Prenatal care provides a means to identify risks and formulate timely interventions to manage specific complications. For example, physicians routinely perform abdominal examinations, blood pressure measurement, urine and blood testing, and, if certain high-risk conditions exist, ultrasound and other testing may be ordered. In view of the technological advances that exist, particularly in the areas of antepartum fetal surveillance, an inquiry into the circumstances surrounding the birth trauma of the child may often revolve around whether a particular physician should have done more during the antepartum period to assess the function of the fetal-placental unit and the well-being and development of the fetus.
Tests Available to Assess the Fetus
There are several antepartum fetal tests that are available to assist the clinician in distinguishing the normal fetus from the hypoxic or compromised fetus, including:
fetal movement counting,
the non-stress test ("NST"),
the contraction stress test ("CST"),
the oxytocin challenge test ("OCT")
the biophysical profile ("BPP"),
ultrasound, and
doppler flow testing.
These tests are used to gather information about the following:
whether the fetus has adequate reserves to withstand the stress of labor,
whether the intrauterine environment is hostile and no longer capable of promoting normal fetal growth and development, and
whether the fetus is under stress and would benefit from immediate delivery.
The standard of care calls for some type of antepartum fetal assessment when risk factors for uteroplacental insufficiency exist, or other specific clinical situations develop, such as:
decreased fetal movement,
hypertensive disorders,
diabetes,
oligohydramnios,
intrauterine growth retardation, and
post-dated pregnancy.
Each clinician and institution will have preferences that will be dictated by the experiences of the individual practitioner and the location of his or her training. The objective of each test is to identify a fetus that is currently experiencing hypoxia and/or who is at risk for developing asphyxia, if the pregnancy continues and proceeds to labor and delivery. The clinician cannot ignore abnormal tests just because some investigators have released studies indicating that antepartum tests have false-positive results. Until the clinician rules out a potential life-threatening condition, such as hypoxia or asphyxia, further assessment and intervention may be necessary.
The Key Points to Remember!
It is often difficult, if not impossible, for a clinician to predict the precise moment when irreversible brain damage will occur. Fetuses do not always deteriorate in a predictable manner that allows obstetricians adequate time to plan for operative delivery. Obstetricians must anticipate that staff members may be assisting other patients who develop serious complications and/or that operating rooms may be in use when the electronic fetal monitor demonstrates the need for immediate intervention. Thus, it is imperative that plans for operative delivery be made for example, before variable decels progress from mild to severe, or before variability is diminished or lost altogether, so that delivery can occur quickly in the event that the antepartum tests reveal that the fetus is deteriorating and at risk for asphyxial brain damage.
Please Note:
This web site is not intended as legal advice on cerebral palsy, and is not a substitute for obtaining guidance from your own legal counsel about cerebral palsy litigation. It provides general educational information about the standards of care and causation issues that can arise in obstetrical malpractice and cerebral palsy litigation. Readers of the articles contained within this web site should not act upon the cerebral palsy information without first consulting with a lawyer who is experienced in evaluating and litigating cerebral palsy and obstetrical malpractice cases. Mr. Apfel is admitted to practice law in Maryland and the District of Columbia. When Mr. Apfel is asked to participate in cerebral palsy
litigation filed in other states, he will associate with, and act as co-counsel with, an attorney licensed in that state who is familiar with the local laws and procedures.
