Electronic Fetal Monitoring on Trial

In most instances, although not always, if the injury occurred prior to the onset of labor, it is difficult to establish that obstetrical management is responsible for the injury. That is because most antenatal causes of injury are difficult to predict, and even more difficult to prevent. That is not the case where the mother has successfully carried the fetus to term or near term and arrives at the hospital carrying a healthy baby, but that baby then suffers an acute asphyxial event in the course of labor and delivery.

Asphyxia has been defined in the perinatal context as 'cessation of respiratory exchange resulting in hypoxia and carbon dioxide accumulation.' Queenan, Management of High Risk Pregnancy, 4^th Ed., at page 521. Blackwell Science, Massachusetts, 1999. If the asphyxia is permitted to continue for a sufficient length of time, the fetus will go on to develop a metabolic acidosis, which can be measured through the use of umbilical cord blood gases. While there is some debate as to how low the pH has to go before the fetus can begin to sustain brain damage, even the obstetrical community agrees that an arterial cord pH of less than 7.0, with a base deficit of 12 or more, is sufficient to cause permanent brain damage and cerebral palsy. Neonatal Encephalopathy and Cerebral Palsy, Defining the Pathogenesis and Pathophysiology, American College of Obstetricians and Gynecologists and American Academy of Pediatrics, 2003. So when a newborn is delivered with this level of metabolic acidosis, or worse, the focus then turns to whether, looking prospectively, the obstetrical caretakers should have intervened sooner to prevent the child's injuries.