Intrapartum fetal hypoxia and biochemical markers: A review

Obstetrical and Gynecological Survey

Volumn 53, Issue 10, 1998, Pages 645-657

  Nordström, Lennart ^a,b   Arulkumaran, Sabaratnam ^a  

^a NATIONAL UNIVERSITY HOSPITAL   (Singapore)

^b ÖSTERSUND HOSPITAL   (Sweden)

Author keywords

[No Author keywords available]

Indexed keywords

ADENOSINE; BIOCHEMICAL MARKER; CATECHOLAMINE; ERYTHROPOIETIN; EXCITATORY AMINO ACID; LACTIC ACID; OXYGEN; OXYGEN RADICAL; PURINE DERIVATIVE; PYRUVIC ACID;

ACID BASE BALANCE; ANAEROBIC METABOLISM; BRAIN INJURY; CEREBRAL PALSY; FETUS; FETUS DISTRESS; FETUS HYPOXIA; HUMAN; LIPID PEROXIDATION; OXYGEN SATURATION; PH; REOXYGENATION; REPERFUSION; REVIEW;

BIOLOGICAL MARKERS; CEREBRAL PALSY; FEMALE; FETAL BLOOD; FETAL DISTRESS; FETAL HYPOXIA; FETUS; HUMANS; OBSTETRIC LABOR COMPLICATIONS; PREGNANCY;

EID: 0031669835     PISSN: 00297828     EISSN: None     Source Type: Journal    
DOI: 10.1097/00006254-199810000-00023     Document Type: Review

References (152)

