the available evidence regarding complications of labor and delivery and their potential effects on adverse neonatal injury in general and neurological morbidity in particular. We hope this information will enable physicians to make educated, informed, and rational obstetrical decisions, thereby improving overall patient care.

Cesarean section

In the United States in 2004, 29.1% of live births were via cesarean section. The rate of primary cesarean section in 2004 was 20.6%, compared with 14.6% in 1996. On the other hand, in 2004 the rate of vaginal delivery after previous cesarean (VBAC) was only 9.2%, while in 1996 the rate was 28.3%. The current rise in cesarean section rates is driven by multiple factors including increasing multiple gestations, obstetrical litigation, rising elective cesarean section on maternal demand, advanced maternal age, and decreasing operative vaginal delivery.

Type
Chapter
Information
Fetal and Neonatal Brain Injury , pp. 134 - 142
Publisher: Cambridge University Press
Print publication year: 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

,American College of Obstetricians and Gynecologists. Neonatal Encephalopathy and Cerebral Palsy. Executive summary. www.acog.org. Accessed October, 2008.
,March of Dimes. Peri Stats. Births by method of delivery, 1994–2004. http://www.marchofdimes.com/peristats/. Accessed January, 2008.
,NIH State-of-the-Science Conference Statement on Cesarean Delivery on Maternal Request. NIH Consensus Statements 2006; 23: 1–29.
Villar, J, Carroli, G, Zavaleta, N, et al. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ 2007; 335: 1025–35.CrossRefGoogle ScholarPubMed
Nisenblat, V, Barak, S, Griness, OB, et al. Maternal complications associated with multiple cesarean deliveries. Obstet Gynecol 2006; 108: 21–6.CrossRefGoogle ScholarPubMed
Silver, RM, Landon, MB, Rouse, DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006; 107: 1226–32.CrossRefGoogle ScholarPubMed
Kennare, R, Tucker, G, Heard, A, et al. Risks of adverse outcomes in the next birth after a first cesarean delivery. Obstet Gynecol 2007; 109: 270–6.CrossRefGoogle ScholarPubMed
Grobman, WA, Lai, Y, Landon, MB, et al. Development of a nomogram for prediction of vaginal birth after cesarean delivery. Obstet Gynecol 2007; 109: 806–12.CrossRefGoogle ScholarPubMed
Peaceman, AM, Gersnoviez, R, Landon, MB, et al. The MFMU Cesarean Registry: impact of fetal size on trial of labor success for patients with previous cesarean for dystocia. Am J Obstet Gynecol 2006; 195: 1127–31.CrossRefGoogle ScholarPubMed
Landon, MB, Spong, CY, Thom, E, et al. Risk of uterine rupture with a trial of labor in women with multiple and single prior cesarean delivery. Obstet Gynecol 2006; 108: 12–20.CrossRefGoogle ScholarPubMed
,ACOG Practice Bulletin #54: vaginal birth after previous cesarean. Obstet Gynecol 2004; 104: 203–12.
Gyamfi, C, Juhasz, G, Gyamfi, P, et al. Single- versus double-layer uterine incision closure and uterine rupture. J Matern Fetal Neonatal Med 2006; 19: 639–43.CrossRefGoogle ScholarPubMed
Cahill, AG, Stamilio, DM, Odibo, AO, et al. Does a maximum dose of oxytocin affect risk for uterine rupture in candidates for vaginal birth after cesarean delivery?Am J Obstet Gynecol 2007; 197: 495.e1–5.CrossRefGoogle ScholarPubMed
Landon, MB, Hauth, JC, Leveno, KJ, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med 2004; 351: 2581–9.CrossRefGoogle ScholarPubMed
Spong, CY, Landon, MB, Gilbert, S, et al. Risk of uterine rupture and adverse perinatal outcome at term after cesarean delivery. Obstet Gynecol 2007; 110: 801–7.CrossRefGoogle ScholarPubMed
Cahill, AG, Macones, GA. Vaginal birth after cesarean delivery: evidence-based practice. Clin Obstet Gynecol 2007; 50: 518–25.CrossRefGoogle ScholarPubMed
Macones, GA, Peipert, J, Nelson, DB, et al. Maternal complications with vaginal birth after cesarean delivery: a multicenter study. Am J Obstet Gynecol 2005; 193: 1656–62.CrossRefGoogle ScholarPubMed
