Amniotic fluid is the term that describes the fluid surrounding the uterus. Amniotic fluid is produced through fetal urination. A sufficient amount of fluid must surround the fetus for proper protection and growth. The amniotic fluid helps the lungs to properly develop, and permits movement within the womb, allowing for good bone growth. The amniotic fluid contains many maternal and fetal nutrients such as water and electrolytes. (more…)

Amniotic fluid embolism (AFE) is an obstetric emergency in which amniotic fluid, fetal cells, hair, or other debris enters the mother’s blood stream via the placental bed of the uterus and trigger an allergic reaction. This reaction then results in cardiorespiratory (heart and lung) collapse and coagulopathy.

Anoxia is an extreme form of hypoxia (low levels of oxygen in the blood) in which there is a complete lack of oxygen supply to the body as a whole or to a specific organ or tissue region.

The Apgar score is a number calculated by scoring the heart rate, respiratory effort, muscle tone, skin color, and reflex irritability. Each of these objective signs can receive 0, 1, or 2 points.  A perfect Apgar score of 10 means an infant is in the best possible condition. An infant with an Apgar score of 0-3 needs immediate resuscitation.  The Apgar score is done routinely 60 seconds after the birth of the infant and then is repeated five minutes after birth.

The baseline fetal heart rate is normally between 120 and 160 beats per minute (110 to 160 at full term).

A biophysical profile (BPP) test measures the health of the baby during pregnancy. A BPP test may include a nonstress test with electronic fetal heart monitoring and a fetal ultrasound. The BPP measures the baby’s heart rate, muscle tone, movement, breathing, and the amount of amniotic fluid around the baby.  A BPP is commonly done in the last trimester of pregnancy

The brachial plexus is a network of nerves that conducts signals from the spinal cord, which is housed in the spinal canal of the vertebral column (or spine), to the shoulder, arm and hand. These nerves originate in the fifth, sixth, seventh and eighth cervical (C5-C8), and first thoracic (T1) spinal nerves, and innervate the muscles and skin of the chest, shoulder, arm and hand. Brachial plexus injuries, also known as “Erb’s Palsy” are caused by damage to those nerves.

Breech presentation is defined as a fetus in a longitudinal lie with the buttocks or feet closest to the cervix.

Brow presentation describes a fetal position when the baby’s head is extended back, with the forehead leading the way through the birth canal. The fetal head is midway between full flexion (vertex position) and hyperextension (face position) along a longitudinal axis. Because the diameter of the fetal head at this angle may be greater than that of the mother’s pelvic outlet, a cesarean section may be recommended. (more…)

A cephalic presentation is a situation at childbirth where the fetus is in a longitudinal lie and the head enters the pelvis first; the most common form of cephalic presentation is the vertex presentation where the occiput is the leading part (the part that first enters the birth canal).  All other presentations are abnormal (malpresentations) which are either more difficult to deliver or not deliverable by natural means.

A hemorrhage of blood between the skull of a newborn baby and the periosteum secondary to the rupture of blood vessels crossing the periosteum is called cephalohematoma. (more…)

Cerebral palsy is a term used to describe a disorder of movement, muscle tone, or posture that is caused by injury or abnormal development in the immature brain. Signs and symptoms appear during infancy or preschool years. Patients with cerebral palsy often have impaired movement which is associated with exaggerated reflexes and/or rigidity of the limbs and trunk, abnormal posture, involuntary movements, unsteadiness of walking, or some combination of these. The effect of cerebral palsy on functional abilities varies greatly. (more…)

Early decelerations are periodic slowing of the fetal heartbeat, synchronized exactly with the contractions. These dips are rarely more than 20 or 30 BPM below the baseline.