1. Sykes GS, Molloy PM, Johnson P et al. Do Apgar scores indicate asphyxia? Lancet 1982;1:494-496.
2. Rooth G. Perinatal acid-base balance. Studentlitteratur. Lund, Sweden, 1988, pp 30-33.
3. Thornburg KL, Morton MJ. Development of the cardiovascular system. In: Thornburn G, Harding R, eds. Textbook of Fetal Physiology. New York: Oxford University Press, 1994, pp 118-120.
4. Peeters LL, Sheldon RD, Jones MD et al. Blood flow to fetal organs as a function of arterial oxygen content. Am J Obslet Gynecol 1979;135:637-646.
5. Rurak DW, Gruber NC. The effect of neuromuscular blockade on oxygen consumption and blood gases in the fetal lamb. Am J Obstel Gynecol 1983;145:258-262.
6. Bekedam DJ, Visser GHA. Effects of hypoxemic events on breathing movements and heart rate variation: A study in growth-relarded human fetuses. Am J Obstet Gynecol 1985; 153:52-56.
7. Vintzileos AN, Fleming AD, Scorza WE et al. Relationship between fetal biophysical activities and umbilical cord blood gas values. Am J Obstet Gynecol 1991;165:707-713.
8. Booking AD, White SE, Homan J et al. Oxygen consumption is maintained in fetal sheep during prolonged hypoxaemia. J Dev Physiol 1992;17:169-174.
9. Longo LD. Respiratory gas exchange in the placenta. In: Fishman AP, Farhi LE, Tenney SM, eds. Handbook of Physiology. Washington, DC: American Physiology Society, 1987, vol 4, p 351.
10. Nicolini U, Hubinont C, Santolaya J et al. Effects of fetal glucose challenge in normal and growth retarded fetuses. Horm Metab Res 1990;22:426-430.
11. Pulsinelli W, Brierly J, Plum F. Temporal profile of neuronal damage in a model of transient forebrain ischemia. Ann Neurol 1982;11:491-498.
12. Demopoulos HB, Flamm ES, Seligman ML et al. Molecular pathology of lipids in CNS membranes. In: Jobis FF, ed. Oxygen and Physiological Functions. Dallas: Professional Information Library, 1976, pp 491-508.
13. Flamm ES, Demopoulos HB, Seligman ML et al. Free radicals in cerebral ischaemia. Stroke 1978;9:445-447.
14. Armstead WM, Mirro WE, Busija DW et al. Postischemic generation of superoxide anion by newborn pig brain. Am J Physiol 1988;255(No. 2 Part 2):H401-H403.
15. Saugstad OD. Neonatal oxygen radical disease. Recent Adv Ped 1992;10:173-187, Davies TJ (ed).
16. Palmer C, Vannucci RC, Towfighi J. Reduction of perinatal hypoxic-ischemic brain damage by allopurinol. Pediatr Res 1990;27:332-336.
17. Bromont C, Marie C, Bralet J. Increased lipid peroxidation in vulnerable brain regions after transient forebrain ischemia in rats. Stroke 1989;20:918-924.
18. Thiringer K, Hrbek A, Karlsson K et al. Postasphyxial cerebral survival in newborn sheep after treatment with oxygen free radical scavengers and calcium antagonists. Pediatr Res 1987;22:62-66.
19. Rosenberg AA, Murdaugh E, White CW. The role of oxygen free radicals in postasphyxia cerebral hypoperfusion in newborn lambs. Pediatr Res 1989;26:215-219.
20. Bågenholm R, Andiné P, Hagberg H et al. Effects of the 21-aminosteroid U74006F on brain damage and edema following perinatal hypoxia/ischemia in the rat. J Cereb Blood Flow Metab 1991;11(Suppl 2):134-140.
21. 2+ in mammalian neurons. Trends in Pharmaceutical Sciences Special Report, 1991, pp 36-42.
22. Greenmayre T, Penney JB, Young AB et al. Evidence for transient perinatal glutamatergic innervation of globus pallidus. J Neurosci 1987;7:1022-1030.
23. Hagberg H, Andersson P, Kjellmer I et al. Extracellular overflow of glutamate, aspartate, GABA and taurine during hypoxia-ischemia. Neurosci Lett 1987;78:311-317.
24. Andriné P, Lehmann A, Ellrén K et al. The amino acid antagonist kynurenic acid administered after hypoxic-ischemia in neonatal rats offers neuroprotection. Neurosci Lett 1988;90: 208-212.
25. Apgar V, Holaday DA, James LS et al. Evaluation of the newborn infant - second report. JAMA 1958;168:1985-1988.
26. Silverman F, Suidan J, Wasserman J et al. The Apgar score: Is it enough? Am J Obstet Gynecol 1985;66:331-336.