Landon, MB, Leindecker, S, Spong, CY, et al. The MFMU Cesarean Registry: factors affecting the success of trial of labor after previous cesarean delivery. Am J Obstet Gynecol 2005; 193: 1016–23.CrossRefGoogle ScholarPubMed
Cahill, AG, Stamilio, DM, Odibo, AO, et al. Is vaginal birth after cesarean (VBAC) or elective repeat cesarean safer in women with a prior vaginal delivery?Am J Obstet Gynecol 2006; 195: 1143–7.CrossRefGoogle ScholarPubMed
Macario, A, El-Sayed, YY, Druzin, ML. Cost-effectiveness of a trial of labor after previous cesarean delivery depends on the a priori chance of success. Clin Obstet Gynecol 2004; 47: 378–85.CrossRefGoogle Scholar
Chung, A, Macario, A, El-Sayed, YY, et al. Cost-effectiveness of a trial of labor after previous cesarean. Obstet Gynecol 2001; 97: 932–41.Google ScholarPubMed
Pare, E, Quinones, JN, Macones, GA. Vaginal birth after caesarean section versus elective repeat caesarean section: assessment of maternal downstream health outcomes. BJOG 2006; 113: 75–85.CrossRefGoogle ScholarPubMed
Ridgeway, JJ, Weyrich, DL, Benedetti, TJ. Fetal heart rate changes associated with uterine rupture. Obstet Gynecol 2004; 103: 506–12.CrossRefGoogle ScholarPubMed
Miller, DA, Goodwin, TM, Gherman, RB, et al. Intrapartum rupture of the unscarred uterus. Obstet Gynecol 1997; 89: 671–3.CrossRefGoogle ScholarPubMed
Sweeten, KM, Graves, WK, Athanassiou, A. Spontaneous rupture of the unscarred uterus. Am J Obstet Gynecol 1995; 172: 1851–5.CrossRefGoogle ScholarPubMed
Walsh, CA, Baxi, LV. Rupture of the primigravid uterus: a review of the literature. Obstet Gynecol Surv 2007; 62: 327–34.CrossRefGoogle ScholarPubMed
,American College of Obstetricians and Gynecologists. Operative vaginal delivery: clinical management guidelines for obstetrician–gynecologists. Int J Gynaecol Obstet 2001; 74: 69–76.
Carmona, F, Martinez-Roman, S, Manau, D, et al. Immediate maternal and neonatal effects of low-forceps delivery according to the new criteria of the American College of Obstetricians and Gynecologists compared with spontaneous vaginal delivery in term pregnancies. Am J Obstet Gynecol 1995; 173: 55–9.CrossRefGoogle Scholar
Yancey, MK, Herpolsheimer, A, Jordan, GD, et al. Maternal and neonatal effects of outlet forceps delivery compared with spontaneous vaginal delivery in term pregnancies. Obstet Gynecol 1991; 78: 646–50.Google ScholarPubMed
Kolderup, LB, Laros, RK, Musci, TJ. Incidence of persistent birth injury in macrosomic infants: association with mode of delivery. Am J Obstet Gynecol 1997; 177: 37–41.CrossRefGoogle ScholarPubMed
Johnson, JH, Figueroa, R, Garry, D, et al. Immediate maternal and neonatal effects of forceps and vacuum-assisted deliveries. Obstet Gynecol 2004; 103: 513–18.CrossRefGoogle ScholarPubMed
Caughey, AB, Sandberg, PL, Zlatnik, MG, et al. Forceps compared with vacuum: rates of neonatal and maternal morbidity. Obstet Gynecol 2005; 106: 908–12.CrossRefGoogle ScholarPubMed
Towner, D, Castro, MA, Eby-Wilkens, E, et al. Effect of mode of delivery in nulliparous women on neonatal intracranial injury. N Engl J Med 1999; 341: 1709–14.CrossRefGoogle ScholarPubMed
Carmody, F, Grant, A, Mutch, L, et al. Follow up of babies delivered in a randomized controlled comparison of vacuum extraction and forceps delivery. Acta Obstet Gynecol Scand 1986; 65: 763–6.CrossRefGoogle Scholar
Wesley, BD, Berg, BJ, Reece, EA. The effect of forceps delivery on cognitive development. Am J Obstet Gynecol 1993; 169: 1091–5.CrossRefGoogle ScholarPubMed
Ngan, HY, Miu, P, Ko, L, et al. Long-term neurological sequelae following vacuum extractor delivery. Aust NZ J Obstet Gynaecol 1990; 30: 111–14.CrossRefGoogle ScholarPubMed
Sokol, RJ, Blackwell, SC. ACOG practice bulletin: shoulder dystocia. Number 40, November 2002. Int J Gynaecol Obstet 2003; 80: 87–92.Google ScholarPubMed
MacKenzie, IZ, Shah, M, Lean, K, et al. Management of shoulder dystocia: trends in incidence and maternal and neonatal morbidity. Obstet Gynecol 2007; 110: 1059–68.CrossRefGoogle ScholarPubMed
,Fetal macrosomia. ACOG Technical Bulletin Number 159, September 1991. Int J Gynaecol Obstet 1992; 39: 341–5.