Eclampsia is diagnosed when a pregnant woman has tonic-clonic seizures along with high blood pressure and proteinuria. This serious complication of pregnancy may lead to the development of swelling in the brain or coma. Eclampsia may lead to premature labor, convulsions, or in rare cases, fatality. (more…)

Encephalopathy is a term that means brain disease, damage, or malfunction. A very broad range of symptoms may be seen in patients with this diagnosis. The symptoms can be mild, such as memory loss or subtle personality changes, or they can be more severe and include dementia, seizures, coma, and death. In general, encephalopathy is manifested by an altered mental state that is sometimes accompanied by physical manifestations (for example, poor coordination of limb movements). (more…)

The term face presentation refers to the part of the baby that leads the way through the mother’s birth canal. In a face presentation, the fetal head and neck are hyperextended, causing the occiput to come in contact with the upper back of the fetus while lying in a longitudinal axis. The presenting portion of the fetus is the fetal face between the orbital ridges and the chin. If a fetus is in the face presentation and the chin is extended, the head can become caught in the symphysis pubis which would mandate performance of a cesarean section. (more…)

Fetal Acidosis occurs when the chemistry of an infant’s body, specifically blood plasma, becomes too acidic, or falls below a 7.35 on the Ph scale. Fetal Acidosis is a complication often associated with fetal hypoxia and the loss of oxygen during childbirth. This acidity in body chemistry can cause complications including severe and permanent brain damage, and death. (more…)

Fetal bradycardia occurs when there is evidence of sustained depression of the fetal heart rate (below 100 beats per minute) for a period of five minutes or longer as demonstrated on Fetal Heart Tracings. This condition is generally associated with hypoxia and/or placental insufficiency. (more…)

Fetal Tachycardia occurs when there is evidence of a sustained elevation of the fetal heart rate (baseline above 160 BPM) as seen on the Fetal Heart Tracings. A normal baseline fetal heart rate is between 120-160 BPM. Fetal tachycardia commonly occurs in the form of sinus tachycardia, which causes an increased heart rate when the baby breathes. The condition can be a warning sign that a fetus is in distress. (more…)

Gestational hypertension is elevated blood pressure as a result of pregnancy. This condition is determined to be present when a pregnant woman has a blood pressure higher than 140/90 without the presence of protein in her urine and which occurs after 20 weeks of pregnancy. This condition is often the result of the body not secreting enough insulin during pregnancy. (more…)

Hypoxia occurs when there is an inadequate supply of oxygen received to the body’s tissues. This deficient oxygen supply will expose a fetus to the increased likelihood of serious brain injury. Harmful effects can occur as a result of even partial oxygen disruption. Cognitive, physical, and psychological functioning can be impaired when a baby’s oxygen supply is adversely affected. (more…)

Hypoxic Ischemic Encephalopathy (HIE) is a condition that occurs when the entire brain is deprived of an adequate oxygen supply. This is a result of hypoxia (an inadequate amount of oxygen in the blood), and ischemia (damage to the brain due to lack of nutrients). This is an injury where cells in the central nervous system are damaged, and can result in the need for lifelong medical care and treatment. (more…)

An intra-cranial hemorrhage is bleeding in the brain which is caused by the rupture of a blood vessel within the skull. In an infant, intracranial hemorrhage may be the result of deformity of the skull bones during delivery, or from a lack of oxygen. An intracranial hemorrhage, if left untreated, can damage to areas of the brain crucial to motor function and development. (more…)

This type of hemorrhage occurs when there is bleeding into the brain tissue itself.

Intrauterine hypoxia (IH) occurs when the fetus does not receive an adequate supply of oxygen before delivery. IH may be the result of a variety of conditions such as cord prolapse, cord occlusion, and placental infarction. IH, if not timely recognized and treated, can result in hypoxic ischemic encephalopathy which is cellular damage within the central nervous system. Organs such as the brain, heart, and lungs can be permanently damaged due to IH. (more…)

Intraventricular hemorrhage (IVH) of the newborn is bleeding into the fluid-filled areas (ventricles) surrounded by the brain.

