Intrapartum deaths: missed opportunities

Abstract 

Although fetal and perinatal death remains a common event in obstetric practice, only a minority of these deaths occur during, or as a consequence of, events during labour or delivery. Unfortunately, many of these deaths are associated with substandard care. In some cases, avoidance of labour altogether, with delivery by Caesarean section, will prevent such adverse events and these risk factors can be determined antenatally. For most women, ostensibly ‘low-risk’ for such problems at the onset of labour, good midwifery and obstetric care, with the judicious use of fetal monitoring and intervention when concerns arise, are the cornerstone of avoiding delivery-related perinatal death. In this review we examine risk factors for delivery-related perinatal death and consider how such tragedies could hopefully be avoided.

Keywords: abruption, breech, caesarean section, cord accident, electronic fetal monitoring, fetal death, growth restriction, instrumental delivery, malpresentation, multiple pregnancy, patient safety, risk management, uterine rupture, vaginal birth after caesarean section