Document Detail

Antecedents of neonatal encephalopathy with fetal acidaemia at term.
MedLine Citation:
PMID:  10453826     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To identify the relative contribution of antenatal hypoxia, obstetric catastrophe during labour and fetal monitoring practice to the occurrence of neonatal encephalopathy associated with acidaemia at term. DESIGN: Prospective study. SETTING: Tertiary referral hospital in Auckland, New Zealand. SAMPLE: Twenty-two term babies born between January 1996 and October 1997 with umbilical artery pH < or = 7.09 (median 6.88) or 5 minute Apgar score < 7 (median 5.0), and moderate to severe encephalopathy within five hours of birth. METHODS: Antenatal and intrapartum events and fetal heart rate monitoring practice were reviewed by an experienced obstetrician. RESULTS: More than half the cases were associated with events beyond the control of the clinician: 5 of 22 (23%) had evidence of antenatal hypoxia and 5 of 22 (23%) experienced an obstetric catastrophe during labour. Use of continuous fetal monitoring techniques or the interpretation of fetal heart rate changes was suboptimal in 8 of 12 cases. Continuous monitoring was not performed at all in three cases. All pregnancies were of either low or medium risk; none had proteinuric hypertension and no case was breech, small for gestational age or had a gestational age > or = 42 weeks. CONCLUSIONS: A significant proportion of babies with encephalopathy associated with acidaemia at term experienced either antenatal hypoxia or catastrophic events beyond the control of the clinician. Further improvements in obstetric care will require greater vigilance in low to medium risk pregnancies and improved fetal monitoring practice during both induction and labour.
J A Westgate; A J Gunn; T R Gunn
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  British journal of obstetrics and gynaecology     Volume:  106     ISSN:  0306-5456     ISO Abbreviation:  Br J Obstet Gynaecol     Publication Date:  1999 Aug 
Date Detail:
Created Date:  1999-09-22     Completed Date:  1999-09-22     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7503752     Medline TA:  Br J Obstet Gynaecol     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  774-82     Citation Subset:  AIM; IM    
Department of Obstetrics and Research Centre for Developmental Medicine and Biology, School of Medicine, University of Auckland, New Zealand.
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MeSH Terms
Acidosis / etiology*
Brain Diseases / etiology*
Delivery, Obstetric / adverse effects*
Fetal Hypoxia / complications*
Fetal Monitoring
Heart Rate, Fetal
Infant, Newborn
Maternal Age
Obstetric Labor Complications*
Pregnancy, High-Risk
Prospective Studies
Risk Factors
Comment In:
BJOG. 2000 Mar;107(3):434   [PMID:  10740347 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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