Pathophysiology of foetal oxygenation and cell damage during labour

A foetus exposed to oxygenation compromise is capable of several adaptive responses, which can be categorised into those affecting metabolism and those affecting oxygen transport. However, both the extent and duration of the impairment in oxygenation will have a bearing on these adaptive responses....

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Bibliographic Details
Published in:Best practice & research. Clinical obstetrics & gynaecology 2016-01, Vol.30, p.9-21
Main Authors: Yli, Branka M., MD, PhD, Kjellmer, Ingemar, MD, PhD
Format: Article
Language:English
Subjects:
Acidosis - metabolism
Acidosis - physiopathology
acid–base status
asphyxia
Brain - blood supply
Brain - metabolism
Brain - physiopathology
brain injury
Cell Death
Cerebral Palsy - metabolism
Cerebral Palsy - physiopathology
Female
Fetal Hypoxia - metabolism
Fetal Hypoxia - physiopathology
Fetus - blood supply
Fetus - metabolism
Fetus - physiopathology
foetal physiology
Humans
Hypoxia-Ischemia, Brain - metabolism
Hypoxia-Ischemia, Brain - physiopathology
hypoxic–ischaemic encephalopathy
Infant, Newborn
Labor, Obstetric
Obstetric Labor Complications - metabolism
Obstetric Labor Complications - physiopathology
Obstetrics and Gynecology
oxygen delivery
Pediatrics
Pediatrik
Pregnancy
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Summary:A foetus exposed to oxygenation compromise is capable of several adaptive responses, which can be categorised into those affecting metabolism and those affecting oxygen transport. However, both the extent and duration of the impairment in oxygenation will have a bearing on these adaptive responses. Although intrapartum events may account for no more than one-third of cases with an adverse neurological outcome, they are important because they can be influenced successfully. This review describes the mechanisms underlying foetal hypoxia during labour, acid–base balance and gas exchange, and the current scientific understanding of the role of intrauterine asphyxia in the pathophysiology of neonatal encephalopathy and cerebral palsy. Although the mechanisms involved include similar initiating events, principally ischaemia and excitotoxicity, and similar final common pathways to cell death, there are certain unique maturational factors that influence the type and pattern of cellular injury.
ISSN:1521-6934
1532-1932
1532-1932
DOI:10.1016/j.bpobgyn.2015.05.004