Study identifies signals that may predict infant neurological impairment
Doctors use electronic fetal monitoring (EFM) when a
woman is in labor to detect problems and prevent
injury to the baby. However, because EFM tracks fetal
heart rate (FHR) patterns and not neurological activity,
its usefulness may be limited in preventing a birth-related
neurological disability, such as cerebral palsy. A
new study that examined FHR patterns finds that three
other signals, when combined with routine EFM
showing nonreassuring FHR patterns, may help predict
whether a baby will be born with severe neurological
damage.
Researchers compared 36 malpractice cases in which
infants were born with birth-related neurological injuries after exhibiting certain FHR patterns, such as
very rapid or very slow heart rates, with medical
records of infants who also had these FHR patterns
during labor but were born with no neurological
problems. They found that 25 percent of the mothers
whose babies were born with neurological injuries
experienced vaginal bleeding before childbirth
compared with only 1 percent of the mothers in the
control group.
In fact, the odds of giving birth to a baby with neurological impairment were 27 times greater for
women who experienced vaginal bleeding in the
antenatal period and then had non-reassuring FHR
patterns during labor than for women who had
nonreassuring FHR patterns alone. The authors suggest
that vaginal bleeding may indicate an abnormal placenta
that could reduce the baby's oxygen supply during a
stressful childbirth and result in neurological injury.
Half of the women whose babies were born with
neurological injuries had an unusually long latent phase
or delayed dilation during the first stage of labor
compared with 25 percent of the control group's
mothers. In fact, the odds of neurological injury to the
baby were four times as great for the women
experiencing longer first-stage labor and nonreassuring
FHR patterns than for women who did not face
prolonged first-stage labor in addition to their
nonreassuring FHR patterns. Finally, the odds were also four times as great that a
baby would suffer neurological impairment when the
fetal monitor showed minimal heart rate variation along
with nonreassuring FHR patterns during the first stage
of labor than when the routine EFM showed
nonreassuring FHR patterns alone.
The authors recommend future research to assess
whether aggressive intervention could prevent
neurological injury to infants when these signals are
present. This study was funded in part by the Agency
for Healthcare Research and Quality (HS11886).
See "Using malpractice claims to identify risk factors
for neurological impairment among infants following
non-reassuring fetal heart rate patterns during labour,"
by Aaron S. Kesselheim, M.D., M.P.H., Martin T.
November, M.D., M.B.A., Karen L. Lifford, M.D.,
Sc.D., and others in the Journal of Evaluation in
Clinical Practice 16(3), pp. 476-483, 2010.
— KB
Return to Contents
Proceed to Next Article