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OBSTETRIC FACTORS IN FETAL-NEONATAL VISCERAL INJURY

From the Department or Pathology (Neonatology Section) and the Department of Obstetrics and Gynecology at Norwood Hospital, Norwood, Massachusetts, the Medical Department at W. E. Fernald Stale School, Belmont, Massachusetts, and the Department of Neuropathology, the Collaborative Perinatal Project, at Harvard University Medical School. Boston. Massachusetts

From studies in the national Collaborative Perinatal Project and other current investigations, basic concepts have emerged indicating that 1) most visceral damage present in the newborn is due to prenatal factors; and 2) although many toxic, infectious, and genetic disorders affect the fetus, two 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 infarctionol damage in the heart, lungs, kidneys, adrenals, brain, and other viscera, often with lasting chronic sequels. Perinatal hypoxic brain injury is of two 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. The 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 placenta! disorders, in cases with fetal-neonatal damage, and indicates the need for the incorporation of more comprehensive obstetric case information in interdisciplinary investigation of perinatal visceral injuries and their sequels.