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Peripartum foetal asphyxia may lead to cerebral motor infirmity due to hypoxic and ischaemic encephalopathy. This cerebral motor infirmity has severe social, familial and medicolegal consequences, as it is one of the two leading reasons for filing a legal complaint, and is a burden on public health expenditure (costs of managing affected children).The aetiology of this encephalopathy is difficult to determine and is, in most cases, antenatal. Prevention is possible, through improvements in the management of patients during labour based on the analysis of foetal heart rate. One of the essential criteria for attributing neonatal encephalopathy to peripartum asphyxia is a pH in the umbilical artery below 7.0.Midwives attended a theoretical training course on peripartum heart rate at the maternity unit. This led to a significant decrease in the number of cases in which an umbilical artery pH below 7.0 was recorded. To confirm these findings, we set up a procedure for evaluating professional practices based on a retrospective analysis of obstetric files for cases in which an umbilical artery pH below 7.0 was recorded.Every month, the files concerned are analysed by the doctors and senior staff of the department. For each file, we complete a computerised data form covering 14 analytical criteria based on:Peripartum foetal heart rate (continuous recording, anomalies identified and characterised).The study of uterine contractions (interpretable recordings, anomalies identified, possibility of analysing foetal heart rate as a function of contractions).Determination of pH in utero in accordance with the recommendations of the CNGOF (indication, decision after noting the results).Why the doctor was called (as a function of heart rate or pH when carried out).Time between the decision to operate being taken and extraction, in cases of Caesarean section.At the end of the year, four indicators are calculated:The percentage of heart rate anomalies for which continuous recordings were made.The percentage of anomalies characterised.The percentage of anomalies justifying pH measurement for which this indication was retained.The number of cases of Caesarean section for which the interval between the decision to operate being taken and extraction exceeded 20 min.An analysis of these indicators in 2008 identified several improvements that could be made. Colour codes according to the urgency of the Caesarean section were introduced, and a new training session on foetal heart rate for midwives was programmed for 2009 (in one quarter of cases, the heart rate anomalies were not characterised, contraction anomalies were not identified and pH tests were not carried out).The indicators for 2009 will be calculated at the end of December.This institutional approach has led to a decrease in the number of cases in which an umbilical artery blood pH below 7.0 is recorded (from 0.71% in 2006, to 0.54% in 2007 and 0.57% in 2008).Despite the low frequency with which a pH below 7.0 in the umbilical artery is recorded, the particular gravity of the con...