[Can subpartal fetal acidosis be avoided? Investigations on the complex causes of intrauterine asphyxia].
OBJECTIVE
The extent to which faulty medical treatment and defective apparatus are concomitant causes for the development of subpartal acidosis was investigated in a retrospective study. At the same time, the incidence of acidosis in the Lippe-Detmold Hospital, Department of Gynaecology and Obstetrics, its morbidity and mortality were analysed.


METHODS
Data from all case histories of neonates with acidosis (pH in the umbilical artery < 7.100) who were born between 1 st January 1992 and 31 st December 1998 at the Department of Gynecology and Obstetrics at the Lippe-Detmold Hospital were evaluated electronically. Analytical measurements of blood gases (pH, pCO 2 and pO 2 ) in umbilical artery and venous blood were available from all cases. The base excess was corrected by computations according to Siggaard-Andersen and R. Zander for the actual oxygen saturation. The delivery cardiotocograms (CTG) were appraised qualitatively. Equipment defects, mistakes on the part of doctors and/or midwives (including the head of the department) were recorded after critical analysis of each individual case and documented in accordance with a key. The neonatal data were taken from the files of the paediatric division of the hospital (head of the department Dr. K. Wesseler).


RESULTS
In seven years under report, 9.876 babies were born, 156 (1.58 %) of whom showed a pH of less than 7.100 in the umbilical arterial blood. The mean actual pH value was 7.047 +/- 0.058, and the oxygen-corrected base excess was - 16.3 +/- 3.2 mmol/l. Correction of the base excess resulted in a numerical lowering by about 2.0 mmol/l. The rate of premature births was 17.4 %. One newborn baby died of hypoxic shock (0.67 %). 94 % of these neonates could be discharged in a healthy condition. 4.6 % still showed symptoms on discharge. Disorders of respiratory adaptation were the most prominent feature in morbidity from acidosis (about 18 %). Only two babies showed neonatal convulsions. Renal, cardiac and haemostaseological complications were rarely observed. Only 5 (3.9 %) of the 128 neonates with available recordings did not show any pathological changes in the CTG. 26.4 % of all acidoses had to be designated as "pure fate". In a further 35 % medical mistakes could not be discerned. Consequently, 61.4 % of the acidoses had to be designated as "unavoidable". In the remaining roughly 40 %, inadequate cardiotocographical knowledge, inattentiveness, defective equipment etc. clearly played a causal role. In the severe cases (pH in the umbilical artery < 7.000), medical mistakes were much more frequent (50 %).


CONCLUSIONS
Three-fifths of all subpartal acidoses in this study have a fateful nature, i.e. they cannot be prevented even by optimal professional management in good time. About two-fifths are avoidable if appropriate equipment and trained staff are available around the clock. Use of cardiotocography alone enables the threat of asphyxia to be detected in 97 % of the cases. The short-term prognosis of subpartal acidosis is good provided very low pH values (< 6.900) can be avoided. In perinatological studies, the base excess value should be corrected by computation. "Quality control" worthy of the name should include critical single-case analysis at least in severe acidosis.
Roemer
V M
VM
Frauenklinik der Klinikum Lippe Detmold GmbH, Germany.
Mähling
B
B
D000142:Acidosis, Respiratory / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D001784:Blood Gas Analysis; D015148:Cardiotocography; D002423:Cause of Death; D005260:Female; D005323:Fetal Monitoring; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007049:Iatrogenic Disease; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors