Fetal defenses against intrapartum head compression – implications for intrapartum decelerations and hypoxic-ischemic injury

Abstract Uterine contractions during labor and engagement in the birth canal can compress the fetal head. The impact on the fetus is unclear and still controversial. In this integrative physiological review we highlight evidence that decelerations are uncommonly associated with fetal head compression. Next, the fetus has an impressive ability to adapt to increased intracranial pressure through activation of the intracranial baroreflex, such that fetal cerebral perfusion is well maintained during labor except in the setting of prolonged systemic hypoxemia leading to secondary cardiovascular compromise. Thus, when it occurs fetal head compression is not necessarily benign but does not seem to be a common contributor to intrapartum decelerations. Finally, the intracranial baroreflex and the peripheral chemoreflex (the response to acute hypoxemia) have overlapping efferent effects. We propose the hypothesis that these reflexes may work synergistically to promote fetal adaptation to labor.