27. Dijxhoorn MJ, Visser GHA, Vidler VJ et al. Apgar score, meconium and acidaemia at birth in relation to neonatal neurological morbidity in term infants. Br J Obstet Gynaecol 1986;93:217-222.
28. Gilstarp LC, Leveno KJ, Burris J et al. Diagnosis of birth asphyxia on the basis of fetal pH, Apgar score and newborn cerebral dysfunction. Am J Obstet Gynecol 1989;161:825-830.
29. Hull J, Dodd K. What is birth asphyxia? Br J Obstet Gynaecol 1991;98:953-955.
30. Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress: A clinical and electroencephalographic study. Arch Neurol 1976;33:696-705.
31. Low JA, Galbraith RS, Muir DW et al. The relationship between perinatal hypoxia and newborn encephalopathy. Am J Obstet Gynecol 1985;152:256-260.
32. Nelson KB, Leviton A. How much of neonatal encephalopathy is due to birth asphyxia. Am J Dis Child 1991;145:1325-1331.
33. American Academy of Pediatricians, American College of Obstetricians and Gynecologists. Relationship between perinatal factors and neonatal outcome. In Poland RL, Freeman RK, eds. Guidelines for Perinatal Care, 3rd Ed. Elk Grove Village, Illinois: American Academy of Pediatrics, 1992, pp 21-24.
34. Levene M, Kornberg J, Williams T. The incidence and severity of post-asphyxial encephalopathy in full-term infants. Early Hum Dev 1985;11:21-26.
35. Thornberg E. Birth asphyxia. Incidence, clinical course and outcome related to neurophysiological and neurochemical parameters. [thesis] Göteborg, Sweden: Tryckt & Bunden, Vasastadens Bokbinderi AB, 1994, pp 7-9.
36. Blair E, Stanley FJ. Intrapartum asphyxia: A rare cause of cerebral palsy. J Pediatr 1988;112:515-519.
37. Gårdmark S, Eckerlund I, Lindberg B et al. Perinatal Revision [in Swedish]. Stockholm: SPRI, 1991, pp 21-23.
38. Bretscher J, Saling E. pH values in the human fetus during labor. Am J Obstet Gynecol 1967;97:906-911.
39. Fee SC, Malee K, Deddisch R et al. Severe acidosis and subsequent neurologic status. Am J Obstet Gynecol 1990; 162:802-806.
40. Goldaber KG, Gilstrap LC, Leveno KJ et al. Pathologic fetal acidemia. Obstet Gynecol 1991;78:1103-1107.
41. Winkler CL, Hauth JC, Tucker MJ et al. Neonatal complications at term as related to the degree of umbilical artery acidemia. Am J Obstet Gynecol 1991;164:637-641.
42. Goodwin TM, Belai I, Hernandez P et al. Asphyxial complications in the term newborn with severe umbilical acidemia. Am J Obstet Gynecol 1992;167:1506-1512.
43. Goodlin RC, Freedman WL, McFee et al. The neonate with unexpected acidaemia. J Reprod Med 1994;39:97-100.
44. Thorp JA, Sampson JE, Parisi VM et al. Routine umbilical cord blood gas determinations? Am J Obstet Gynecol 1989; 161:600-605.
45. Low JA, Galbraith RS, Muir DW et al. Motor and cognitive deficits after intrapartum asphyxia in the mature fetus. Am J Obstet Gynecol 1988;158:356-361.
46. Low JA, Panagiotopolous C, Derrick EJ. Newborn complications after intrapartum asphyxia with metabolic acidosis in the term fetus. Am J Obstet Gynecol 1994;170:1081-1087.
47. Rosén KG, Murphy KW. How to assess fetal metabolic acidosis from cord samples. J Perinat Med 1991;19:221-226.
48. Foxdal P, Sjödin B, Runstam H et al. Lactate concentration differences in plasma, whole blood, capillary finger blood and erythrocytes during submaximal graded exercise in humans. Eur J Appl Physiol 1991;61:218-222.
49. Yoshioka T, Roux JF. Correlation of fetal scalp blood pH, glucose, lactate and pyruvate concentration with cord blood determinations at time of delivery and cesarean section. J Reprod Med 1970;5:63-68.
50. Smith NC, Soutter W, Sharp F. Fetal scalp blood lactate as an indicator of intrapartum hypoxia. Br J Obstet Gynaecol 1983;90:821-831.
51. Eguiluz A, López Bernal A, McPherson K et al. The use of intrapartum fetal blood lactate measurements for the early diagnosis of fetal distress. Am J Obstet Gynecol 1983;147: 949-954.
52. Piquard F, Schaefer A, Dellenbach P et al. Is fetal acidosis in the human fetus maternogenic during labour? A reanalysis. Am J Physiol 1991;261 (No. 5 Part 2):R1294-R1299.