A “deceleration” describes a decrease in the heart rate of the fetus from its baseline heartrate. “Late decelerations” are described as a transient decrease in the fetal heart rate occurring at or after the peak of a uterine contraction. Late decelerations may represent some degree of utero-placental insufficiency. All blood flow in and out of the intravillious space stops briefly during a contraction. A normal fetus with normal reserve (oxygen in its bloodstream, in the blood of the placenta, and in the intravillous space) will probably not notice the tiny drop in total oxygen availability during these contractions. But a fetus that has used up its reserve, or cannot maintain its reserve will, over the course of the contraction, may develop some degree of hypoxia, hypercarbia and acidosis. This otherwise normal fetus will respond by slowing its heart rate, to conserve energy. After the contraction passes and fresh blood resupplies the intravillous space, the hypoxia, hypercarbia and acidosis is eased and the fetal heart rate returns to normal. (more…)

Meconium is the earliest stools of an infant. Unlike later feces, meconium is composed of materials ingested during the time the infant spends in the uterus. Meconium is almost sterile, unlike later feces, is viscous and sticky like tar, and has no odor. It should be completely passed by the end of the first few days of life, with the stools progressing toward yellow.  Meconium is normally stored in the infant’s bowel until after birth, but sometimes it is expelled into the amniotic fluid prior to birth or during labor and delivery. Meconium liquor is recognized by medical staff as a sign of fetal distress, and puts the neonate at risk of meconium aspiration.

Meconium aspiration syndrome is a condition which describes respiratory distress in a newborn who has breathed (aspirated) meconium into the lungs at or before the time of birth. Affected newborns have bluish skin, breathe rapidly, and grunt when attempting to exhale. The diagnosis is based on the presence of meconium in the amniotic fluid at birth, respiratory distress in the newborn, and an abnormal chest x-ray. (more…)

Multicystic encephalomalacia is a diffuse lesion involving the brain parenchyma in the perinatal period. The most common causative factor that is implicated in the pathogenesis of this condition is severe hypoxia causing ischemic insult and subsequent cerebral necrosis.

Neonatal Asphyxia is defined as respiratory failure in a newborn infant. This condition can be caused by the inadequate intake of oxygen before, during, or just after birth. Newborn infants normally start to breathe without assistance and cry almost immediately after delivery. Within one minute of delivery, most infants are breathing well without assistance. Neonatal asphyxia is present when an infant fails to establish sustained respiration after birth. Another sign of Neonatal asphyxia is when an infant has no tone and/or low tone (unable to move extremities on its own) after delivery. (more…)

Oligohydramnios is a condition which occurs when there is a decreased amount of fluid in the amniotic sac. This condition is most often seen in the third trimester, and affects less than 10% of pregnancies. (more…)

Periventricular Leukomalacia (PVL) describes injury to the white-matter of the brain. It is characterized by evidence of necrosis of white matter near the lateral ventricles. It affects both newborns and fetuses. This pathology of the brain has been described under various names including: “encephalodystrophy,” “ischemic necrosis,” “periventricular infarction,” “coagulation necrosis,” “leukomalacia,” “softening of the brain,” “infarct periventricular white matter,” “necrosis of white matter,” “diffuse symmetrical periventricular leukoencephalopathy.” (more…)

Placenta previa is a condition which occurs when a baby’s placenta partially or totally covers the mother’s cervix. Placenta previa can cause severe bleeding before or during delivery. The placenta provides oxygen and nutrients to the growing baby and removes waste products from the baby’s blood. It attaches to the wall of the uterus, and the baby’s umbilical cord arises from it. In most pregnancies, the placenta attaches at the top or side of the uterus. In placenta previa, the placenta attaches to the lower area of the uterus. (more…)

Placental abruption occurs when the placenta peels away from the inner wall of the uterus before delivery, either partially or completely. Placental abruption can deprive the baby of oxygen and nutrients and cause heavy bleeding in the mother. (more…)

Polyhydramnios is a term used to signify that there is an excess amount of amniotic fluid in the amniotic sac. Amniotic fluid is important to the health and development of the fetus. The fetus regulates the amount of the amniotic fluid by swallowing the fluid, passing it through the kidneys, and excreting it as urine. (more…)

