Objective To review unexpected term admissions to SCBU, identify areas for improvement in care of women in labour and highlight specific cases for learning points.

Background Birth asphyxia is a significant cause of neonatal morbidity and carries a significant risk to the trust for future litigation. The overall incidence of neonatal encephalopathy attributable to intra-partum hypoxia in the absence of any other abnormality is 1–2/1000 live births.¹ The international Cerebral Palsy Task Force² issued criteria to guide the attribution of birth asphyxia to intra-partum events. These include ‘evidence of a metabolic acidosis in intra-partum foetal, umbilical arterial cord or very early neonatal blood sampling, a sentinel hypoxic event occurring immediately before or during labour, a sudden, rapid and sustained deterioration of the foetal heart rate pattern where this was previously normal, and APGAR score of six for longer than five minutes’.²

Method Prospective review of casenotes. All births after 34 weeks’ gestation admitted to SCBU were identified. Exclusions included congenital anomalies and post-natal transfers.

Results Over the two year period there were 106 unexpected admissions to SCBU with 23 cases of hypoxic ischaemic encephalopathy. 67% of unexpected admissions were to primiparous mothers and 60% were over 40 weeks’ gestation. Onset of labour was equally split between spontaneous and induction or augmentation.

The small numbers make interpretation of the data and extrapolation of trends difficult however, trends from the current data suggest those mothers who are primaparous, post-date, induction of labour may be at increased risk of worse neonatal outcomes.

Reference

1. Deborah E Campbell, et al. Textbook of Paediatric Care. AAP 2008

2. Alastair MacLennan for the International Cerebral Palsy Task Force. A Template for defining a causal relation between acute intrapartum events and cerebral palsy: international consensus statement, BMJ 1999;319:1054–9