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What is fetal monitoring and why is it relevant do evaluating cerebral palsy cases from a medical – legal perspective?

Electronic fetal monitoring (“EFM”) has helped decrease fetal and neonatal death rates by helping identify fetal distress.  Fetal monitoring is intended to prevent fetal hypoxia when it starts by monitoring the fetus in the womb and identifying signs of fetal distress.

Timing is crucial to responding to fetal distress

Fetal distress refers to an abnormal fetal heart rate pattern that can signal oxygen deprivation.  A fetus is also at risk for: arrhythmia, anemia, infection, and localized restricted blood supply to the brain or organs.

Fetal monitoring strips monitor fetal heart rate (“FHR”), which is recorded on a continuous strip of paper.  The strip can be evaluated to determine fetal heart rate baseline and any changes or trends over time.  Clinicians determine a baseline rate (bpm – beats per minute) to compare any variability, acceleration, or deceleration.  Baseline is the persistently stable rate, where there are not contractions or other provocations.

Acceleration /  Deceleration Relationship In Measuring Fetal Health

Acceleration is a sudden increase in FHR and deceleration is a gradual decrease in FHR with a return to baseline.  Fetal bradycardia (slow heart rate) and tachycardia (rapid heart rate) are compared to baseline.  Depending on the timing of decelerations and changes in baseline and variability, it can signal distress possibly requiring immediate delivery or intervention.

Usually, normal FHR patterns preclude fetal hypoxia; whereas, abnormal FHR patterns only signal an increased chance of adverse outcome and do not actually correlate with hypoxia or adverse outcomes.  Fetal heart rates are cyclical in natural with periods of variability, accelerations, and decelerations.  Therefore, it is important for patterns to be observed over a period of time in order to determine the importance of the pattern, instead of focusing on brief periods of normal activity.

Fetal strips as evidence in medical malpractice cases

In medical malpractice cases involving birth injuries, the fetal monitoring strips are a crucial piece of the puzzle in determining the chid’s condition vs. interventional steps taken by treating physicians and hospital staff during labor and delivery.

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