Post-Partum Hemorrhage (PPH) occurs when a new mother has vaginal bleeding in excess of 500 ml within 24 hours after delivery. Severe PPH occurs when the blood loss exceeds 1,000 ml. When mothers become severely anemic after giving birth, they are at risk for suffering from hypovolemic shock before they have lost 500 ml of blood. Severe bleeding during and after the third stage of labor may be caused by conditions including: uterine atony (failure of the uterus to contract properly after delivery), trauma (cervical, vaginal, or perineal lacerations), retained or adherent placental tissue, clotting disorders, and inverted or ruptured uterus. Post-partum hemorrhage is the most serious complication associated with the third stage of labor (after the baby has been delivered, but before the delivery of the placenta). (more…)

Preeclampsia occurs when a pregnant mother’s blood pressure is greater than 140/90 with “proteinuria” (excess protein in the urine). Preeclampsia is considered severe when the blood pressure is greater than 160/110, and the mother is exhibiting other signs and symptoms. Preeclampsia is most often seen after 37 weeks of pregnancy, but it can occur anytime during the second half of the pregnancy. (more…)

Preterm labor occurs when a woman goes into labor between 20 and 37 weeks of pregnancy. A full-term pregnancy lasts 37 to 42 weeks. Preterm labor is also called premature labor.

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Premature Preterm rupture of membranes (PPROM) is the rupture of membranes between 24-37 weeks’ gestation.  Most patients deliver within one week of the rupture of membranes.  The symptoms of PPROM include leakage of fluid, vaginal discharge, vaginal bleeding, and pelvic pressure, without contractions.

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Premature rupture of membranes (PROM) at term is the rupture of membranes prior to the onset of labor at or beyond 37 weeks’ gestation. Patients with PROM experience symptoms including leakage of fluid, vaginal discharge, vaginal bleeding, and pelvic pressure, without having contractions.

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If a portion of the umbilical cord comes out of the cervix or vulva ahead of the fetus, this is called a prolapsed umbilical cord.  Prolapsed umbilical cords are often preceded by variable decelerations of the fetal heart rate, demonstrated on the electronic fetal monitor.

Shoulder dystocia is a specific case of dystocia whereby after the delivery of the head, the anterior shoulder of the infant cannot pass below the pubic symphysis, or requires significant manipulation to pass below the pubic symphysis. It is diagnosed when the shoulders fail to deliver shortly after the fetal head. In shoulder dystocia, it is the chin that presses against the walls of the perineum.

Spastic quadriplegia occurs in patients with the most severe form of Cerebral Palsy. Spastic quadriplegia causes marked motor impairment of all four limbs. Patients with this condition may also have dysfunction of the muscles of the mouth and tongue. (more…)

This type of hemorrhage occurs below the innermost of the two membranes that cover the brain.

This type of hemorrhage occurs between the outer and the inner layers of brain covering. A subdural hemorrhage can put increased pressure on the surface of the brain.

Twin to Twin Transfusion Syndrome (commonly referred to as “TTTS”) is a condition which can occur in an identical twin pregnancy that is monochorionic/diamniotic. In almost all of these pregnancies, the single placenta contains blood vessel connections between the twins. In approximately 20% of monochorionic/diamniotic twins, the blood flow through these blood vessel connections becomes unbalanced. (more…)

The normal fetal heart rate baseline is from 120 to 160 BPM and has both short and long-term “variability.” Short-Term variability means that from one moment to the next, the fetal heart speeds up slightly and then slows down slightly, usually with a range of 3-5 BPM from the baseline.  Long-Term Variability represents broad-based swings in fetal heart rate, or “waviness,” occurring up to several times a minute. One form of long-term variability of particular significance is fetal heart “acceleration.”

Variable decelerations are variable in onset, duration and depth. They may occur with contractions or between contractions. Typically, they have an abrupt onset and rapid recovery.