Original Article
Uncertain Value of Electronic Fetal Monitoring in Predicting Cerebral Palsy
N Engl J Med 1996; 334:613-619March 7, 1996
- Abstract
Background
Electronic monitoring of the fetal heart rate is commonly performed, in part to detect hypoxia during delivery that may result in brain injury. It is not known whether specific abnormalities on electronic fetal monitoring are related to the risk of cerebral palsy.
Methods
Among 155,636 children born from 1983 through 1985 in four California counties, we identified singleton infants with birth weights of at least 2500 g who survived to three years of age and had moderate or severe cerebral palsy. The children with cerebral palsy were compared with randomly selected control children with respect to characteristics noted in the birth records.
Results
Seventy-eight of 95 children with cerebral palsy and 300 of 378 controls underwent intrapartum fetal monitoring. Characteristics found to be associated with an increased risk of cerebral palsy were multiple late decelerations in the heart rate, commonly defined as slowing of the heart rate well after the onset of uterine contractions (odds ratio, 3.9; 95 percent confidence interval, 1.7 to 9.3), and decreased beat-to-beat variability of the heart rate (odds ratio, 2.7; 95 percent confidence interval, 1.1 to 5.8); there was no association between the highest or lowest fetal heart rate recorded for each child and the risk of cerebral palsy. Even after adjustment for other risk factors, the association of abnormalities on fetal monitoring with an increased risk of cerebral palsy persisted (adjusted odds ratio, 2.7; 95 percent confidence interval, 1.4 to 5.4). The 21 children with cerebral palsy who had multiple late decelerations or decreased variability in heart rate on fetal monitoring represented only 0.19 percent of singleton infants with birth weights of 2500 g or more who had these fetal-monitoring findings, for a false positive rate of 99.8 percent.
Conclusions
Specific abnormal findings on electronic monitoring of the fetal heart rate were associated with an increased risk of cerebral palsy. However, the false positive rate was extremely high. Since cesarean section is often performed when such abnormalities are noted and is associated with risk to the mother, our findings arouse concern that, if these indications were widely used, many cesarean sections would be performed without benefit and with the potential for harm.
Media in This Article
Table 1
Characteristics of the Deliveries of Singleton Children with Birth Weights of 2500 g or More, According to the Presence or Absence of Cerebral Palsy.Table 2
Heart-Rate Patterns on Electronic Intrapartum Monitoring of Singleton Infants with Birth Weights of 2500 g or More, According to the Presence or Absence of Cerebral Palsy.Article Activity
- Article
Electronic fetal monitoring during labor was developed to detect fetal-heart-rate patterns thought to indicate hypoxia. The early recognition of hypoxia would, it was reasoned, alert clinicians to potential problems and enable them to intervene quickly to prevent fetal death or irreversible brain injury. When electronic fetal monitoring was introduced, it was hoped that the use of this technique would prevent the majority of birth injuries due to hypoxia or asphyxia, thus greatly reducing the frequency of cerebral palsy and mental retardation.
The introduction and wide dissemination of fetal monitoring occurred before randomized clinical trials had evaluated its efficacy. More than 20 years and 11 randomized trials later,1-6 electronic fetal monitoring appears to have little documented benefit over intermittent auscultation with respect to perinatal mortality or long-term neurologic outcome. Furthermore, probably in part because of the widespread use of fetal monitoring,7 the rate of cesarean section has increased, with a resulting increase in maternal morbidity and costs but without apparent decrease in the incidence of cerebral palsy.
Few of the trials performed so far have been large enough or have lasted long enough to investigate a possible association between findings on fetal monitoring and a relatively rare outcome such as cerebral palsy, which can be confidently diagnosed only years after birth. No randomized trial has explored possible associations between specific heart-rate patterns detected on electronic monitoring and long-term neurologic outcomes.
In a population-based study, we assessed the association of cerebral palsy in children with birth weights of 2500 g or more with specific patterns on fetal monitoring and evaluated the possible confounding effects of other risk factors. We investigated the usefulness of fetal monitoring as interpreted by the treating physicians at the time of the delivery of infants who would later be given the diagnosis of cerebral palsy.
Methods
Cerebral palsy was defined as a chronic disability originating in the central nervous system, characterized by aberrant control of movement or posture, appearing early in life, and not resulting from progressive disease. Children in whom cerebral palsy was acquired after the first 28 days of life or through nonaccidental head trauma in the first month and children with mild involvement or isolated hypotonia were not included.
The case patients were singleton children born during the three-year period from 1983 through 1985 to residents of four counties in the San Francisco Bay area; the children weighed 2500 g or more at birth, survived to the age of three years, were residents of California at the age of three, and had moderate or severe cerebral palsy. For the initial ascertainment of cases, we relied on the records of two state agencies known to enroll virtually all eligible children. The inclusion or exclusion of each identified child was determined by means of a standardized clinical examination or extensive review of the medical records. Detailed information about definitions and procedures has been published elsewhere.8 Controls were randomly selected singleton children who met all the criteria for the case children except the diagnosis of cerebral palsy.
Demographic and clinical data were obtained from birth certificates and medical records at more than 40 hospitals. Data were abstracted by nurses working at the California Birth Defects Monitoring Program who did not know whether the records were those of case or control children and did not know that the study was about cerebral palsy.
The findings on fetal monitoring that we recorded were those noted in the birth records by the physicians attending the deliveries. No monitoring strips were available for review. We collected data on the highest fetal heart rate above 160 or 180 beats per minute, the lowest fetal heart rate below 100 or 80 beats per minute, and the presence or absence of multiple late decelerations (commonly defined as bradycardia occurring well after the onset of uterine contractions, although in this study the term was recorded as used by the clinicians involved) and decreased beat-to-beat variability in heart rate. Multiple late decelerations and decreased beat-to-beat variability were then combined into a single variable indicating the occurrence of either or both during labor. Inconsistent reporting prevented us from including the duration of monitoring or specific heart-rate patterns in the analyses.
Gestational age was derived from measures recorded in the mothers' charts before delivery, with precedence given to dates established early in pregnancy and to estimates based on ultrasound examinations before 19 weeks of gestation. The level of care provided at the hospital where the delivery occurred was determined according to the criteria of the California Children's Services program.9 Level 1 hospitals were those without specialized services for sick or premature infants, level 2 hospitals those that provided care for sick neonates who did not require intensive care, and level 3 hospitals those that provided a full range of services including neonatal intensive care. Standards for birth weight for gestational age were derived from vital-records data (classified according to sex, race, and number of fetuses in the gestation) on more than a million children born in California from 1966 through 1970.10
Certain factors identified in the literature on fetal monitoring as associated with a heightened risk of cerebral palsy3,5,11 were examined for their univariate association with both cerebral palsy and fetal-heart-rate abnormality in this study. These factors were vaginal bleeding during pregnancy, breech presentation, meconium in the amniotic fluid (classified as absent, light, or heavy), gestational age below 37 weeks at delivery, and maternal infection (indicated by a diagnosis of maternal sepsis, chorionitis, or amnionitis; a maximal temperature during labor of 38°C or higher; or foul-smelling meconium). Factors in terms of which case children and controls differed significantly in the univariate analysis were further evaluated by logistic regression to determine the separate contribution of each to the risk of cerebral palsy, with control for the other factors. These analyses were repeated for spastic quadriplegia, a subtype of cerebral palsy often linked to asphyxia during delivery.12,13
Results
Among 155,636 children born alive during the period we studied, the overall prevalence of moderate or severe congenital cerebral palsy among singleton children who survived to the age of three years was 1.1 per 1000. Among such children, 95.4 percent weighed 2500 g or more at birth, and in this group the prevalence of cerebral palsy was 0.67 per 1000. Children with birth weights of 2500 g or more made up 56.4 percent of all singleton children with cerebral palsy.
