Litigation related to intrapartum fetal surveillance

Schifrin, Barry S.; Soliman, Mohamed S.; Koos, Brian J.

doi:10.1016/j.bpobgyn.2015.06.007

Cited by 10 publications

(11 citation statements)

References 101 publications

(114 reference statements)

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“…Thus, if decelerations due to head compression do occur, for example during obstructed labour when the fetal head is engaged in the birth canal, these data suggest that such decelerations reflect severe cerebral hypoperfusion and hypoxia (Schifrin et al . ), and in contrast with current proposed interpretation (Sholapurkar, ; National Institute for Health and Care Excellence, ), should not be considered to be benign.…”

Section: Introductionmentioning

confidence: 73%

The myths and physiology surrounding intrapartum decelerations: the critical role of the peripheral chemoreflex

Lear

Galinsky

Wassink

et al. 2016

The Journal of Physiology

162

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A distinctive pattern of recurrent rapid falls in fetal heart rate, called decelerations, are commonly associated with uterine contractions during labour. These brief decelerations are mediated by vagal activation. The reflex triggering this vagal response has been variably attributed to a mechanoreceptor response to fetal head compression, to baroreflex activation following increased blood pressure during umbilical cord compression, and/or a Bezold–Jarisch reflex response to reduced venous return from the placenta. Although these complex explanations are still widespread today, there is no consistent evidence that they are common during labour. Instead, the only mechanism that has been systematically investigated, proven to be reliably active during labour and, crucially, capable of producing rapid decelerations is the peripheral chemoreflex. The peripheral chemoreflex is triggered by transient periods of asphyxia that are a normal phenomenon associated with all uterine contractions. This should not cause concern as the healthy fetus has a remarkable ability to adapt to these repeated but short periods of asphyxia. This means that the healthy fetus is typically not at risk of hypotension and injury during uncomplicated labour even during repeated brief decelerations. The physiologically incorrect theories surrounding decelerations that ignore the natural occurrence of repeated asphyxia probably gained widespread support to help explain why many babies are born healthy despite repeated decelerations during labour. We propose that a unified and physiological understanding of intrapartum decelerations that accepts the true nature of labour is critical to improve interpretation of intrapartum fetal heart rate patterns.

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Section: Introductionmentioning

confidence: 73%

The myths and physiology surrounding intrapartum decelerations: the critical role of the peripheral chemoreflex

Lear

Galinsky

Wassink

et al. 2016

The Journal of Physiology

162

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“…At the same time, CTG has been implicated in the raising of cesarean delivery and operative vaginal delivery rates especially for 'fetal distress', the majority of which are considered unnecessary because objective criteria of hypoxia (low pH and low Apgar score) are not met. [23][24][25] Instead, the use of cCTG to alert clinicians has been shown to be beneficial in predicting the pH of the umbilical artery at birth, 26 especially since the development of a computerized algorithm for the recognition of maternal heart rate in order to avoid erroneous monitoring of maternal heart rate as fetal during labor. 27 Computerized International Federation of Gynecology and Obstetrics (FIGO) analysis of CTG, however, has been associated with high sensitivity but low specificity.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiotocography has been used in labor for the past 50 years to help prevent hypoxic neurologic injury during labor, but it has not affected the rate of long‐term handicap. At the same time, CTG has been implicated in the raising of cesarean delivery and operative vaginal delivery rates especially for ‘fetal distress’, the majority of which are considered unnecessary because objective criteria of hypoxia (low pH and low Apgar score) are not met …”

Section: Discussionmentioning

confidence: 99%

Computerized analysis of fetal heart rate variability signal during the stages of labor

Annunziata

Tagliaferri

Esposito

et al. 2016

J of Obstet and Gynaecol

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Aim To analyze computerized cardiotocographic (cCTG) parameters (baseline fetal heart rate, baseline FHR; short term variability, STV; approximate entropy, ApEn; low frequency, LF; movement frequency, MF; high frequency, HF) in physiological pregnancy in order to correlate them with the stages of labor. This could provide more information for understanding the mechanisms of nervous system control of FHR during labor progression. Methods A total of 534 pregnant women were monitored on cCTG from the 37th week before the onset of spontaneous labor and during the first and the second stage of labor. Statistical analysis was performed using Kruskal–Wallis test and Wilcoxon rank‐sum test with the Bonferroni adjusted α (< 0.05). Results Statistically significant differences were seen between baseline FHR, MF and HF (P < 0.001), in which the first two were reduced and the third was increased when compared between pre‐labor, and the first and second stages of labor. Differences between some of the stages were found for ApEn, LF and for LF/(HF + MF), where the first and the third were reduced and the second was increased. Conclusions cCTG modifications during labor may reflect the physiologic increased activation of the autonomous nervous system. Using computerized fetal heart rate analysis during labor it may be possible to obtain more information from the fetal cardiac signal, in comparison with the traditional tracing.

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“…1 The causes of the increasing CD rate are multifactorial, but intervention for presumed fetal distress and fear of litigation for "delayed delivery" are high on the list of preventable concerns of obstetrical stakeholders. 1,2 A significant component of the operative delivery rate during a trial of labor (TOL) are those cases deemed to require "emergent operative deliveries" (EOD), undertaken for fetal distress during a TOL whether by CD, vacuum, or forceps. The incidence of adverse outcome is greater among EOD deliveries, especially those requiring "crash" CDs than for non-EOD deliveries.…”

Section: Introductionmentioning

confidence: 99%

Reengineering Electronic Fetal Monitoring Interpretation: Using the Fetal Reserve Index to Anticipate the Need for Emergent Operative Delivery

Eden

Evans

et al. 2018

Reprod. Sci.

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Litigation related to intrapartum fetal surveillance

Cited by 10 publications

References 101 publications

The myths and physiology surrounding intrapartum decelerations: the critical role of the peripheral chemoreflex

The myths and physiology surrounding intrapartum decelerations: the critical role of the peripheral chemoreflex

Computerized analysis of fetal heart rate variability signal during the stages of labor

Reengineering Electronic Fetal Monitoring Interpretation: Using the Fetal Reserve Index to Anticipate the Need for Emergent Operative Delivery

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