The obstetric management of fetal distress and its association with cerebral palsy.

Objective: To determine the relation between the obstetric management of fetal distress and cerebral palsy.

Methods: The obstetric details of all 78 children with cerebral palsy born in a geographically defined area between 1975-1980 were compared with those of 591 control children.

Results: Fetal distress was identified more frequently in children with cerebral palsy who were born at term (24%) than among controls (11%).

Antecedents and outcome of very early neonatal seizures in infants born at or after term.

Recent experimentally derived evidence has confirmed earlier suggestions that seizures which occur within 48 h of birth in babies born at or later than 37 completed weeks gestation are particularly likely to reflect intrapartum asphyxia. We have compared 54 cases of such seizures with 41,090 controls in a geographically defined population. Nulliparity, hydramnios, post-term pregnancy, oxytocin augmentation of labour, abnormalities of fetal heart rate and/or meconium-stained amniotic fluid, prolonged second stage of labour, emergency caesarean section, assisted vaginal delivery, low Apgar score and resuscitation at delivery and subsequent ventilatory support were all statistically significantly more common among cases than among controls.

Quality of obstetric care and occurrence of fetal asphyxia and cerebral palsy. Is there a relationship?

Whether a relationship exists between the quality of obstetric care and poor fetal outcome, notably cerebral palsy, remains uncertain. We herein report a study which suggests that substandard obstetric care bears little relationship to the etiology of cerebral palsy. In none of our 34 cases of cerebral palsy was there any recognized delay on the physician's part in reacting to evidence of fetal asphyxia.

Adverse outcome of pregnancy and the quality of obstetric care.

The case-control method was used to study the relation between four possibly preventable adverse outcomes of pregnancy and suboptimal antepartum and intrapartum obstetric care defined by clinical consensus. Fetuses whose deaths were ascribed to asphyxia or trauma, and babies born at term who had seizures within 48 h of delivery, were significantly more likely than controls to have received suboptimal care during pregnancy. Babies with seizures, as well as those with terminal apnoea, were also substantially more likely than controls to have been born after a failure to react appropriately to signs of severe fetal distress during labour.