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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, Joachim W.

Editorial Board Member: / Bancalari, Eduardo / Greenough, Anne / Genc, Mehmet R. / Chervenak, Frank A. / Chappelle, Joseph / Bergmann, Renate L. / Bernardes, J.F. / Bevilacqua, G. / Blickstein, Isaac / Cabero Roura, Luis / Carbonell-Estrany, Xavier / Carrera, Jose M. / D`Addario, Vincenzo / D'Alton, MD, Mary E. / Dimitrou, G. / Grunebaum, Amos / Hentschel, Roland / Köpcke, W. / Kawabata, Ichiro / Keirse, M.J.M.C. / Kurjak M.D., Asim / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, MD, PhD, HonD, Istvan / Vetter, Klaus / Winn, MD, Hung N. / Young, Bruce K. / Zimmermann, Roland

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Increased IMPACT FACTOR 2012: 1.949
Rank 29 out of 77 in category Obstretics & Gynecology and 39 out of 121 in category Pediatrics in the 2012 Thomson Reuters Journal Citation Report/Science Edition

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Uterine activity: implications for the condition of the fetus

Petra C.A.M. Bakker1 / Herman P. van Geijn2

1Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands

2Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands

Corresponding author: Prof. Dr. Herman P. van Geijn, MD, PhD Professor and Head of Department of Obstetrics and Gynaecology VU University Medical Center Mailbox 7057 1007 MB Amsterdam The Netherlands Tel.: +31-204442227 Fax: +31-204444811

Citation Information: Journal of Perinatal Medicine. Volume 36, Issue 1, Pages 30–37, ISSN (Online) 16193997, ISSN (Print) 03005577, DOI: 10.1515/JPM.2008.003, January 2008

Publication History

Received:
2007-04-20
Revised:
2007-07-15
Accepted:
2007-10-15
Published Online:
2008-01-10

Abstract

Aim: The aim of this review is to provide more insight in the fetal mechanisms as a response to uterine contractions and to emphasize the importance of correct assessment of uterine activity (UA) patterns during labor.

Study results: UA causes a decreased flow through the uterine artery. In the healthy uncompromised fetus, this will not cause fetal acidemia. The fetus has developed certain protection mechanisms to survive labor; (1) During a contraction, fetal preload increases and enables the fetus to maintain a constant blood flow through the umbilical artery and (2) UA increases the blood flow in the fetal middle cerebral artery, i.e., a brain sparing effect.

The shortcoming of those protection mechanisms in the compromised fetus and in case of excessive UA increases the risk of adverse fetal outcome. The brain sparing effect will become more pronounced to compensate for the decreased umbilical artery blood flow and fetal oxygen saturation. Maintenance of normal UA, especially a sufficiently long relaxation time, is essential so that the supply of well oxygenated maternal blood to the intervillous space will be restored and the fetal cerebral oxygen saturation can remain stable.

Conclusion: Adequate UA monitoring is a prerequisite for proper reading and interpretation of cardiotocograms. It alarms in cases of excessive UA and can help to prevent fetal acidemia. Uterine contraction monitoring deserves full attention in daily obstetric practice.

Keywords: Fetal heart rate pattern; fetal outcome; fetal oxygenation; paturation; umbilical artery blood flow velocity; uterine activity; uterine artery blood flow velocity

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