Reducing intrapartum stillbirths and intrapartum-related neonatal deaths

Abstract

Acute intrapartum emergencies and poor fetal oxygenation commonly contribute to stillbirth and neonatal deaths, as well as to long-term neurologic disabilities including mental impairment and cerebral palsy [1–5]. Much of modern obstetric care in high- and many middle-income countries has been directed at reducing both antepartum and intrapartum fetal oxygen deprivation. These efforts have included the identification of women at risk, such as those women with pre-eclampsia, sickle cell disease and diabetes, and those with compromised fetuses at risk in the absence of maternal complications, such as those with growth restriction or oligohydramnios. Identification of these conditions in the antepartum period is usually followed by various types of prenatal screening to detect those fetuses at even higher risk for poor oxygenation. The use of ultrasound for monitoring amniotic fluid levels and fetal growth, electronic fetal heart rate monitoring, fetal movement counting, and Doppler blood flow measurements have all contributed to better identification of at-risk pregnancies [6–8]. At least as important is skilled care during labor, including fetal heart rate monitoring to identify those fetuses in jeopardy. Rapid instrumental birth or cesarean delivery results in substantial mortality reductions during labor and in the early neonatal period [9]. Thus, by and large, high-income countries have successfully reduced intrapartum fetal organ damage and the associated adverse pregnancy outcomes, including intrapartum stillbirth and intrapartum-related neonatal mortality [5].