1. Quality And Safety In Maternity Services – Panel Discussion
Malcolm Battin

2. Two challenging questions
How important is intrapartum status WRT a range of long term adverse neurodevelopmental outcomes ?
What should we aim to achieve in critical review of cases with suboptimal outcome?

3. Antepartum Vs Intrapartum Factors
Badawi, N. et al. BMJ 1998;317:
Copyright ©1998 BMJ Publishing Group Ltd.

4. Antepartum Vs Intrapartum Factors
Evidence of acute insult without established injury in 80% of infants with NE
Cowan 2003
Causal link fetal status & spectrum of poor outcomes
Rennie 2007
Apgar scores and resuscitation linked with:
IQ, social performance, school performance, education length, and income
Odd 2009, Odd 2011
MRI has proven a powerful tool in investigation of NE

5. Two areas for consideration
Review NE or suboptimal outcome cases
Was it potentially avoidable ?
Was resuscitation adequate ?
Adequately recognise compromised baby ?
Was Apgar score done properly
Cord gases collected
Was appropriate postnatal treatment given?
Investigation, counseling family
Appropriate observation after birth

6. Important factors SUEND:
Primigravida
Mother alone
Skin to Skin
Guidelines after last meeting
Would such a poster work in your hospital ?
Or is it “medicalisation” of natural process ?