Nine of the 95 children with birth weights of 2500 g or more who had cerebral palsy (9.5 percent) and 30 of the 378 control children (7.9 percent) were delivered without labor (P not significant), indicating that the risk of cerebral palsy in infants born at or near term was not associated with the presence or absence of labor. Of the children born after labor, 9.3 percent of those with cerebral palsy and 13.9 percent of the controls did not undergo intrapartum monitoring — also a nonsignificant difference. A total of 78 children with cerebral palsy, of whom 41 percent had spastic quadriplegia, and 300 controls underwent fetal monitoring.
The children with cerebral palsy did not differ significantly from the controls in terms of a variety of demographic and medical characteristics (Table 1Table 1
Characteristics of the Deliveries of Singleton Children with Birth Weights of 2500 g or More, According to the Presence or Absence of Cerebral Palsy.). There was no relation between the highest and lowest fetal heart rates measured by fetal monitoring in each child and the risk of cerebral palsy (Table 2Table 2Heart-Rate Patterns on Electronic Intrapartum Monitoring of Singleton Infants with Birth Weights of 2500 g or More, According to the Presence or Absence of Cerebral Palsy.). Multiple late decelerations, decreased beat-to-beat variability, or both were noted in 21 children with cerebral palsy and 28 controls. Multiple late decelerations were associated with nearly a quadrupling of the risk of cerebral palsy (odds ratio, 3.9; 95 percent confidence interval, 1.7 to 9.3), and decreased beat-to-beat variability with nearly a tripling of the risk (odds ratio, 2.7; 95 percent confidence interval, 1.1 to 5.8). The occurrence of multiple late decelerations, decreased beat-to-beat variability, or both abnormalities was associated with a sharp increase in the risk of cerebral palsy (odds ratio, 3.6; 95 percent confidence interval, 1.9 to 6.7). The odds ratios for the association of fetal-heart-rate patterns with spastic quadriplegia were similar to those for all types of cerebral palsy combined. It is notable that 73 percent of the children with cerebral palsy did not have multiple late decelerations or decreased beat-to-beat variability, whereas 9.3 percent of the controls did.The presence of multiple late decelerations, decreased beat-to-beat variability, or both was associated with similar increases in the risk of cerebral palsy regardless of whether the delivery was the mother's first live birth (Table 3Table 3
Association of Multiple Late Decelerations, Decreased Beat-to-Beat Variability, or Both (MLD/DV) with the Risk of Cerebral Palsy in Singleton Children with Birth Weights of 2500 g or More, According to Characteristics of the Delivery and the Presence or Absence of Cerebral Palsy.). These heart-rate abnormalities were observed more often when internal monitoring was used than when only external monitoring was used. However, the proportional increase in the rate of these abnormalities was greater for the controls than for the children with cerebral palsy. Thus, the increase in the risk of cerebral palsy associated with these abnormalities on fetal monitoring was larger among those with only external monitoring.Among children with gestational ages of 40 weeks or less at delivery, the presence of an abnormality on monitoring was associated with a risk almost five times that among children without an abnormality and twice that among children with greater gestational ages (Table 3). Abnormalities on fetal monitoring were more frequent among children — both those with cerebral palsy and controls — whose birth weights were below the 10th percentile for gestational age, but such abnormalities were not associated with a greater risk of cerebral palsy among infants who were small for gestational age as compared with infants whose birth weights were appropriate for gestational age.
The presence of multiple late decelerations, decreased beat-to-beat variability, or both was associated with similar increases in the risk of cerebral palsy whether the delivery was vaginal or surgical (Table 3). Among children with abnormalities on monitoring, 10 of those with cerebral palsy (48 percent) and 10 control children (36 percent) were delivered by cesarean section; this was not a significant difference. Among these children, cesarean delivery was not associated with a significantly altered risk of cerebral palsy (odds ratio for vaginal vs. cesarean delivery, 1.6; 95 percent confidence interval, 0.52 to 5.2).
We found that the risk factors identified in the medical literature were, on univariate analysis, associated with an increased risk of cerebral palsy in this population (Table 4Table 4
Crude and Adjusted Odds Ratios for Cerebral Palsy According to Literature-Identified Risk Factors and Specific Heart-Rate Patterns on Electronic Fetal Monitoring in Singleton Children with Birth Weights of 2500 g or More.). These factors were vaginal bleeding during pregnancy, breech presentation, delivery at less than 37 weeks of gestation, the presence of meconium in the amniotic fluid, and infection in the mother. Logistic regression including those five factors along with fetal-monitoring abnormalities (Table 4) provided an excellent fit for the data. The adjusted odds ratios were close to those obtained by univariate analysis, suggesting that each factor contributed independently to the risk of cerebral palsy and that none of the other factors accounted for the increased risk associated with abnormalities on fetal monitoring.Thirty-seven percent of the children with cerebral palsy and 69 percent of the controls had none of the five risk factors we examined. In this low-risk group, the presence of an abnormality on fetal monitoring was not associated with a significant increase in risk (odds ratio, 1.7; 95 percent confidence interval, 0.53 to 5.4). Among those with one or more risk factors, an abnormality on monitoring was recorded for 35 percent of the children with cerebral palsy and 11 percent of the controls (odds ratio, 4.4; 95 percent confidence interval, 1.8 to 10.5). When the data were expressed in terms of standard measures of association (Table 5Table 5
Measures of the Association between Multiple Late Decelerations, Decreased Variability in Heart Rate, or Both on Electronic Fetal Monitoring with Cerebral Palsy in Singleton Children with Birth Weights of 2500 g or More, According to Risk Group.), although certain abnormalities on monitoring were associated with an increase in risk, their presence did not provide a reliable indicator of subsequent cerebral palsy.Extrapolation to the Entire Population
To examine the implications of the findings on electronic fetal monitoring for the assessment of the risk of cerebral palsy, we projected the observations in this case–control study to the entire population of children born during three years in the four counties from which it was drawn. On the basis of the frequency of intrapartum monitoring among the controls, we estimate that in the total population there were 115,511 surviving singleton children with birth weights of 2500 g or more who had undergone electronic fetal monitoring. Assuming that the controls were representative of the total population, 9.3 percent, or 10,770 monitored children without cerebral palsy and 21 monitored children with cerebral palsy, would be expected to have had multiple late decelerations or decreased beat-to-beat variability of the fetal heart rate, or both. Of the estimated total of 10,791 monitored infants weighing 2500 g or more who had abnormalities on monitoring, 21 (0.19 percent) had cerebral palsy — for a projected false positive rate of 99.8 percent. The estimated false positive rate is 99.9 percent among children with none of the other risk factors we examined and 99.6 percent in the high-risk group.