53. Nordström L, Persson B, Shimojo N et al. Fetal scalp and umbilical artery lactate measured with a new test strip method. Br J Obstet Gynaecol 1992;99:307-309.
54. Nordström L, Ingemarsson I, Kublickas M et al. Scalp blood lactate - a new test strip method for monitoring fetal well-being in labour. Br J Obstet Gynaecol 1995;102:894-899.
55. Westgren M, Kruger K, Ek S et al. Lactate compared with pH analysis at fetal scalp blood sampling: A prospective randomized study. Br J Obstet Gynaecol 1998;105:29-33.
56. Shimojo N, Naka K, Uenoyama H et al. Electrochemical assay system with single-use electrode strip for measuring lactate in whole blood. Clin Chem 1993;39:2312-2314.
57. Westgren M, Divon M, Horal M et al. Routine measurements of umbilical artery lactate levels in the prediction of perinatal outcome. Am J Obstet Gynecol 1995;173:1416-1422.
58. Ruth VJ, Riavio KO. Perinatal brain damage: Predictive value of metabolic acidosis and Apgar score. BMJ 1988;297:24-27.
59. Johnson JWC, Richards DS, Wagaman RA. The case for routine umbilical blood acid-base studies at delivery. Am J Obstet Gynecol 1990;162:621-625.
60. Greene KR, Rosén KG. Intrapartum asphyxia. In: Levene MI, Lilford RJ, eds. Fetal and Neonatal Neurology and Neurosurgery. Edinburgh: Churchill Livingstone, 1995, pp 389-404.
61. Nordström L, Arulkumaran S, Chua S et al. Continuous maternal glucose infusion during labor. Effects on maternal and fetal glucose and lactate levels. Am J Perinatol 1995;357-362.
62. Lunell NO, Joelsson I, Larsson A et al. The immediate effect of a β-adrenergic agonist (salbutamol) on carbohydrate and lipid metabolism during the third trimester of pregnancy. Acta Obstet Gynecol Scand 1977;56:475-478.
63. Huch R. Maternal hyperventilation and the fetus. J Perinat Med 1986;14:3-17.
64. Hotchkiss RS, Rust RS, Song SK et al. Effect of sepsis on brain energy metabolism in normoxic and hypoxic rats. Circ Shock 1993;40:303-310.
65. Daniels SS, Adamson K, James LS. Lactate and pyruvate as an index of prenatal oxygen deprivation. Pediatrics 1966;37: 942-953.
66. Low JA, Panchan SR, Worthington D et al. Acid-base, lactate and pyruvate characteristics of the obstetric patient and fetus during the intrapartum period. Am J Obstet Gynecol 1974;120:862-867.
67. Low JA, Panchan SR, Piercy WN et al. Maternal and fetal lactate characteristics during labour and at delivery. In: Bossart H, Perret C, eds. Lactate in Acute Conditions. Farmington, CT: S Karger, 1979, pp 29-47.
68. Saugstad OD, Aasen AO. Plasma hypoxanthine levels as a prognostic aid of tissue hypoxia. Eur Surg Res 1980;12:123-129.
69. Thiringer K, Saugstad OD, Kjellmer I. Plasma hypoxanthine in exteriorized, acutely asphyxiated fetal lambs. Pediatr Res 1980;14:905-909.
70. deHaan HH, Ijzermans AC, deHaan J et al. Effects of surgery and asphyxia on levels of nucleosides, purine bases, and lactate in cerebrospinal fluid of fetal lambs. Pediatr Res 1994;36:595-600.
71. Saugstad OD. Hypoxanthine as a measurement of hypoxia. Pediatr Res 1975;9:158-161.
72. O'Connors MC, Harkness RA, Simmonds RJ. The measurement of hypoxanthine, xanthine, inosine, and uridine in umbilical cord blood and fetal scalp blood samples as a measure of fetal hypoxia. Br J Obstet Gynaecol 1981;88:381-390.
73. Thiringer K. Cord plasma hypoxanthine as a measure of foetal asphyxia. Acta Paediatr Scand 1983;72:231-237.
74. Saugstad OD, Ziegler M, Kessel B et al. Correlation of plasma hypoxanthine and catecholamine levels in the umbilical vein. J Perinat Med 1986;14:339-343.
75. Pietz J, Guttenberg N, Gluck L. Hypoxanthine: New standard for asphyxia. Pediatr Res 1987;21:373A.
76. Issel EP, Lun A, Pohle R et al. Hypoxanthine plasma concentration in pregnancy and labour with regard to hypoxia. J Perinat Med 1988;16:99-107.
77. Porter KB, O'Brien WF, Benoit R. Comparison of cord purine metabolites to maternal and neonatal variables of hypoxia. Obstet Gynecol 1992;79:394-397.
78. Richey SD, Ramin SM, Bawdon RE et al. Markers of acute and chronic asphyxia in infants with meconium-stained amniotic fluid. Am J Obstet Gynecol 1995;172:1212-1215.
