Brain Injury Not Identified by Fetal Monitoring

A study has found that fetal monitoring does not identify babies who are diagnosed with white matter brain injury after birth. The results were reported at the annual meeting of the Society for Gynecologic Investigation in Houston (TX, USA) in March 2004.

If a fetus has difficulty obtaining an adequate supply of oxygen from the mother's blood supply during labor, white matter brain injury can occur. White matter is located in the border zones between the ends of major blood vessels, an area very sensitive to cerebral blood flow. Less than 10% of cerebral palsy (CP) cases are caused by this so-called hypoxic-ischemic encephalopathy. Doctors have thought for some years that they were able to tell when a baby is about to undergo this type of brain injury by the electronic monitoring of the fetal heart rate and could thus intervene when necessary.

Because the incidence of CP has not decreased in 40 years, researchers conducted a study to see if monitoring was doing the job expected of it. They searched a database of infants, identifying 40 born with white matter brain injury. These were matched against 40 babies born at the same gestational age, 23-34 weeks, and in the same manner. When they looked at the fetal heart monitoring data, they could not find any signs of impending brain injury from the last hour of the first stage of labor in vaginal deliveries or the hour prior to delivery in cesarean deliveries.

"Fetal heart monitoring is the primary way doctors have tried to identify babies who may later be diagnosed with brain injury,” said Janyne Althaus, M.D., a perinatology fellow at Johns Hopkins Medical Institutions (Baltimore, MD, USA), who participated in the study. "We may need to go back to the drawing board.”




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