Kramer, MS, Rouleau, J, Baskett, TF, et al. Amniotic-fluid embolism and medical induction of labour: a retrospective, population-based cohort study. Lancet 2006; 368: 1444–8.CrossRefGoogle ScholarPubMed
Clark, SL, Hankins, GD, Dudley, DA, et al. Amniotic fluid embolism: analysis of the national registry. Am J Obstet Gynecol 1995; 172: 1158–67.CrossRefGoogle ScholarPubMed
Clark, SL, Montz, FJ, Phelan, JP. Hemodynamic alterations associated with amniotic fluid embolism: a reappraisal. Am J Obstet Gynecol 1985; 151: 617–21.CrossRefGoogle ScholarPubMed
Creasy, RK, Resnik, R, Iams, JD. Maternal–Fetal Medicine, 5th edn. Philadelphia, PA: Saunders, 2004.Google Scholar
Yang, JI, Kim, HS, Chang, KH, et al. Amniotic fluid embolism with isolated coagulopathy: a case report. J Reprod Med 2006; 51: 64–6.Google ScholarPubMed
Levy, G. [Amniotic fluid embolism]. Ann Fr Anesth Reanim 2004; 23: 861.CrossRefGoogle Scholar
Awad, IT, Shorten, GD. Amniotic fluid embolism and isolated coagulopathy: atypical presentation of amniotic fluid embolism. Eur J Anaesthesiol 2001; 18: 410–13.CrossRefGoogle ScholarPubMed
Moore, J. Amniotic fluid embolism: on the trail of an elusive diagnosis. Lancet 2006; 368: 1399–401.CrossRefGoogle ScholarPubMed
Moore, J, Baldisseri, MR. Amniotic fluid embolism. Crit Care Med 2005; 33: S279–85.CrossRefGoogle ScholarPubMed
Cunningham, FG, Williams, JW. Williams Obstetrics, 21st edn. New York, NY: McGraw-Hill, 2001.Google Scholar
Gibbs, RS, Duff, P. Progress in pathogenesis and management of clinical intraamniotic infection. Am J Obstet Gynecol 1991; 164: 1317–26.CrossRefGoogle ScholarPubMed
Romero, R, Espinoza, J, Kusanovic, JP, et al. The preterm parturition syndrome. BJOG 2006; 113: 17–42.CrossRefGoogle ScholarPubMed
Grether, JK, Nelson, KB. Maternal infection and cerebral palsy in infants of normal birth weight. JAMA 1997; 278: 207–11.CrossRefGoogle ScholarPubMed
Wu, YW, Colford, JM. Chorioamnionitis as a risk factor for cerebral palsy: a meta-analysis. JAMA 2000; 284: 1417–24.CrossRefGoogle ScholarPubMed
Hopkins, L, Smaill, F. Antibiotic regimens for management of intraamniotic infection. Cochrane Database Syst Rev 2002; (3): CD003254.CrossRefGoogle ScholarPubMed
,ACOG Practice Bulletin. Clinical management guidelines for obstetricians–gynecologists. Number 55, September 2004. Management of postterm pregnancy. Obstet Gynecol 2004; 104: 639–46.
,ACOG Committee Opinion Number 346, October 2006: amnioinfusion does not prevent meconium aspiration syndrome. Obstet Gynecol 2006; 108: 1053.
Rais-Bahrami, K, Rivera, O, Seale, WR, et al. Effect of nitric oxide and high-frequency oscillatory ventilation in meconium aspiration syndrome. Pediatr Crit Care Med 2000; 1: 166–9.CrossRefGoogle ScholarPubMed
Dargaville, PA, Copnell, B. The epidemiology of meconium aspiration syndrome: incidence, risk factors, therapies, and outcome. Pediatrics 2006; 117: 1712–21.CrossRefGoogle ScholarPubMed
Fraser, WD, Hofmeyr, J, Lede, R, et al. Amnioinfusion for the prevention of the meconium aspiration syndrome. N Engl J Med 2005; 353: 909–17.CrossRefGoogle ScholarPubMed
Chou, MR, Kreiser, D, Taslimi, MM, et al. Vaginal versus ultrasound examination of fetal occiput position during the second stage of labor. Am J Obstet Gynecol 2004; 191: 521–4.CrossRefGoogle ScholarPubMed
Cruikshank, DP, White, CA. Obstetric malpresentations: twenty years' experience. Am J Obstet Gynecol 1973; 116: 1097–104.CrossRefGoogle ScholarPubMed
Hannah, ME, Hannah, WJ, Hewson, SA, et al. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet 2000; 356: 1375–83.CrossRefGoogle ScholarPubMed
,ACOG Committee Opinion: number 265, December 2001. Mode of term single breech delivery. Obstet Gynecol 2001; 98: 1189–90.
