Intra-partum (IP) surveillance of the unborn child by cardiotacography (CTG) monitoring is the commonest obstetric procedure in the developed world.1 It is also the most medico-legally contested obstetric procedure in labour. In 2011, ‘birth asphyxia’ comprised 50% of the UK National Health Service (NHS) litigation costs,2 and in the 2000–2010 decade, the same NHS paid out £3.1 billion for maternity medico-legal claims (the highest of any speciality), mostly involving cerebral palsy and CTG misinterpretation.3 This article looks at a number of characteristics of IP CTG monitoring which argue for its questionable solidity of base in court proceedings.
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2.
NHS Litigation Authority. Factsheet 3: information on claims. London: NHSLA, 2011, http://www.nhsla.com.
3.
KmietowiczZ. NHS in England paid out £3.1bn in compensation claims linked to maternity care in past decade. Br Med J2012; 345: e7290.
4.
SpencerCMurphyDBewleyS. Editorial: caesarean delivery in the second stage of labour. Br Med J2006; 333: 613–614.
5.
This is one theoretical argumentation which is not used in this case.
6.
HoveLDBockJChristoffersenJK. Analysis of 127 peripartum hypoxic brain injuries from closed claims registered by the Danish Patient Insurance Association. Acta Obstet Gynecol2008; 87: 72–75.
7.
Ibid.
8.
BoogG. Cerebral palsy and perinatal asphyxia (II – Medicolegal implications and prevention). Gynécol Obstét Fertil2011; 39: 146–173.
Roberto Caldeyro-Barcia did pioneering studies on the effect of maternal uterine contractions on fetal heart rate in 1958 and in 1967 completely altered his original CTG classification.
11.
NelsonKBDambrosiaJMTingTY. Uncertain value of electronic fetal monitoring in predicting cerebral palsy. N Engl J Med1996; 324: 613–618. Level II-2.
12.
SholapurkarSL. Editorial: NICE’s draft guideline on intra-partum care. Br Med J2014; 348: g4279.
