Obstetric factors in fetal-neonatal visceral injury
Towbin, A.; Turner, G.L.
Obstetrics and Gynecology 52(1): 113-124
1978
ISSN/ISBN: 0029-7844 PMID: 683621 Document Number: 137915
Most visceral damage present in the newborn apparently is due to prenatal factors; although many toxic, infectious and genetic disorders affect the fetus, 2 primary processes, hypoxia and mechanical trauma, are the cause of most fetal-neonatal morbidity and mortality. Of the main forms of mechanical injury, attention is directed to the predominance of parturitional crush injury of the liver, trauma to spinal structures and, less known, brain stem injury. Hypoxia results in a consistent sequence of pathologic processes leading to changes of congestive circulatory failure in the fetus and newborn, with consequent local venous stasis-thrombosis, with focal hemorrhagic infarctional damage in the heart, lungs, kidneys, adrenals, brain and other viscera, often with lasting chronic sequels. Perinatal hypoxic brain injury is of 2 main forms, deep cerebral damage in the premature fetus and newborn infant and cortical damage at term, with related specific clinical symptoms in the newborn infant. Occurrence of chronic sequels is correspondingly related; cerebral palsy proves to be the disease common to premature infants, the result of deep cerebral damage. Mental retardation, epilepsy and related psychopathy commonly result from cortical damage incurred at term. This review points to the importance of endogenous perinatal causal factors, especially placental disorders, in cases with fetal-neonatal damage and indicates the need for incorporation of more comprehensive obstetric case information in interdisciplinary investigation of perinatal visceral injuries and their sequels.