It is widely assumed that fetal ischemic brain injury during labor derives almost exclusively from severe, systemic hypoxemia with marked neonatal depression and acidemia. Severe asphyxia, however, is one of several c...It is widely assumed that fetal ischemic brain injury during labor derives almost exclusively from severe, systemic hypoxemia with marked neonatal depression and acidemia. Severe asphyxia, however, is one of several causes of perinatal neurological injury and may not be the most common;most neonates diagnosed with hypoxic-ischemic encephalopathy do not have evidence of severe asphyxia. Sepsis, direct brain trauma, and drug or toxin exposure account for some cases, while mechanical forces of labor and delivery that increase fetal intracranial pressure sufficiently to impair brain perfusion may also contribute. Because of bony compliance and mobile suture lines, the fetal skull changes shape and redistributes cerebrospinal fluid during labor according to constraints imposed by contractions, and bony and soft tissue elements of the birth canal as the head descends. These accommodations, including the increase in intracranial pressure, are adaptive and necessary for efficient descent of the head while safeguarding cerebral blood flow. Autonomic reflexes mediated through central receptors normally provide ample protection of the brain from the considerable pressure exerted on the skull. On occasion, those forces, which are transmitted intracranially, may overcome the various adaptive anatomical, cardiovascular, metabolic, and neurological mechanisms that maintain cerebral perfusion and oxygen availability, resulting in ischemic brain injury. Accepting the notion of a potentially adverse impact of fetal head compression suggests that avoidance of excessive uterine activity and of relentless pushing without steady progress in descent may offer protection for the fetal brain during parturition. Excessive head compression should be considered in the differential diagnosis of ischemic encephalopathy.展开更多
A method of studying the contributions of leaky modes to the wave field is presented based on the analysis of the Riemann surface structure of the characteristic function, and the sensitivities of con- tributions to v...A method of studying the contributions of leaky modes to the wave field is presented based on the analysis of the Riemann surface structure of the characteristic function, and the sensitivities of con- tributions to various factors of interest are examimed. Numerical results show that their contributions to the compressional head wave are related to the distributions of complex poles on (-1, -1) and (0, -1) Riemann sheets on the frequency-wavenumber (ω - k) plane. For fast formations, their contributions are small, while for slow formations with large Poisson’s ratio, their contributions are large because of those complex poles with small imaginary parts near the compressional vertical branch cut. The decaying factor of the contributions of leaky modes is approximately proportional to 1/distance2.展开更多
文摘It is widely assumed that fetal ischemic brain injury during labor derives almost exclusively from severe, systemic hypoxemia with marked neonatal depression and acidemia. Severe asphyxia, however, is one of several causes of perinatal neurological injury and may not be the most common;most neonates diagnosed with hypoxic-ischemic encephalopathy do not have evidence of severe asphyxia. Sepsis, direct brain trauma, and drug or toxin exposure account for some cases, while mechanical forces of labor and delivery that increase fetal intracranial pressure sufficiently to impair brain perfusion may also contribute. Because of bony compliance and mobile suture lines, the fetal skull changes shape and redistributes cerebrospinal fluid during labor according to constraints imposed by contractions, and bony and soft tissue elements of the birth canal as the head descends. These accommodations, including the increase in intracranial pressure, are adaptive and necessary for efficient descent of the head while safeguarding cerebral blood flow. Autonomic reflexes mediated through central receptors normally provide ample protection of the brain from the considerable pressure exerted on the skull. On occasion, those forces, which are transmitted intracranially, may overcome the various adaptive anatomical, cardiovascular, metabolic, and neurological mechanisms that maintain cerebral perfusion and oxygen availability, resulting in ischemic brain injury. Accepting the notion of a potentially adverse impact of fetal head compression suggests that avoidance of excessive uterine activity and of relentless pushing without steady progress in descent may offer protection for the fetal brain during parturition. Excessive head compression should be considered in the differential diagnosis of ischemic encephalopathy.
基金Supported by the National Natural Science Foundation of China (Grant No. 10534040)
文摘A method of studying the contributions of leaky modes to the wave field is presented based on the analysis of the Riemann surface structure of the characteristic function, and the sensitivities of con- tributions to various factors of interest are examimed. Numerical results show that their contributions to the compressional head wave are related to the distributions of complex poles on (-1, -1) and (0, -1) Riemann sheets on the frequency-wavenumber (ω - k) plane. For fast formations, their contributions are small, while for slow formations with large Poisson’s ratio, their contributions are large because of those complex poles with small imaginary parts near the compressional vertical branch cut. The decaying factor of the contributions of leaky modes is approximately proportional to 1/distance2.