79. Russel GA, Jeffers G, Cooke RW. Plasma hypoxanthine: A marker for hypoxic-ischaemic induced periventricular leucomalacia? Arch Dis Child 1992;67:388-392.
80. Kjellmer I, Andiné P, Hagberg H et al. Extracellular increase of hypoxanthine and xanthine in the cortex and basal ganglia of fetal lambs during hypoxia-ischemia. Brain Res 1989;478: 241-247.
81. Berne RM. Adenosine: An important physiological regulator. New Physiol Sci 1986;1:163-167.
82. Ross Russell RI, Greenough A, Lagercrantz H et al. Fetal anaemia and its relation with increased concentrations of adenosine. Arch Dis Child 1993;68:35-36.
83. Yoneyama Y, Wakatsuki M, Sawa R et al. Plasma adenosine concentration in appropriate-and small-for-gestational-age fetuses. Am J Obstet Gynecol 1994;170:684-688.
84. Zini I, Tomasi A, Grimaldi R et al. Detection of free radicals during brain ischemia and reperfusion by spin trapping and microdialysis. Neurosci Lett 1992;138:279-282.
85. Inder TE, Graham P, Sanderson K et al. Lipid peroxidation as a measure of oxygen free radical damage in the very low birthweight infant. Arch Dis Child Fetal Neonatal Ed 1994;70: F107-F111.
86. Varsila E, Pitkänen O, Hallman M et al. Immaturity-dependent free radical activity in preterm infants. Pediatr Res 1994;36:55-59.
87. Wang W, Pang CCP, Phil D et al. Lipid peroxidation in cord blood at birth. Am J Obstet Gynecol 1996;174:62-65.
88. Mongelli M, Wang CC, Wang W et al. Oxygen free radical activity in the second stage of labor. Acta Obstet Gynecol Scand 1997;76:765-768.
89. Wang CC, Rogers MS. Lipid peroxidation in cord blood: The effect of amniotic fluid. Br J Obstet Gynaecol 1997;104: 1140-1144.
90. Wang CC, Rogers MS. Lipid peroxidation in cord blood: A randomized sequential pairs study of prophylactic saline amnioinfusion for intrapartum oligohydramnios. Br J Obstet Gynaecol 1997;104:1145-1151.
91. Lagercrantz H, Slotkin TA. The "stress" of being born. Sci Am 1986;254:92-102.
92. Lagercrantz H, Bistoletti P. Catecholamine release in the newborn infant at birth. Pediatr Res 1977;11:889-893.
93. Falconer AD, Lake DM. Circumstances influencing umbilicalcord plasma catecholamines at delivery. Br J Obstet Gynaecol 1982;89:44-49.
94. Irestedt L, Lagercrantz H, Belfrage P. Causes and consequences of maternal and fetal sympathoadrenal activation during parturition. Acta Obstet Gynecol Scand 1984; 118(Suppl):111-115.
95. Hägnevik K, Faxelius G, Irestedt L et al. Catecholamine surge and metabolic adaptation in the newborn after vaginal delivery and cesarean section. Acta Paediatr Scand 1984;73: 602-609.
96. Nordström L, Marcus C, Persson B et al. Lactate in cord blood and its relationship to pH and catecholamines in spontaneous vaginal deliveries. Early Hum Dev 1996;46:97-99.
97. Nordström L, Chua S, Roy A et al. Lactate, lactate/pyruvate ratio and catecholamine interrelations in cord blood after complicated pregnancies. Early Hum Dev. In press.
98. Ireland R, Abbas A, Thilaganathan B et al. Fetal and maternal erythropoietin levels in normal pregnancy. Fetal Diagn Ther 1992;7:21-25.
99. Schneider H, Malek A. Lack of permeability of the human placenta for erythropoietin. J Perinat Med 1995;23:71-76.
100. Teramo KA, Widness JA, Clemons GK et al. Amniotic fluid erythropoietin correlates with umbilical plasma erythropoietin in normal and abnormal pregnancy. Obstet Gynecol 1987; 69:710-715.
101. Ruth VJ, Fyhrquist F, Clemons G et al. Cord plasma vasopressin, erythropoietin, and hypoxanthine as indices of asphyxia at birth. Pediatr Res 1988;24:490-494.
102. Maier RF, Bohme K, Dudenhausen JW et al. Cord blood erythropoietin in relation to different markers of fetal hypoxia. Obstet Gynecol 1993;81:575-580.
103. Maier RF, Gunther A, Vogel M et al. Umbilical venous erythropoietin and umbilical artery pH in relation to morphologic placental abnormalities. Obstet Gynecol 1994;84:81-87.
104. Fahenstich H, Dame C, Allera A et al. Erythropoietin as a biochemical parameter for fetal hypoxia [in German]. Klin Pädiatr 1995;207:326-330.
