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Fetal Complications of Labour and Vaginal Delivery

Fetal complications of labour and vaginal delivery Fetus passing through cervix and birth canal puts pressure and physical stress on the head Labour/vaginal delivery Fetus is not presented head- first in the vaginal canal (e.g. breech, shoulder, transverse) Abnormal positioning increases risk of umbilical cord becoming entangled or dropping in front of the fetus in the birth canal Passage of the fetus through birth canal compresses the umbilical cord Edema Perinatal hypoxia Signs of fetal distress (e.g. late decelerations, changes in fetal heart rate, ↓ fetal movement) Infant death Uterine contractions are too weak to progress labour Prolonged time in labour results in increased total number of contractions Fractures (most commonly affecting the clavicle) Uterine contractions compress blood vessels in the placenta, resulting in reduced blood flow Severe obstetric hemorrhage causes circulating blood flow to decrease as blood volume is lost (see relevant slide for pathogenesis) Small birth canal to baby size ratio Lack of space traps the fetal shoulders following delivery of the head (shoulder dystocia) Excessive lateral traction or stretching damages nerves in the brachial plexus Erb’s palsy (paralysis of the arm caused by injury to C5-C6 of the brachial plexus) Shearing force on the skull and scalp ruptures blood vessels Cephalohematoma (blood accumulation below periosteum) Boggy, soft lump on infant’s head Soft tissue injury triggers release of inflammatory signaling molecules, which ↑ vascular permeability Caput succedaneum (scalp swelling) Boggy, soft swelling of infant’s head that extends across suture lines Mild soft tissue injury Hypoxic ischemic encephalopathy Variable signs of brain injury: seizures, hypotonia, difficulty feeding, etc. Cerebral palsy Developmental delay, hypotonia, spasticity, etc. Authors: Jasmine Nguyen Reviewers: Akanksha Bhargava Michelle J. Chen Sarah Glaze* * MD at time of publication Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published Apr 29, 2024 on www.thecalgaryguide.com