Discussion
We conducted a population-based study relating specific abnormalities in heart-rate patterns detected by electronic fetal monitoring to the risk of cerebral palsy in infants born at or near term. The records of the children in this study reflect clinical practice during the mid-1980s in a large, diverse, urban area; this study thus represents a cross-section of abnormalities on fetal monitoring as interpreted by clinicians at all levels of expertise. Important strengths of the study are its population-wide nature, the relatively homogeneous range of birth weights that included the large majority of all live births, the examination of specific abnormalities on fetal monitoring, and the assessment of the effects of potential confounding factors. The chief limitations of the study are the absence of standardized definitions of abnormalities or monitoring protocols, including the lack of consistent information on the duration of fetal-heart-rate patterns and the time of their appearance during labor, and our inability to compare examinations performed early in labor with later findings to investigate abnormalities that developed during the course of labor. The absence of information on the duration of severe bradycardia is especially regrettable, although lengthy bradycardias can be recognized without electronic monitoring.
This study was designed as an investigation of the use of fetal monitoring in clinical practice. Monitoring strips were not available for reinterpretation by experts or for an investigation of interrater reliability. In studies from specialized centers, consistency among raters and for individual raters over time has not been very good.4,11,14 In this study, interpretations of patterns seen on fetal monitoring by care givers in level 2 and 3 hospitals were not associated with the risk of cerebral palsy any more closely than interpretations by readers in level 1 facilities.
We observed an association of multiple late decelerations and of decreased beat-to-beat variability in the fetal heart rate, but not of the highest or lowest recorded fetal heart rate for each child, with the risk of cerebral palsy overall and in the high-risk group, but not in the low-risk group. Leveno et al.11 concluded, on the basis of other outcome variables, that the outcome of low-risk pregnancies was not improved by electronic monitoring. The association of abnormalities on fetal monitoring with cerebral palsy in our study persisted after we controlled for other factors known to be related to the risk of cerebral palsy. However, the proportion of pregnancies erroneously identified as at risk because of these monitoring abnormalities (the false positive rate) was extremely high.
Electronic fetal monitoring was developed to detect intrapartum asphyxia associated with death or cerebral palsy. The causative factors in cerebral palsy are heterogeneous. Perhaps 3 to 20 percent of cases of cerebral palsy in infants born at term are due to intrapartum asphyxia15-18; the lower estimates include consideration of risk factors present before labor began, whereas the higher estimates do not. Thus, the prevalence of the target disorder for fetal monitoring among children who survive to three years of age — cerebral palsy related to asphyxia during delivery — is much lower than the overall prevalence of cerebral palsy.
Estimates derived from this study indicate that among 100,000 singleton children born at term, 9.3 percent, or 9300, would be expected to have multiple late decelerations or decreased beat-to-beat variability on fetal monitoring. Of those with these abnormalities, about 18 children (0.19 percent of 9300) would be expected to have cerebral palsy. If in 20 percent of these children cerebral palsy might be related to asphyxia during delivery and if there were an intervention that could prevent asphyxia-related cerebral palsy once monitoring abnormalities were recognized, then approximately 4 (18 × 0.2 = 3.6) of 100,000 full-term infants might benefit. However, the intervention would be administered in 9296 (9300 - 4) additional deliveries (2324 nonbeneficial interventions for each child in whom cerebral palsy was prevented).
If it is assumed that all the cases of cerebral palsy in children with abnormalities on fetal monitoring are due to asphyxia during delivery and, further, that there is a perfectly effective intervention to prevent cerebral palsy (neither assumption is warranted given currently available evidence), then the number of interventions performed during delivery in which there was no benefit would be 516 ([9300 - 18] ÷ 18) for each child saved from cerebral palsy. Once monitoring abnormalities are noted, cesarean section is often performed. In evaluating the wisdom of this policy, it is necessary to evaluate the risks — as well as costs — to the 516 or 2324 mother–baby pairs exposed to surgical delivery for each infant who might benefit. In one large study, 11.6 percent of cesarean sections were associated with intraoperative complications.19 In 2.1 percent, the complications were major, chiefly serious hemorrhage; in surgical deliveries performed during labor, the rate of major complications was 4.1 percent.19 Postoperative complications of surgical delivery are also relatively common, occurring in 13 to 65 percent in different studies.20
So far as we know, neither cesarean section21 nor any other intervention during delivery has been shown to prevent cerebral palsy in infants born at term. In this study, children who had abnormalities on fetal monitoring during labor and were delivered by cesarean section did not have a lower frequency of cerebral palsy than children with these abnormalities who were delivered vaginally.
The increase in the rate of cesarean section in the United States and elsewhere during recent decades has not been reflected in a decrease in the incidence of cerebral palsy.22-24 Whether electronic fetal monitoring is helpful in reducing perinatal mortality remains uncertain,5,25,26 and most randomized trials have not found low Apgar scores, acidosis, neonatal apnea, or the need for intubation to be less frequent among infants who were monitored electronically.5,27
It is likely that technological approaches to fetal surveillance are here to stay.28 The same issues that confront us with regard to fetal monitoring and intervention by means of cesarean delivery are likely to continue to confront us as new methods are developed for the assessment of the risk due to asphyxia during delivery and as new therapeutic interventions appear. We need to consider how to balance the possibility of helping the small number of babies threatened by death or irreversible brain injury as a result of asphyxiating conditions during labor against the possibility of harm to some of the very large number of mothers and babies who, despite similar heart-rate patterns and other clinical findings during delivery, would not benefit from intervention. What trade-offs are reasonable?
The focus on a relatively rare but severe outcome, cerebral palsy caused by asphyxia during delivery, may have diverted clinical and research attention from an exploration of factors other than birth asphyxia that can contribute to maldevelopment or injury of the infant's brain.16,29-31
Supported in part by a cooperative agreement with the Center for Environmental Health and Injury Control, Centers for Disease Control and Prevention, in part by funds from the Comprehensive Environmental Response, Compensation, and Liability Act Trust Fund through an interagency agreement with the Agency for Toxic Substances and Disease Registry, Public Health Service, and in part by a training grant from the Department of Health and Human Services, Maternal and Child Health Bureau (MCJ 002001-28-0).
We are indebted to the children and parents who participated in this study.
Source Information
From the Neuroepidemiology Branch (K.B.N.) and the Biometry and Field Studies Branch (J.M.D.), National Institute of Neurological Disorders and Stroke, Bethesda, Md.; the Howard Hughes Medical Institute, Bethesda, Md., and the University of Pennsylvania School of Medicine, Philadelphia (T.Y.T.); and the Birth Defects Monitoring Program, California Department of Health Services, Emeryville (J.K.G.).
Address reprint requests to Dr. Grether at the California Birth Defects Monitoring Program, 1900 Powell St., Suite 1050, Emeryville, CA 94608-1811.
- References
References
1
Shy KK ,Larson EB ,Luthy DA . Evaluating a new technology: the effectiveness of electronic fetal heart rate monitoring. Annu Rev Public Health 1987;8:165-190
CrossRef | Web of Science | Medline2
Lumley J . Does continuous intrapartum fetal monitoring predict long-term neurological disorders? Paediatr Perinat Epidemiol 1988;2:299-307
CrossRef | Medline3
Grant A. Monitoring the fetus during labour. In: Chalmers I, Enkin M, Keirse MJNC, eds. Effective care in pregnancy and childbirth. Vol. 2. Oxford, England: Oxford University Press, 1989:846-82.
