Intrauterine Asphyxia: Clinical Implications for Providers of Intrapartum Care

Jenifer Fahey, CNM, MSN, MPH; Tekoa L. King, CNM, MPH

Disclosures

J Midwifery Womens Health. 2005;50(6):498-506. 

In This Article

Summary

The single worst fear of expectant parents and providers of obstetric care is an adverse neonatal outcome. When an unfortunate event occurs, there is a natural human tendency to want to know why it happened. Poor neonatal outcome, particularly neurologic dysfunction in the term infant, has long been attributed to events during labor and birth. As a better understanding of the pathogenesis of neurologic dysfunction of the neonate has developed, it has become increasingly clear that neonatal encephalopathy and cerebral palsy may frequently have origins in the antepartum period. Furthermore, in many instances, the damage cannot be prevented. Although it appears that the majority of neurologic injuries (asphyxial or nonasphyxial) predate labor, labor is, nonetheless, a time of risk for hypoxemia and academia and a time, therefore, during which increased fetal surveillance is warranted. EFM provides us with a reliable tool with which to establish fetal well-being, but, unfortunately, it is not a reliable predictor of adverse neurologic outcome. Although evidence suggests that there are certain fetal heart rate patterns that are associated with an increased risk of fetal asphyxia, most of the fetuses with these patterns will show no evidence of asphyxia at birth. Therefore, when these patterns are present, further evaluation of fetal well-being should be conducted to decrease the rate of unnecessary interventions. The ability to elicit accelerations in the fetus through scalp or vibroacoustic stimulation is indicative of a fetus that is not acidemic. Providers of obstetric care should take a leading role in ensuring that permanent neurologic damage does not continue to be inaccurately attributed to intrapartum events. The diagnosis of intrauterine asphyxia should not be made without biochemical evidence to support the diagnosis. Similarly, even in the presence of a diagnosis of intrauterine asphyxia, adverse neurologic outcome should not be attributed to intrapartum events unless the criteria outlined by the ACOG/AAP task force are met.

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