105. Widness JA, Teramo KA, Clemons GK et al. Temporal response of immunoreactive erythropoietin to acute hypoxemia in fetal sheep. Pediatr Res 1986;20:15-19.
106. Soothill PW, Nicolaides KH, Campbell S. Prenatal asphyxia, hyperlactacidaemia, hypoglycaemia and erythroblastosis in growth retarded fetuses. Br Med J 1987;294:1051-1053.
107. Korst LM, Phelan JP, Ahn MO et al. Nucleated red blood cells: An update on the marker for fetal asphyxia. Am J Obstet Gynecol 1996;175:843-846.
108. Naeye LR, Localio AR. Determining the time before birth when ischemia and hypoxemia initiated cerebral palsy. Obstet Gynecol 1995;86:713-719.
109. Hashiguchi K, Takagi K, Nakabayashi M et al. Relationship between fetal hypoxia and endothelin-1 in fetal circulation. J Cardiovasc Pharmacol 1991;19(Suppl 7):S509-S510.
110. OhnoY, Mizutani S, Kurauchi O et al. Umbilical plasma concentration of endothelin-1 in intrapartum fetal stress: Effect of fetal heart rate abnormalities. Obstet Gynecol 1995;86: 822-825.
111. Wolff K, Carlström K, Kublickiene K et al. Endothelin-1 and big-endothelin-1 levels in normal term pregnancy and in preeclampsia. Regul Pept 1996;67:211-216.
112. DeVane GW, Porter JC. An apparent stress-induced release of arginine vasopressin by human neonates. J Clin Endocrinol Metab 1980;51:1412-1416.
113. Rudolph AM, Ikovitz J, Iwamoto H et al. Fetal cardiovascular response to stress. Semin Perinatal 1981;5:109-121.
114. Alexander DP, Britton HG, Forsling ML et al. Pituitary and plasma concentrations of adrenocorticotrophin, growth hormone, vasopressin and oxytocin in fetal and maternal sheep during the latter half of gestation and the response to haemorrhage. Biol Neonate 1974;24:206-219.
115. Revoltella RP, Borney F, Dal-Canto B et al. Apoptosis of serum-free C2.8 mouse embryo hepatocytic cells caused by hepatocyte growth factor deprivation. Cytotechnology 1993; 13:13-19.
116. Vinatier D, Dufor PH, Subtil D. Apoptosis: A programmed cell death involved in ovarian and uterine physiology. A review. Eur J Obstet Gynecol Reprod Biol 1996;67:85-102.
117. Hagberg H, Thornberg E, Blennow M et al. Excitatory amino acids in the cerebrospinal fluid of asphyxiated infants: Relationship to hypoxic-ischemic encephalopathy. Acta Paediatr 1993;82:925-929.
118. Chao CC, Hu S. Tumor necrosing factor-alpha potentiates glutamate neurotoxicity in human fetal brain cell culture. Dev Neurosci 1994;16:172-179.
119. Yamada M, Hatanaka H. Interleukin-6 protects cultured rat hippocampal neurons against glutamate-induced cell death. Brain Res 1994;643:173-180.
120. Hill FA, Crawford R, Harding S et al. The effect of labor on maternal and fetal levels of insulin-like growth factor binding protein-1. Am J Obstet Gynecol 1994;171:1292-1295.
121. Thornberg E, Thiringer K, Hagberg H et al. Neuron specific enolase in asphyxiated newborns: Association with encephalopathy and cerebral function monitoring trace. Arch Dis Child Fetal Neonatal Ed 1995;72:F39-F42.
122. Blennow M, Hagberg H, Rosengren L Glial fibrillary acidic protein in the cerebrospinal fluid: A possible indicator of prognosis in full-term asphyxiated newborn infants? Pediart Res 1995;37:260-264.
123. Blennow M, Rosengren L, Jonsson S et al. Glial fibrillary acidic protein is increased in the cerebrospinal fluid of preterm infants with abnormal neurological findings. Acta Paediatr 1996;85:485-489.
124. McRae A, Gilland E, Bona E et al. Microglia activation after neonatal hypoxic-ischemia. Brain Res Dev Brain Res 1995; 84:245-252.
125. Huch A, Huch R, Schneider H et al. Continuous transcutaneous monitoring of fetal oxygen tension during labour. Br J Obstet Gynaecol 1977;84:1-39.
126. 2 during labour. J Perinat Med 1987;15:395-400.
127. Dawes GS, Lobb M, Moulden M et al. Antenatal cardiotocogram quality and interpretation using computers. Br J Obstet Gynaecol 1992;99:791-797.
128. Bernardes J, Moura ACF, Marques-de-Sá et al. The Porto system. In: van Geijn HP, Copray FJA, eds. A Critical Appraisal of Fetal Surveillance. Amsterdam: Elsevier Science BV, 1994, pp 315-324.