4
Paneth N ,Bommarito M ,Stricker J . Electronic fetal monitoring and later outcome. Clin Invest Med 1993;16:159-165
Web of Science | Medline5
Neilson JP . Electronic fetal heart rate monitoring during labor: information from randomized trials. Birth 1994;21:101-104
CrossRef | Web of Science | Medline6
Thacker SB ,Stroup DF ,Peterson HB . Efficacy and safety of intrapartum electronic fetal monitoring: an update. Obstet Gynecol 1995;86:613-620
Web of Science | Medline7
Rostow VP ,Osterweis M ,Bulger RJ . Medical professional liability and the delivery of obstetrical care. N Engl J Med 1989;321:1057-1060
Full Text | Web of Science | Medline8
Grether JK ,Cummins SK ,Nelson KB . The California Cerebral Palsy Project. Paediatr Perinat Epidemiol 1992;6:339-351
CrossRef | Medline9
Cummins SK ,Nelson KB ,Grether JK ,Velie EM . Cerebral palsy in four northern California counties, births 1983 through 1985. J Pediatr 1993;123:230-237
CrossRef | Web of Science | Medline10
Cunningham GC, Hawes WE, Madore C, Norris FD, Williams RL. Intrauterine growth and neonatal risk in California. Santa Barbara: Community and Organization Research Institute, University of California, 1979.
11
Leveno KJ ,Cunningham FG ,Nelson S , et al. A prospective comparison of selective and universal electronic fetal monitoring in 34,995 pregnancies. N Engl J Med 1986;315:615-619
Full Text | Web of Science | Medline12
Stanley FJ ,Blair E ,Hockey A ,Petterson B ,Watson L . Spastic quadriplegia in Western Australia: a genetic epidemiological study. I. Case population and perinatal risk factors. Dev Med Child Neurol 1993;35:191-201
CrossRef | Web of Science | Medline13
Krageloh-Mann I ,Hagberg G ,Meisner C , et al. Bilateral spastic cerebral palsy -- a collaborative study between southwest Germany and western Sweden. III. Aetiology. Dev Med Child Neurol 1995;37:191-203
CrossRef | Web of Science | Medline14
Cohen AB ,Klapholz H ,Thompson MS . Electronic fetal monitoring and clinical practice: a survey of obstetric opinion. Med Decis Making 1982;2:79-95
CrossRef | Medline15
Nelson KB ,Ellenberg JH . Antecedents of cerebral palsy: multivariate analysis of risk. N Engl J Med 1986;315:81-86
Full Text | Web of Science | Medline16
Blair E ,Stanley F . When can cerebral palsy be prevented? The generation of causal hypotheses by multivariate analysis of a case-control study. Paediatr Perinat Epidemiol 1993;7:272-301
CrossRef | Medline17
Naulty CM ,Long LB ,Pettett G . Prevalence of prematurity, low birthweight, and asphyxia as perinatal risk factors in a current population of children with cerebral palsy. Am J Perinatol 1994;11:377-381
CrossRef | Web of Science | Medline18
Yudkin PL ,Johnson A ,Clover LM ,Murphy KW . Assessing the contribution of birth asphyxia to cerebral palsy in term singletons. Paediatr Perinat Epidemiol 1995;9:156-170
CrossRef | Web of Science | Medline19
Nielsen TF ,Hokegard K-H . Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand 1984;63:103-108
CrossRef | Web of Science | Medline20
Nielsen TF. Cesarean section. In: Sachs BP, Beard R, Papiernik E, Russell C, eds. Reproductive health care for women and babies. New York: Oxford University Press, 1995:279-90.
21
Scheller JM ,Nelson KB . Does cesarean delivery prevent cerebral palsy or other neurologic problems of childhood? Obstet Gynecol 1994;83:624-630
CrossRef | Web of Science | Medline22
Hagberg B ,Hagberg G ,Olow I ,von Wendt L . The changing panorama of cerebral palsy in Sweden. V. The birth year period 1979-82. Acta Paediatr Scand 1989;78:283-290
CrossRef | Web of Science | Medline23
Stanley F ,Watson L . Trends in perinatal mortality and cerebral palsy in Western Australia, 1967 to 1985. BMJ 1992;304:1658-1663
CrossRef | Web of Science | Medline24
MacGillivray I ,Campbell DM . The changing pattern of cerebral palsy in Avon. Paediatr Perinat Epidemiol 1995;9:146-155
CrossRef | Web of Science | Medline25
Vintzileos AM ,Nochimson DJ ,Guzman ER ,Knuppel RA ,Lake M ,Schifrin BS . Intrapartum electronic fetal heart rate monitoring versus intermittent auscultation: a meta-analysis. Obstet Gynecol 1995;85:149-155
CrossRef | Web of Science | Medline26
Bader TJ ,Morgan MA . Intrapartum electronic fetal heart rate monitoring versus intermittent auscultation: a meta-analysis. Obstet Gynecol 1995;85:643-643
CrossRef | Web of Science | Medline27
MacDonald D ,Grant A ,Sheridan-Pereira M ,Boylan P ,Chalmers I . The Dublin randomized controlled trial of intrapartum fetal heart rate monitoring. Am J Obstet Gynecol 1985;152:524-539
Web of Science | Medline28
Paul RH . Electronic fetal monitoring and later outcome: a thirty-year overview. J Perinatol 1994;14:393-395
Medline29
Nelson KB ,Ellenberg JH . Antecedents of cerebral palsy. I. Univariate analysis of risks. Am J Dis Child 1985;139:1031-1038
Web of Science | Medline30
Torfs CP ,van den Berg BJ ,Oechsli FW ,Cummins S . Prenatal and perinatal factors in the etiology of cerebral palsy. J Pediatr 1990;116:615-619
CrossRef | Web of Science | Medline31
Nelson KB ,Grether JK . Can magnesium sulfate reduce the risk of cerebral palsy in very low birthweight infants? Pediatrics 1995;95:263-269
Web of Science | Medline
- Citing Articles (121)
Citing Articles
1
Michael Nageotte. 2012. Interpreting Intrapartum Fetal Heart Tracings. , 89-92.
CrossRef2
Declan Devane, Joan G Lalor, Sean Daly, William McGuire, Valerie Smith, Declan Devane. 2012. Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing. .
