title: The clinical diagnosis of asphyxia responsible for brain damage in the human fetus.
abstract: OBJECTIVE
  Our objective was to review the clinical findings in infants who died in the perinatal period with brain damage attributable to asphyxia.
  
  
  METHODS
  The neuropathologic findings in 208 perinatal deaths have been reviewed. Thirty cases (22 fetal, eight newborn) had evidence of white matter or neuronal necrosis due to asphyxia. The clinical course of the pregnancy in 22 cases with brain damage attributable to fetal asphyxia were examined.
  
  
  RESULTS
  The diagnosis of asphyxia was confounded by several factors: (1) asphyxia may occur at any time in the last half of pregnancy, (2) 50% of the antepartum asphyxia occurred when the pregnancy had no risk factors, (3) periodic fetal assessment in the complicated preterm pregnancies failed to identify the asphyxial episodes in the remaining cases of antepartum asphyxia, and (4) indicators of fetal asphyxia in the cases of intrapartum fetal asphyxia were obtained after the central nervous system injury had occurred.
  
  
  CONCLUSIONS
  These findings highlight the difficulty in the diagnosis of fetal asphyxia at a stage that could permit intervention to prevent brain damage.
authors.affiliation: Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada.
authors.forename: J A
authors.initials: JA
authors.lastname: Low
authors.forename: L L
authors.initials: LL
authors.lastname: Simpson
authors.forename: D A
authors.initials: DA
authors.lastname: Ramsey
mesh_terms: D000328:Adult; D001927:Brain Diseases / Q000209:etiology*; D005260:Female; D005313:Fetal Death / Q000209:etiology; D005315:Fetal Diseases / Q000209:etiology; D005311:Fetal Hypoxia / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D012189:Retrospective Studies