PMID: 16529671Mar 15, 2006Paper

The current crisis in obstetrics

Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'obstétrique Et Gynécologie Du Canada : JOGC
James A Low

Abstract

Of the issues leading to legal actions in obstetrics, the most important are events occurring before delivery that are deemed to account for the birth of a physically or mentally challenged child. In determining causation in the clinical setting, the diagnosis of fetal asphyxia can be made using blood gas and acid-base assessment. However, there are many subsidiary questions that in most cases cannot be answered, including when the asphyxia began, the severity and nature of the asphyxia during the exposure, the quality of the cardiovascular compensation, and when the brain damage occurred. When scientific proof is not available, the dilemma for the court is the requirement to reach a conclusion about the timing of brain damage on the balance of probabilities. Although it is of value, clinical risk scoring using fetal heart rate (FHR) monitoring may result in false positive predictions of fetal asphyxia. The problem in FHR monitoring is the lack of a detailed algorithm for the interpretation of FHR patterns with appropriate recommendations for management. Until such an algorithm is developed, health care workers cannot be expected to respond to fetal heart rate patterns consistently. Responsibility for the crisis in obstetrics m...Continue Reading

Citations

Jan 15, 2014·BMC Pregnancy and Childbirth·Václav ChudáčekLenka Lhotská
Mar 2, 2010·The Journal of Surgical Research·Casey A ReedPirooz Eghtesady

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