CrossRef3
Seiichi Morokuma, Kotaro Fukushima, Yuka Otera, Yasuo Yumoto, Kiyomi Tsukimori, Masayuki Ochiai, Toshiro Hara, Norio Wake. (2012) Ultrasound evaluation of fetal brain dysfunction based on behavioral patterns. Brain and Development
CrossRef4
Sergey Vaisman, Shimrit Yaniv Salem, Gershon Holcberg, Amir B. Geva. (2011) Passive fetal monitoring by adaptive wavelet denoising method. Computers in Biology and Medicine
CrossRef5
M K Julkunen, J Uotila, K Eriksson, M Janas, T Luukkaala, O Tammela. (2011) Obstetric parameters and Doppler findings in cerebral circulation as predictors of 1 year neurodevelopmental outcome in asphyxiated infants. Journal of Perinatology
CrossRef6
Giuseppe Chiossi, Maged M. Costantine, Joy M. Pfannstiel, Gary D. V. Hankins, George R. Saade, Zhao Helen Wu. (2011) Intervention for Fetal Distress Among Obstetricians, Registered Nurses, and Residents. Obstetrics & Gynecology 118:4, 809-817
CrossRef7
Emeline Maisonneuve, François Audibert, Lucie Guilbaud, Julie Lathelize, Marielle Jousse, Fabrice Pierre, William Fraser, Bruno Carbonne. (2011) Risk Factors for Severe Neonatal Acidosis. Obstetrics & Gynecology 118:4, 818-823
CrossRef8
Miriam Martinez-Biarge, Rosario Madero, Antonio González, José Quero, Alfredo García-Alix. (2011) Perinatal morbidity and risk of hypoxic-ischemic encephalopathy associated with intrapartum sentinel events. American Journal of Obstetrics and Gynecology
CrossRef9
JH Becker, MEMH Westerhuis, K Sterrenburg, ESA van den Akker, E van Beek, AC Bolte, TJHM van Dessel, AP Drogtrop, HP van Geijn, GCM Graziosi, JMM van Lith, BWJ Mol, KGM Moons, JG Nijhuis, SG Oei, HP Oosterbaan, MM Porath, RJP Rijnders, NWE Schuitemaker, LDE Wijnberger, C Willekes, GHA Visser, A Kwee. (2011) Fetal blood sampling in addition to intrapartum ST-analysis of the fetal electrocardiogram: evaluation of the recommendations in the Dutch STAN® trial. BJOG: An International Journal of Obstetrics & Gynaecology 118:10, 1239-1246
CrossRef10
Wenbin Liang, Tanya Chikritzhs. (2011) Obstetric conditions and risk of first ever mental health contact during infancy, childhood and adolescence. Midwifery
CrossRef11
Janet Rennie, Lewis Rosenbloom. (2011) How long have we got to get the baby out? A review of the effects of acute and profound intrapartum hypoxia and ischaemia. The Obstetrician & Gynaecologist 13:3, 169-174
CrossRef12
K.J. Kaluzynski, T. Kret, K. Czajkowski, J. Sieńko, J. Żmigrodzki. (2011) System for objective assessment of fetal activity. Medical Engineering & Physics 33:6, 692-699
CrossRef13
Amita A. Mahendru, Christoph C. Lees. (2011) Is intrapartum fetal blood sampling a gold standard diagnostic tool for fetal distress?. European Journal of Obstetrics & Gynecology and Reproductive Biology 156:2, 137-139
CrossRef14
Muriel Doret, Mona Massoud, Anne Constans, Pascal Gaucherand. (2011) Use of peripartum ST analysis of fetal electrocardiogram without blood sampling: a large prospective cohort study. European Journal of Obstetrics & Gynecology and Reproductive Biology 156:1, 35-40
CrossRef15
Elena V. Wachtel, Karen D. Hendricks-Muñoz. (2011) Current Management of the Infant Who Presents with Neonatal Encephalopathy. Current Problems in Pediatric and Adolescent Health Care 41:5, 132-153
CrossRef16
Molly J. Stout, Alison G. Cahill. (2011) Electronic Fetal Monitoring: Past, Present, and Future. Clinics in Perinatology 38:1, 127-142
CrossRef17
S. Schiermeier, G. Westhof, A. Leven, H. Hatzmann, J. Reinhard. (2011) Intra- and Interobserver Variability of Intrapartum Cardiotocography: A Multicenter Study Comparing the FIGO Classification with Computer Analysis Software. Gynecologic and Obstetric Investigation 72:3, 169-173
CrossRef18
Akimune Fukushima, Kenji Nakai, Tomonobu Kanasugi, Miyuki Terata, Toru Sugiyama. (2011) Assessment of Fetal Autonomic Nervous System Activity by Fetal Magnetocardiography: Comparison of Normal Pregnancy and Intrauterine Growth Restriction. Journal of Pregnancy 2011, 1-6
CrossRef19
L. Bennet, L. Booth, A.J. Gunn. (2010) Potential biomarkers for hypoxic–ischemic encephalopathy. Seminars in Fetal and Neonatal Medicine 15:5, 253-260
CrossRef20
Jeffrey P. Phelan, Shailen S. Shah. 2010. Fetal Considerations in the Critically Ill Gravida. , 605-625.
CrossRef21
Declan Devane, Joan G Lalor, Sean Daly, William McGuire, Valerie Smith, Declan Devane. 2010. Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing. .
CrossRef22
Robert D. Sanders, Helen J. Manning, Nicola J. Robertson, Daqing Ma, A. David Edwards, Henrik Hagberg, Mervyn Maze. (2010) Preconditioning and Postinsult Therapies for Perinatal Hypoxic–Ischemic Injury at Term. Anesthesiology 113:1, 233-249
CrossRef23
Roger K. Freeman. 2010. Intrapartum Fetal Heart Rate Monitoring. , 500-504.
CrossRef24
Michelle E. M. H. Westerhuis, Gerard H. A. Visser, Karel G. M. Moons, Erik van Beek, Manon J. Benders, Saskia M. Bijvoet, Hendrikus J. H. M. van Dessel, Addy P. Drogtrop, Herman P. van Geijn, Giuseppe C. Graziosi, Floris Groenendaal, Jan M. M. van Lith, Jan G. Nijhuis, S. Guid Oei, Herman P. Oosterbaan, Martina M. Porath, Robbert J. P. Rijnders, Nico W. E. Schuitemaker, Louisa M. Sopacua, Ingeborg van der Tweel, Lia D. E. Wijnberger, Christine Willekes, Nicolaas P. A. Zuithoff, Ben Willem J. Mol, Anneke Kwee. (2010) Cardiotocography Plus ST Analysis of Fetal Electrocardiogram Compared With Cardiotocography Only for Intrapartum Monitoring. Obstetrics & Gynecology 115:6, 1173-1180
CrossRef25
Roger K. Freeman, Michael P. Nageotte. (2010) Comments on American College of Obstetricians and Gynecologists Practice Bulletin No. 106. American Journal of Obstetrics and Gynecology 202:5, 411-412
CrossRef26
Aaron S. Kesselheim, Martin T. November, Karen L. Lifford, Thomas F. McElrath, Ann L. Puopolo, E. John Orav, David M. Studdert. (2010) Using malpractice claims to identify risk factors for neurological impairment among infants following non-reassuring fetal heart rate patterns during labour. Journal of Evaluation in Clinical Practiceno-no
CrossRef27
Bernard M. Dickens, Rebecca J. Cook. (2010) The legal effects of fetal monitoring guidelines. International Journal of Gynecology & Obstetrics 108:2, 170-173
CrossRef28
Linda S. de Vries, Frances M. Cowan. (2009) Evolving Understanding of Hypoxic-Ischemic Encephalopathy in the Term Infant. Seminars in Pediatric Neurology 16:4, 216-225
CrossRef29
Alistair Jan Gunn, Laura Bennet. (2009) Fetal Hypoxia Insults and Patterns of Brain Injury: Insights from Animal Models. Clinics in Perinatology 36:3, 579-593
CrossRef30
Laura Bennet, Alistair Jan Gunn. (2009) The Fetal Heart Rate Response to Hypoxia: Insights from Animal Models. Clinics in Perinatology 36:3, 655-672
CrossRef31
Jake A. BROWN, John C. MORRISON, Everett F. MAGANN, Robert C. CEFALO. (2009) Fetal extrasystole may predict poor neonatal outcome. Australian and New Zealand Journal of Obstetrics and Gynaecology 49:4, 404-406
CrossRef32
C Vayssière, V Tsatsaris, O Pirrello, C Cristini, C Arnaud, F Goffinet. (2009) Inter-observer agreement in clinical decision-making for abnormal cardiotocogram (CTG) during labour: a comparison between CTG and CTG plus STAN. BJOG: An International Journal of Obstetrics & Gynaecology 116:8, 1081-1088
CrossRef33
A. Nonnenmacher, H. Hopp, J. Dudenhausen. (2009) Perspektiven der CTG-Anwendung während der Geburt. Der Gynäkologe 42:5, 350-360
CrossRef34
S.K. Doumouchtsis, S. Arulkumaran. (2009) Einfluss der CTG-Überwachung auf das klinische Outcome. Der Gynäkologe 42:5, 336-342
CrossRef35
MEMH Westerhuis, E van Horen, A Kwee, I van der Tweel, GHA Visser, KGM Moons. (2009) Inter- and intra-observer agreement of intrapartum ST analysis of the fetal electrocardiogram in women monitored by STAN. BJOG: An International Journal of Obstetrics & Gynaecology 116:4, 545-551
CrossRef36
Risa Hayashi, Kenji Nakai, Akimune Fukushima, Manabu Itoh, Toru Sugiyama. (2009) Development and Significance of a Fetal Electrocardiogram Recorded by Signal-Averaged High-Amplification Electrocardiography. International Heart Journal 50:2, 161-171
CrossRef37
K.K. Roy, Jinee Baruah, Sunesh Kumar, A.K. Deorari, J.B. Sharma, Debjyoti Karmakar. (2008) Cesarean section for suspected fetal distress, continuous fetal heart monitoring and decision to delivery time. The Indian Journal of Pediatrics 75:12, 1249-1252
CrossRef38
Yoram Sorokin, Sean C Blackwell. 2008. Intrapartum evaluation of fetal well-being. , 713-724.
