Re-visiting the role of intra-partum cardio-tocography (I-P CTG) in cerebral palsy jurisprudence: Time to take cognizance

Abstract

Both clinical obstetrics as well the relevant medico-legal litigation was severely let down by false scientific conclusions emanating from the USA in the 1960's. The false assumptions considered birth asphyxia as the predominant cause of new-born Cerebral Palsy and proclaimed the just introduced fetal cardio-tocography (CTG), as the great saviour from CP through the detection of intra-partum hypoxia. Although today, fifty odd years later, science admits that neither conclusion is correct, CTG has retained its misplaced strength in CP litigation. Not only does it still hold much pre-eminence in both UK and US jurisprudence, but sometimes, it constitutes the sole basis of discussion.The only scientifically valid and practical way of correction is the recognition that CP due to intra-partum hypoxia has the underlying hallmark pathology of Hypoxic Ischaemic Encephalopathy (HIE). This constitutes no more than 20% of CP. Other aspects of obstetric care, including in the antenatal period may have a basis for alleging negligence, but CP due to peri-partum hypoxia must be accompanied by HIE. The 2003/2014 criteria for diagnosing HIE were established by the American College of Obstetricians in liaison with the American Academy of Paediatricians. This provides a reliable guide to the diagnosis by integrating clinical obstetrics/ neonatology/midwifery observations, fetal/ newborn biochemical data, newborn cerebral MRI/ MRI spectroscopy imaging, and evidence of fetal multisystem organ failure. These must be the new parameters on which CP jurisprudence should be justly and scientifically based.