The 30 minute yardstick is in danger of becoming a rod for our backs
- David James, professor of fetomaternal medicine (David.James@nottingham.ac.uk)
- Queen's Medical Centre, Nottingham NG7 2UH
Papers pp 1330, 1334
Intrapartum hypoxia complicates about 1% of labours and results in death in about 0.5 in 1000 pregnancies and cerebral palsy in 1 in 1000 pregnancies.1 When it is diagnosed clinically as “fetal distress” swift delivery is the aim, and the standard has become delivery within 30 minutes of diagnosing fetal distress. As two papers in this week's BMJ illustrate, however, this standard is hard to achieve. Is it actually necessary?
The pathogenesis of intrapartum hypoxia is often multifactorial but poorly understood. Processes such as uteroplacental vascular disease, reduced uterine perfusion, fetal sepsis, reduced fetal reserves, and cord compression can be involved alone or in combination, and gestational and antepartum factors can modify the fetal response.2 Methods of screening and diagnosing the condition have limitations.3 Thus when the condition is thought to be present, diagnosed clinically as “fetal distress,” clinicians aim for a swift delivery because they lack a clear understanding of the severity of the hypoxia.
Audit of the speed with which such caesarean sections are performed is important for clinical …