129. Sibony O, Foulliot JP, Benaoudia M et al. Spectral analysis: A method for quantitating fetal heart rate variability. In: van Geijn HP, Copray FJA, eds. A Critical Appraisal of Fetal Surveillance. Amsterdam: Elsevier Science BV, 1994, pp 325-332.
130. Mantel R, Ververs I, Colenbrander GJ et al. Automated antepartum baseline FHR determination and detection of accelerations and decelerations. In: van Geijn HP, Copray FJA, eds. A Critical Appraisal of Fetal Surveillance. Amsterdam: Elsevier Science BV,1994, pp 333-348.
131. Breborowicz GH, Moczko JA, Gadzinowski J. Quantification of the fetal heart rate variability by spectral analysis in growth-retarded fetuses. Gynecol Obstet Invest 1988;25: 186-191.
132. Hasbargen U. Application of neural networks for intrapartum surveillance. In: van Geijn HP, Copray FJA, eds. A Critical Appraisal of Fetal Surveillance. Amsterdam: Elsevier Science BV, 1994, pp 363-367.
133. Pardi G, Tucci E, Uderzo A et al. Fetal electrocardiogram changes in relation to fetal heart rate patterns during labour. Am J Obstet Gynecol 1974;118:243-250.
134. Murray HG. The fetal electrocardiogram: Current developments in Nottingham. J Perinat Med 1986;14:399-404.
135. Rosén KG, Kjellmer I. Changes in the fetal heart rate and ECG during hypoxia. Acta Physiol Scand 1975;93:59-66.
136. Westgate J, Harris M, Curnow JSH et al. Plymouth randomized trial of CTG only versus ST waveform plus CTG for intrapartum monitoring in 2400 cases. Am J Obstet Gynecol 1993;169:1151-1160.
137. Gardosi JO, Schram C, Symonds M. Adaptation of pulse oxymetry for fetal monitoring during labour. Lancet 1991; 337:1265-1267.
138. Luttkas A, Dudenhausen JW. Fetal pulse oxymetry. In: Gardosi J, ed. Clinical Obstetrics and Gynaecology - Intrapartum Surveillance. London: WB Saunders Ltd, 1996, pp 295-306.
139. Smits TM. Laser doppler flowmetry in the fetal scalp. [Thesis]. The University of Groningen, Groningen, The Netherlands, 1989.
140. Hamilton RJ, Hodgett SG, O'Brien PMS. Near infrared spectroscopy applied intrapartum fetal monitoring. In: van Geijn HP, Copray FJA, eds. A Critical Appraisal of Fetal Surveillance. Amsterdam: Elsevier Science BV, 1994, pp 307-324.
141. Langner K, Schmidt S, Dudenhausen JW et al. Measurement of fetal pH in guinea-pig by NMR. Lancet 1984;1:1361.
142. Shimojo N, Naka K, Nakajima C et al. Test-strip method for measuring lactate in whole blood. Clin Chem 1989;35:1992-1994.
143. Nickelsen C, Weber T. The current status of intrapartum continuous fetal tissue pH measurements. J Perinat Med 1991;19:87-92.
144. Nordström L, lngemarsson I, Westgren M. Fetal monitoring with lactate. In: Gardosi J, ed. Clinical Obstetrics and Gynaecology - Intrapartum Surveillance. London: WB Saunders Ltd, 1996, pp 225-242.
145. Thorp JA, Dildy GA, Yeomans ER et al. Umbilical cord blood gas analysis at delivery. Am J Obstet Gynecol 1996;175: 517-522.
146. Saugstad OD, Gluck L. Plasma hypoxanthine levels in newborn infants: A specific indicator of hypoxia. J Perinat Med 1982;10:266-272.
147. 2, and bicarbonate following uncomplicated term vaginal deliveries. Am J Obstet Gynecol 1985;151:798-800.
148. Dennis J, Johnson A, Mutch L et al. Acid-base status at birth and neurodevelopmental outcome at four and one half years. Am J Obstet Gynecol 1989;161:213-220.
149. Rooth G, Nilsson I. Studies on foetal and maternal metabolic acidosis. Clin Sci 1964;26:121-132.
150. Jouppila R, Hollmén A. The effect of segmental epidural analgesia on maternal and fetal acid-base balance, lactate, serum potassium and creatine phosphokinase during labour. Acta Anaesthesiol Scand 1976;20:259-268.
151. Suidan JS, Young BK. Outcome of fetuses with lactic acidemia. Am J Obstet Gynecol 1984;150:33-37.
152. Nordström L, Ingemarsson I, Persson B et al. Lactate in fetal scalp blood and umbilical artery blood measured during normal labor with a test strip method. Acta Obstet Gynecol Scand 1994;73:250-254.