CrossRef39
Suneet P. Chauhan, Chad K. Klauser, Thomas C. Woodring, Maureen Sanderson, Everett F. Magann, John C. Morrison. (2008) Intrapartum nonreassuring fetal heart rate tracing and prediction of adverse outcomes: interobserver variability. American Journal of Obstetrics and Gynecology 199:6, 623.e1-623.e5
CrossRef40
Curtis L. Lowery, R.B. Govindan, Pamela Murphy, Hari Eswaran. (2008) Assessing Cardiac and Neurological Maturation During the Intrauterine Period. Seminars in Perinatology 32:4, 263-268
CrossRef41
Robert Mittendorf, Sung Yun Won, John G. Gianopoulos, Peter G. Pryde, Nancy Roizen. (2008) Relationships between umbilical cord arterial blood pH levels at delivery and Bayley Psychomotor Development Index scores in early childhood. Journal of Perinatal Medicine 36:4, 335-340
CrossRef42
Hiroshi Sameshima, Tsuyomu Ikenoue. (2008) Risk factors for perinatal deaths in Southern Japan: Population-based analysis from 1998 to 2005. Early Human Development 84:5, 319-323
CrossRef43
Roberto Luzietti, Karl G. Rosén. 2008. Monitoring in labor. , 276-282.
CrossRef44
K. K. Roy, Jinee Baruah, Sunesh Kumar, A. K. Deorari, J. B. Sharma, Debjyoti Karmakar. (2008) Cesarean section for suspected fetal distress, continuous fetal heart monitoring and decision to delivery time. The Indian Journal of Pediatrics
CrossRef45
Norbert Szunyogh, Jozef Mikus, Pavol Zubor, Jozef Visnovsky, Jan Danko. (2007) Ductus venosus Doppler measurement during labor. Journal of Perinatal Medicine 35:5, 403-407
CrossRef46
Joel D. Larma, Anadir M. Silva, Cynthia J. Holcroft, Richard E. Thompson, Pamela K. Donohue, Ernest M. Graham. (2007) Intrapartum electronic fetal heart rate monitoring and the identification of metabolic acidosis and hypoxic-ischemic encephalopathy. American Journal of Obstetrics and Gynecology 197:3, 301.e1-301.e8
CrossRef47
Jenny A. Westgate, Bert Wibbens, Laura Bennet, Guido Wassink, Julian T. Parer, Alistair J. Gunn. (2007) The intrapartum deceleration in center stage: a physiologic approach to the interpretation of fetal heart rate changes in labor. American Journal of Obstetrics and Gynecology 197:3, 236.e1-236.e11
CrossRef48
E CHANDRAHARAN, S ARULKUMARAN. (2007) Prevention of birth asphyxia: responding appropriately to cardiotocograph (CTG) traces. Best Practice & Research Clinical Obstetrics & Gynaecology 21:4, 609-624
CrossRef49
Suneet P Chauhan. 2007. Intrapartum fetal monitoring. , 67-74.
CrossRef50
Steven L. Clark, Michael A. Belfort, Gary D.V. Hankins, Janet A. Meyers, Frank M. Houser. (2007) Variation in the rates of operative delivery in the United States. American Journal of Obstetrics and Gynecology 196:6, 526.e1-526.e5
CrossRef51
Mariëlle Handel, Hanna Swaab, Linda S. Vries, Marian J. Jongmans. (2007) Long-term cognitive and behavioral consequences of neonatal encephalopathy following perinatal asphyxia: a review. European Journal of Pediatrics 166:7, 645-654
CrossRef52
Sven Becker, Erich Solomayer, Cemal Dogan, Diethelm Wallwiener, Tanja Fehm. (2007) Meconium-stained amniotic fluid—Perinatal outcome and obstetrical management in a low-risk suburban population. European Journal of Obstetrics & Gynecology and Reproductive Biology 132:1, 46-50
CrossRef53
Bloom, Steven L., Spong, Catherine Y., Thom, Elizabeth, Varner, Michael W., Rouse, Dwight J., Weininger, Sandy, Ramin, Susan M., Caritis, Steve N., Peaceman, Alan, Sorokin, Yoram, Sciscione, Anthony, Carpenter, Marshall, Mercer, Brian, Thorp, John, Malone, Fergal, Harper, Margaret, Iams, Jay, Anderson, Garland, . (2006) Fetal Pulse Oximetry and Cesarean Delivery. New England Journal of Medicine 355:21, 2195-2202
Full Text54
Ernest M. Graham, Scott M. Petersen, Dana K. Christo, Harold E. Fox. (2006) Intrapartum Electronic Fetal Heart Rate Monitoring and the Prevention of Perinatal Brain Injury. Obstetrics & Gynecology 108:3, Part 1, 656-666
CrossRef55
Zarko Alfirevic, Declan Devane, Gillian ML Gyte, Zarko Alfirevic. 2006. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. .
CrossRef56
Zarko Alfirevic, Andrew Weeks, Zarko Alfirevic. 2006. Oral misoprostol for induction of labour. .
