Re: OB: Letter From BJOG - CP and Negligence
From: art fougner, md (evsono@pipeline.com)
Tue Jun 8 13:00:05 2004
Left off the authors' names -
Alastair MacLennan & Jeffrey Robinson
Department of Obstetrics and Gynaecology, University of
Adelaide, Australia
art
At Tue, 8 Jun 2004, art fougner, md wrote:
>
>This guy absolutely nails it!
>
>Cerebral palsy and clinical negligence litigation: a
>cohort study
>
>Sir,
>Greenwood et al.1 applied parts of the template from the
>1999 cerebral palsy consensus statement,2 which helps define
>whether an acute hypoxic event around birth was sufficient
>to cause cerebral palsy. As members of that task force there
>is much in their discussion with which we agree. However,
>in assessing the prevalence of the available evidence in their
>1984–1993 cohort, they have applied the template in a manner
>that was not quite intended. Of the eight recommended criteria
>in the template, the first three ‘essential’ criteria helped
>to prove the existence of a severe hypoxia (metabolic acidosis)
>at birth rather than acute hypoxia. If hypoxia at birth was
>likely, the next five criteria, when present or mostly absent as
>a group, helped differentiate whether the hypoxia was acute or
>chronic.
>The consensus statement acknowledged that some evidence
>might often be missing and that in assessing the remaining
>evidence it could not be claimed that the missing criteria would
>or would not have been met. The more evidence that was missing
>the more the diagnosis was in doubt. Missing peripartum gases is
>not a failure of the criteria but the failure to have measured cord
>or early neonatal gases around or after a delivery with perinatal
>risk factors. Prospective documentation of all eight criteria in high
>risk cases will improve obstetric audits. The template was also
>published to define strong research criteria that are necessary to
>validate that sequelae, such as specific brain imaging patterns in
>later life, actually correlate with acute hypoxic events at birth and
>are not confused with chronic hypoxic and non-hypoxic conditions,
>which often manifest themselves for the first time around
>delivery.
>Those considering offering expert medico-legal opinion in this
>complicated area, where the antenatal origins of much of the
>neuropathology of cerebral palsy are beginning to be understood,
>should read the latest Neonatal Encephalopathy and Cerebral
>Palsy Task Force report, published this year by the American
>College of Obstetricians and Gynecologists. It largely endorses
>the 1999 report and its template, but has updated and modified it.
>When properly applied, the template helps exclude non-hypoxic
>and chronic hypoxic causes of cerebral palsy and encourages
>more thorough examination of possible antenatal causes that may
>not be suspected until labour or birth. Until better tests are
>available,
>it provides more objective criteria than ‘expert’ opinion
>that sometimes mistakenly assumes that the non-specific signs of
>meconium staining, non-reassuring cardiotocograms, low Apgar
>scores and neonatal encephalopathy mean that there must have
>been an intrapartum hypoxic event that should have been prevented.
>As pointed out by Greenwood et al. and the consensus
>statement, there is often little proof that cerebral palsy caused by
>an acute intrapartum event necessarily is preventable and criticism
>of details of labour management may not link cause and
>effect.
>
>D RCOG 2004 Br J Obstet Gynaecol 111, pp. 91–94
>
>--
>art fougner, md
>ich bin ein New Yorker
>
--
art fougner, md
ich bin ein New Yorker
