Pathophysiology of foetal oxygenation and cell damage during labour

•Foetuses exhibit cardiovascular, metabolic and behavioural response to hypoxia.•Gradually developing hypoxia affecting the brain damages typically the grey matter.•Acute severe hypoxia damages the basal ganglia while sparing the cerebral cortex.•The severity of damage is determined by the occurrence hypoxic-induced hypotension.

A foetus exposed to oxygenation compromise is capable of several adaptive responses, which can be categorised into those affecting metabolism and those affecting oxygen transport. However, both the extent and duration of the impairment in oxygenation will have a bearing on these adaptive responses. Although intrapartum events may account for no more than one-third of cases with an adverse neurological outcome, they are important because they can be influenced successfully. This review describes the mechanisms underlying foetal hypoxia during labour, acid-base balance and gas exchange, and the current scientific understanding of the role of intrauterine asphyxia in the pathophysiology of neonatal encephalopathy and cerebral palsy. Although the mechanisms involved include similar initiating events, principally ischaemia and excitotoxicity, and similar final common pathways to cell death, there are certain unique maturational factors that influence the type and pattern of cellular injury.