CrossRef57
Robert Resnik. (2006) Can a 29% Cesarean Delivery Rate Possibly Be Justified?. Obstetrics & Gynecology 107:4, 752-754
CrossRef58
Barry S. Schifrin, Stewart Ater. (2006) Fetal hypoxic and ischemic injuries. Current Opinion in Obstetrics and Gynecology 18:2, 112-122
CrossRef59
Carol Hindley, Sophie W. Hinsliff, Ann M. Thomson. (2005) Developing a tool to appraise fetal monitoring guidelines for women at low obstetric risk. Journal of Advanced Nursing 52:3, 307-314
CrossRef60
Declan Devane, Joan Lalor. (2005) Midwives' visual interpretation of intrapartum cardiotocographs: intra- and inter-observer agreement. Journal of Advanced Nursing 52:2, 133-141
CrossRef61
I. Amer-Wåhlin, B. Yli, S. Arulkumaran. (2005) Foetal ECG and STAN technology—a review. European Clinics in Obstetrics and Gynaecology 1:2, 61-73
CrossRef62
J SMITHJR, J ONSTAD. (2005) Assessment of the Fetus: Intermittent Auscultation, Electronic Fetal Heart Rate Tracing, and Fetal Pulse Oximetry. Obstetrics and Gynecology Clinics of North America 32:2, 245-254
CrossRef63
Janyne E. Althaus, Scott M. Petersen, Harold E. Fox, Cynthia J. Holcroft, Ernest M. Graham. (2005) Can Electronic Fetal Monitoring Identify Preterm Neonates With Cerebral White Matter Injury?. Obstetrics & Gynecology 105:3, 458-465
CrossRef64
Anna-Karin Welin, Sofia Blad, Henrik Hagberg, K. G. Rosen, Ingemar Kjellmer, Carina Mallard. (2005) Electrocardiographic changes following umbilical cord occlusion in the midgestation fetal sheep. Acta Obstetricia et Gynecologica Scandinavica 84:2, 122-128
CrossRef65
Declan Devane, Joan G Lalor, Sean Daly, William McGuire, Declan Devane. 2005. Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing. .
CrossRef66
Theresa Mawn, Shoko Nioka, Mark Nijland, Luke Bloy, Mark A. Elliott, Britton Chance, John S. Leigh. (2005) Effect of errors in baseline optical properties on accuracy of transabdominal near-infrared spectroscopy in fetal sheep brain during hypoxic stress. Journal of Biomedical Optics 10:6, 064001
CrossRef67
Valerie A. Arkoosh. (2005) Neonatal Resuscitation. Advances in Anesthesia 23, 75-94
CrossRef68
Claire McLean, Donna Ferriero. (2004) Mechanisms of hypoxic—ischemic injury in the term infant. Seminars in Perinatology 28:6, 425-432
CrossRef69
Keith P. Williams, France Galerneau. (2004) Comparison of intrapartum fetal heart rate tracings in patients with neonatal seizures vs. no seizures: what are the differences?. Journal of Perinatal Medicine 32:5, 422-425
CrossRef70
B SCHIFRIN. (2004) The CTG and the timing and mechanism of fetal neurological injuries. Best Practice & Research Clinical Obstetrics & Gynaecology 18:3, 437-456
CrossRef71
Nelson, Karin B., . (2003) Can We Prevent Cerebral Palsy?. New England Journal of Medicine 349:18, 1765-1769
Full Text72
Seetha Shankaran, Abbot Laptook. (2003) Challenge of conducting trials of neuroprotection in the asphyxiated term infant. Seminars in Perinatology 27:4, 320-332
CrossRef73
Frederick T Kraus. (2003) Perinatal pathology, the placenta, and litigation. Human Pathology 34:6, 517-521
CrossRef74
J. Chipchase, D. Kirkby, D. Peebles, M. Cope, C. Rodeck. (2002) Cerebral hemoglobin concentration and oxygen saturation measured by intensity modulated optical spectroscopy in the human fetus during labor. Journal of Perinatal Medicine 30:6, 502-509
CrossRef75
Lee Sutton, Geoffrey P. Sayer, Barbara Bajuk, Valerie Richardson, Geoffrey Berry, David J. Henderson-Smart. (2001) Do very sick neonates born at term have antenatal risks?. 2. Infants ventilated primarily for lung disease. Acta Obstetricia et Gynecologica Scandinavica 80:10, 917-925
CrossRef76
MARTIN T. NOVEMBER. (2001) Cost Analysis of Vaginal Birth After Cesarean. Clinical Obstetrics and Gynecology 44:3, 571-587
CrossRef77
Kathleen Rice Simpson. (2001) Fetal oxygen saturation monitoring during labor: Implications for perinatal risk management. Journal of Healthcare Risk Management 21:1, 17-27
CrossRef78
Bryony K. Strachan, Daljit S. Sahota, Willem J. Wijngaarden, David K. James, Allan M.Z. Chang. (2001) Computerised analysis of the fetal heart rate and relation to acidaemia at delivery. BJOG: An International Journal of Obstetrics and Gynaecology 108:8, 848-852
CrossRef79
Barbara S. Kisilevsky, Sylvia M. J. Hains, James A. Low. (2001) Maturation of fetal heart rate and body movement in 24-33-week-old fetuses threatening to deliver prematurely. Developmental Psychobiology 38:1, 78-86
CrossRef80
Hirobumi Asakura, Hisashi Ichikawa, Masao Nakabayashi, Kazuto Ando, Kazuhiko Kaneko, Masakiyo Kawabata, Akihiro Tani, Masashi Satoh, Katsuyuki Takahashi, Shouichi Sakamoto. (2000) Perinatal Risk Factors Related to Neurologic Outcomes of Term Newborns with Asphyxia at Birth: A Prospective Study. Journal of Obstetrics and Gynaecology Research 26:5, 313-324
CrossRef81
Lois A. Haggerty, Ronald L. Nuttall. (2000) Experienced Obstetric Nurses' Decision-Making in Fetal Risk Situations. Journal of Obstetric, Gynecologic, <html_ent glyph="@amp;" ascii="&"/> Neonatal Nursing 29:5, 480-490
CrossRef82
B Strachan. (2000) Computerised analysis of the fetal heart rate and relation to acidaemia at delivery. British Journal of Obstetrics and Gynaecology 108:8, 848-852
CrossRef83
Ellen L Mozurkewich, Fredric M Wolf, Ellen L Mozurkewich. 2000. Near-infrared spectroscopy for fetal assessment during labour. .