,ACOG Committee Opinion No. 340. Mode of term singleton breech delivery. Obstet Gynecol 2006; 108: 235–7.
Whyte, H, Hannah, ME, Saigal, S, et al. Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial. Am J Obstet Gynecol 2004; 191: 864–71.CrossRefGoogle ScholarPubMed
,ACOG practice patterns. External cephalic version. Number 4, July 1997. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 1997; 59: 73–80.
Hofmeyr, GJ. Interventions to help external cephalic version for breech presentation at term. Cochrane Database Syst Rev 2004; (1): CD000184.CrossRefGoogle ScholarPubMed
,ACOG Practice Bulletin Number 49, December 2003. Dystocia and augmentation of labor. Obstet Gynecol 2003; 102: 1445–54.
Kilpatrick, SJ, Laros, RK. Characteristics of normal labor. Obstet Gynecol 1989; 74: 85–7.Google ScholarPubMed
Myles, TD, Santolaya, J. Maternal and neonatal outcomes in patients with a prolonged second stage of labor. Obstet Gynecol 2003; 102: 52–8.Google ScholarPubMed
Cheng, YW, Hopkins, LM, Caughey, AB. How long is too long: does a prolonged second stage of labor in nulliparous women affect maternal and neonatal outcomes?Am J Obstet Gynecol 2004; 191: 933–8.CrossRefGoogle Scholar
Sung, JF, Daniels, KI, Brodzinsky, L, et al. Cesarean delivery outcomes after a prolonged second stage of labor. Am J Obstet Gynecol 2007; 197: 306.e1–5.CrossRefGoogle ScholarPubMed
Holme, A, Breen, M, MacArthur, C. Obstetric fistulae: a study of women managed at the Monze Mission Hospital, Zambia. BJOG 2007; 114: 1010–17.CrossRefGoogle Scholar
Menticoglou, SM, Manning, F, Harman, C, et al. Perinatal outcome in relation to second-stage duration. Am J Obstet Gynecol 1995; 173: 906–12.CrossRefGoogle ScholarPubMed
Martin, JA, Hamilton, BE, Sutton, PD, et al. Births: final data for 2002. Natl Vital Stat Rep 2003; 52: 1–113.Google ScholarPubMed
,ACOG Practice Bulletin. Clinical management guidelines for obstetrician–gynecologists, Number 70, December 2005. Intrapartum fetal heart rate monitoring. Obstet Gynecol 2005; 106: 1453–60.
Vintzileos, AM, Nochimson, DJ, Guzman, ER, et al. Intrapartum electronic fetal heart rate monitoring versus intermittent auscultation: a meta-analysis. Obstet Gynecol 1995; 85: 149–55.CrossRefGoogle ScholarPubMed
Nielsen, PV, Stigsby, B, Nickelsen, C, et al. Intra- and inter-observer variability in the assessment of intrapartum cardiotocograms. Acta Obstet Gynecol Scand 1987; 66: 421–4.CrossRefGoogle ScholarPubMed
Blix, E, Sviggum, O, Koss, KS, et al. Inter-observer variation in assessment of 845 labour admission tests: comparison between midwives and obstetricians in the clinical setting and two experts. BJOG 2003; 110: 1–5.CrossRefGoogle ScholarPubMed
Beaulieu, MD, Fabia, J, Leduc, B, et al. The reproducibility of intrapartum cardiotocogram assessments. Can Med Assoc J 1982; 127: 214–16.Google ScholarPubMed
Nelson, KB, Dambrosia, JM, Ting, TY, et al. Uncertain value of electronic fetal monitoring in predicting cerebral palsy. N Engl J Med 1996; 334: 613–18.CrossRefGoogle ScholarPubMed
Thacker, SB, Stroup, D, Chang, M. Continuous electronic heart rate monitoring for fetal assessment during labor. Cochrane Database Syst Rev 2001; (2): CD000063.CrossRefGoogle ScholarPubMed
Clark, SL, Hankins, GD. Temporal and demographic trends in cerebral palsy: fact and fiction. Am J Obstet Gynecol 2003; 188: 628–33.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×