4 - Fetal surveillance in labour

Summary

In his 2007 annual report, the Chief Medical Officer of England expressed his concern about the static perinatal mortality rate in the UK over 7 years. He highlighted the issue of intrapartum deaths in a chapter titled ‘Intrapartum-Related Deaths: 500 Missed Opportunities’. These were cases where the fetus was alive on admission but died during labour. The incidence of intrapartum deaths has declined compared with 1995, when the fourth annual report of the Confidential Enquiry into Stillbirths and Deaths in Infancy reported intrapartum death in 1/1600 fetuses weighing more than 1500 g with no chromosomal or congenital malformation. However, the factors that contributed to these deaths have not changed: inability to interpret the cardiotocograph (CTG) trace, failure to incorporate the ‘clinical picture’, delay in taking action and poor teamwork.

In addition to avoidable intrapartum fetal deaths, the incidence of hypoxic ischaemic encephalopathy (HIE) owing to birth asphyxia has not changed and remains about 2/1000, with 1/1000 being HIE grade I and the remainder being grades II and III. Grades II and III have a high correlation with asphyxia-related deaths and neurological injuries. The mortality and morbidity related to intrapartum asphyxia affect the quality of life of parents and siblings and are an enormous drain on taxpayers, who indirectly contribute to the National Health Services Litigation Authority, which pays out billions of pounds in compensation for obstetric negligence in cases of intrapartum-related neurological injury.