CrossRef84
B Schifrin. (2000) William John Little and cerebral palsy A reappraisal. European Journal of Obstetrics & Gynecology and Reproductive Biology 90:2, 139-144
CrossRef85
Jeffrey P. Phelan, Joo Oh Kim. (2000) Fetal heart rate observations in the brain-damaged infant. Seminars in Perinatology 24:3, 221-229
CrossRef86
E. Rebecca Pschirrer, Edward R. Yeomans. (2000) Does asphyxia cause cerebral palsy?. Seminars in Perinatology 24:3, 215-220
CrossRef87
Julie Smith, Louise Wells, Keith Dodd. (2000) The continuing fall in incidence of hypoxic-ischaemic encephalopathy in term infants. BJOG: An International Journal of Obstetrics and Gynaecology 107:4, 461-466
CrossRef88
A. D. EDWARDS, D. V. AZZOPARDI. (2000) Perinatal Hypoxia-Ischemia and Brain Injury. Pediatric Research 47:4, 431-432
CrossRef89
Eve Blair. (2000) More on asphyxia, cerebral palsy and litigation. The Australian and New Zealand Journal of Obstetrics and Gynaecology 40:1, 93-96
CrossRef90
Bryony K Strachan, Willem J van Wijngaarden, Daljit Sahota, Allan Chang, David K James. (2000) Cardiotocography only versus cardiotocography plus PR-interval analysis in intrapartum surveillance: a randomised, multicentre trial. The Lancet 355:9202, 456-459
CrossRef91
(2000) A template for defining a causal relationship between acute intrapartum events and cerebral palsy: international consensus statement.. The Australian and New Zealand Journal of Obstetrics and Gynaecology 40:1, 13-21
CrossRef92
Alfred Sommer. (1999) Health, medicine, and ophthalmology: facing the facts and paying the piper LVI Edward Jackson memorial lecture. American Journal of Ophthalmology 128:6, 673-679
CrossRef93
W GILES. (1999) VASCULAR DOPPLER TECHNIQUES. Obstetrics and Gynecology Clinics of North America 26:4, 595-606
CrossRef94
Ann Sprague, Marie Josée Trépainer. (1999) Setting Guidelines for Documenting FHR Enhances Care for Laboring Women. AWHONN Lifelines 3:5, 25-30
CrossRef95
Jenny A. Westgate, Alistair J. Gunn, Tania R. Gunn. (1999) Antecedents of neonatal encephalopathy with fetal acidaemia at term. BJOG: An International Journal of Obstetrics and Gynaecology 106:8, 774-782
CrossRef96
Ann Sprague, Marie-Josée Trépanier. (1999) Setting Guidelines for Documenting FHR Enhances Care for Laboring Women. AWHONN Lifelines 3:4, 35-40
CrossRef97
Lois A. Haggerty. (1999) Continuous Electronic Fetal Monitoring: Contradictions Between Practice and Research. Journal of Obstetric, Gynecologic, <html_ent glyph="@amp;" ascii="&"/> Neonatal Nursing 28:4, 409-416
CrossRef98
T Henriksen. (1999) Foetal nutrition, foetal growth restriction and health later in life. Acta Paediatrica 88, 4-8
CrossRef99
Maureen Jane McRae. (1999) Fetal Surveillance and Monitoring: Legal Issues Revisited. Journal of Obstetric, Gynecologic, & Neonatal Nursing 28:3, 310-319
CrossRef100
Karin B. Nelson. (1999) THE NEUROLOGICALLY IMPAIRED CHILD AND ALLEGED MALPRACTICE AT BIRTH. Neurologic Clinics 17:2, 283-293
CrossRef101
E.L.G. Beavis. (1999) Asphyxia, Cerebral Palsy and Litigation. The Australian and New Zealand Journal of Obstetrics and Gynaecology 39:2, 141-144
CrossRef102
Deanna L. Taylor, A. David Edwards, Huseyin Mehmet. (1999) Oxidative Metabolism, Apoptosis and Perinatal Brain Injury. Brain Pathology 9:1, 93-117
CrossRef103
Nicholas W. Dawes, Geoffrey S. Dawes, Mary Moulden, Christopher W.G. Redman. (1999) Fetal heart rate patterns in term labor vary with sex, gestational age, epidural analgesia, and fetal weight. American Journal of Obstetrics and Gynecology 180:1, 181-187
CrossRef104
David A. Sacks, Jeffrey S. Greenspoon. (1998) Déjà vu, again. American Journal of Obstetrics and Gynecology 179:4, 1100
CrossRef105
JENNY A. WESTGATE, ALISTAIR J. GUNN, LAURA BENNET, MARK I. GUNNING, HARMEN H. DE HAAN, PETER D. GLUCKMAN. (1998) Do Fetal Electrocardiogram PR-RR Changes Reflect Progressive Asphyxia after Repeated Umbilical Cord Occlusion in Fetal Sheep?. Pediatric Research 44:3, 297-303
CrossRef106
Herbert F. Sandmire, Robert K. DeMott. (1998) Electronic fetal heart rate monitoring: Research guidelines for interpretation. American Journal of Obstetrics and Gynecology 179:1, 276-277
CrossRef107
C MARTINJR. (1998) Electronic fetal monitoring: a brief summary of its development, problems and prospects. European Journal of Obstetrics & Gynecology and Reproductive Biology 78:2, 133-140
CrossRef108
Tomoaki Ikeda, Yuji Murata, Edward J. Quilligan, Ben H. Choi, Julian T. Parer, Shigeharu Doi, Soung-Day Park. (1998) Physiologic and histologic changes in near-term fetal lambs exposed to asphyxia by partial umbilical cord occlusion. American Journal of Obstetrics and Gynecology 178:1, 24-32
CrossRef109
Bo Hyun Yoon, Chong Jai Kim, Roberto Romero, Jong Kwan Jun, Kyo Hoon Park, Seok Tae Choi, Je G. Chi. (1997) Experimentally induced intrauterine infection causes fetal brain white matter lesions in rabbits. American Journal of Obstetrics and Gynecology 177:4, 797-802
CrossRef110
(1997) Reply. American Journal of Obstetrics and Gynecology 177:2, 480
CrossRef111
(1997) Lessons in Technology Diffusion: The Electronic Fetal Monitoring Experience. Birth 24:1, 58-60
CrossRef112
Frederick T Kraus. (1997) Cerebral palsy and thrombi in placental vessels of the fetus: Insights from litigation. Human Pathology 28:2, 246-248
CrossRef113
Alistair J. Gunn, Tania R. Gunn. (1997) Changes in Risk Factors for Hypoxic-ischaemic Seizures in Term Infants. The Australian and New Zealand Journal of Obstetrics and Gynaecology 37:1, 36-39
CrossRef114
D. M. Peebles, P. O'Brien. (1997) Fetal cerebral oxygenation and hemodynamics during labour measured by near-infrared spectroscopy. Mental Retardation and Developmental Disabilities Research Reviews 3:1, 59-68
CrossRef115
Olaf Dammann, Alan Leviton. (1997) The role of perinatal brain damage in developmental disabilities: An epidemiologic perspective. Mental Retardation and Developmental Disabilities Research Reviews 3:1, 13-21
CrossRef116
Harmen H. de Haan, Alistair J. Gunn, Peter D. Gluckman. (1997) Fetal heart rate changes do not reflect cardiovascular deterioration during brief repeated umbilical cord occlusions in near-term fetal lambs. American Journal of Obstetrics and Gynecology 176:1, 8-17
CrossRef117
(1997) Lessons in Technology Diffusion: The Electronic Fetal Monitoring Experience. Birth 24:1, 58
CrossRef118
Jay Hathaway. (1996) Commentary: Study Offers New Scientific Support for What We Already Knew. Birth 23:4, 202-204
CrossRef119
Robin B. Supplee, Toni M. Vezeau. (1996) Continuous Electronic Fetal Monitoring: Does It Belong In Low-Risk Births?. MCN, The American Journal of Maternal/Child Nursing 21:6, 301-306
CrossRef120
(1996) Electronic Fetal Monitoring in Predicting Cerebral Palsy. New England Journal of Medicine 335:4, 287-289
Full Text121
MacDonald, Dermot, . (1996) Cerebral Palsy and Intrapartum Fetal Monitoring. New England Journal of Medicine 334:10, 659-660
Full Text
- Letters
