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In groups 1-3, N-terminal peptide of proatrial natriuretic peptide concentrations were higher (P <.001) than in the control group. In group 1, neonates with abnormal umbilical artery blood velocity pattern had higher N-terminal peptide of proatrial natriuretic peptide concentrations than neonates with normal umbilical artery Doppler findings (P <.006). N-terminal peptide of proatrial natriuretic peptide concentrations were higher in group 2 (P <.002) than in groups 1 and 3. CONCLUSIONS Maternal hypertensive disorder and fetal acidemia during labor stimulate fetal atrial natriuretic peptide production, which was greatest in fetuses with severe placental insufficiency and signs of congestive heart failure.

The current definition of shoulder dystocia is inconsistent. The American College of Obstetricians and Gynecologists' (ACOG's) Practice Bulletin Number 40 on shoulder dystocia has two pseudo definitions: (1) failure of the shoulders to deliver spontaneously, putting both mother and fetus at risk for injury; and (2) failure of the delivery attendant to deliver the anterior shoulder by gentle downward traction, thus requiring additional obstetric maneuvers. Shoulder dystocia is caused by impaction of the anterior shoulder behind the pubic symphysis. ACOG does not define any cause for brachial plexus palsy; however, moderate or severe downward head traction is implied to be injurious. A downward tilted pelvis is the major cause of anterior shoulder arrest; it is usually relieved or prevented by McRoberts' position. The mother then spontaneously delivers the shoulders. This is postural shoulder arrest and is not true shoulder dystocia (SD). Failure of the mother in full hip flexion to deliver the shoulders spontaneously is true shoulder dystocia. Various maneuvers are available to correct this situation; all supplement physiological delivery forces and movements that do not increase traction on the brachial plexus. Resuscitation of the child must be pre-planned. Brachial plexus injury is a traction injury caused by pulling the head and neck down and away from the shoulder. Nerves may be bruised, stretched, torn or ruptured; nerve roots may be avulsed from the spinal cord. SD is largely preventable by delivering all patients in McRoberts' or equivalent position. Brachial Plexus Palsy (BPP) is avoidable by never applying head traction at any delivery and using maneuvers to deliver the shoulders that avoid any tension on the brachial plexus.

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Hypoxia and hypovolemia produced by experimental birth asphyxia in primates can affect memory ability and development of the adult brain; in humans, hypovolemia produced by ICC and the resultant infant anemia is strongly correlated with behavioral and learning disorders in children, the degree of anemia being proportional to the degree of mental deficiency.Autism comprises a major portion of these disabilities and is epidemic. Autism occurs more frequently after complicated or difficult births that indicate the use of ICC. The clinical features of autism indicate lesions of the auditory, speech and language areas of the brain to be fundamental. Hypoxic-ischemic birth injury to the inferior colliculi (part of the auditory circuit) could account for the later development of autism.Mercury toxicity from vaccines as a cause of autism is controversial and is still under investigation; mercury accumulation in brain nuclei already damaged by hypoxia-ischemia (in the same manner that bilirubin accumulates in dead tissue but does not stain living tissue) may have led researchers to attribute the damage to an incidental finding and miss the real cause.There is considerable evidence that the autism epidemic will end when the current custom of clamping functioning umbilical cords ends.