The incidence and implications of cerebral palsy following potentially avoidable obstetric complications: a preliminary burden of disease study

Leigh, Simon; Granby, Paul; Turner, Mark A.; Wieteska, Sue; Haycox, Alan; Collins, Brendan

doi:10.1111/1471-0528.12897

Cited by 12 publications

(13 citation statements)

References 39 publications

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“…In the absence of suitable evidence of how SEN affect quality of life, we assumed for our base-case scenario that SEN would affect costs only. In the case of SNM, we adjusted the baseline quality of life with a relative decrease following the methodology of Leigh et al, 187 using cerebral palsy (CP) as a proxy for SNM. Full details on the derivation of quality-of-life parameters are presented in Appendix 6.…”

Section: Quality Of Lifementioning

confidence: 99%

Universal late pregnancy ultrasound screening to predict adverse outcomes in nulliparous women: a systematic review and cost-effectiveness analysis

Smith

Moraitis

Wastlund

et al. 2021

Health Technol Assess

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Background Currently, pregnant women are screened using ultrasound to perform gestational aging, typically at around 12 weeks’ gestation, and around the middle of pregnancy. Ultrasound scans thereafter are performed for clinical indications only. Objectives We sought to assess the case for offering universal late pregnancy ultrasound to all nulliparous women in the UK. The main questions addressed were the diagnostic effectiveness of universal late pregnancy ultrasound to predict adverse outcomes and the cost-effectiveness of either implementing universal ultrasound or conducting further research in this area. Design We performed diagnostic test accuracy reviews of five ultrasonic measurements in late pregnancy. We conducted cost-effectiveness and value-of-information analyses of screening for fetal presentation, screening for small for gestational age fetuses and screening for large for gestational age fetuses. Finally, we conducted a survey and a focus group to determine the willingness of women to participate in a future randomised controlled trial. Data sources We searched MEDLINE, EMBASE and the Cochrane Library from inception to June 2019. Review methods The protocol for the review was designed a priori and registered. Eligible studies were identified using keywords, with no restrictions for language or location. The risk of bias in studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Health economic modelling employed a decision tree analysed via Monte Carlo simulation. Health outcomes were from the fetal perspective and presented as quality-adjusted life-years. Costs were from the perspective of the public sector, defined as NHS England, and the costs of special educational needs. All costs and quality-adjusted life-years were discounted by 3.5% per annum and the reference case time horizon was 20 years. Results Umbilical artery Doppler flow velocimetry, cerebroplacental ratio, severe oligohydramnios and borderline oligohydramnios were all either non-predictive or weakly predictive of the risk of neonatal morbidity (summary positive likelihood ratios between 1 and 2) and were all weakly predictive of the risk of delivering a small for gestational age infant (summary positive likelihood ratios between 2 and 4). Suspicion of fetal macrosomia is strongly predictive of the risk of delivering a large infant, but it is only weakly, albeit statistically significantly, predictive of the risk of shoulder dystocia. Very few studies blinded the result of the ultrasound scan and most studies were rated as being at a high risk of bias as a result of treatment paradox, ascertainment bias or iatrogenic harm. Health economic analysis indicated that universal ultrasound for fetal presentation only may be both clinically and economically justified on the basis of existing evidence. Universal ultrasound including fetal biometry was of borderline cost-effectiveness and was sensitive to assumptions. Value-of-information analysis indicated that the parameter that had the largest impact on decision uncertainty was the net difference in cost between an induced delivery and expectant management. Limitations The primary literature on the diagnostic effectiveness of ultrasound in late pregnancy is weak. Value-of-information analysis may have underestimated the uncertainty in the literature as it was focused on the internal validity of parameters, which is quantified, whereas the greatest uncertainty may be in the external validity to the research question, which is unquantified. Conclusions Universal screening for presentation at term may be justified on the basis of current knowledge. The current literature does not support universal ultrasonic screening for fetal growth disorders. Future work We describe proof-of-principle randomised controlled trials that could better inform the case for screening using ultrasound in late pregnancy. Study registration This study is registered as PROSPERO CRD42017064093. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 15. See the NIHR Journals Library website for further project information.

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Section: Quality Of Lifementioning

confidence: 99%

Universal late pregnancy ultrasound screening to predict adverse outcomes in nulliparous women: a systematic review and cost-effectiveness analysis

Smith

Moraitis

Wastlund

et al. 2021

Health Technol Assess

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“…Reliability has proven elusive, with deficiencies in identifying material endpoints and no apparent improvement in neurological outcome or reduction in allegations of obstetrical negligence [15][16][17][18]. Concomitantly, there are worldwide, controversial efforts to reduce the cesarean section rate in part by increasing the tolerance for increasing lengths of labor and for abnormal FHR patterns [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

The “Fetal Reserve Index”: Re-Engineering the Interpretation and Responses to Fetal Heart Rate Patterns

Eden

Evans²,

Evans

et al. 2017

Fetal Diagn Ther

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Objective: Electronic fetal monitoring (EFM) correlates poorly with neonatal outcome. We present a new metric: the “Fetal Reserve Index” (FRI), formally incorporating EFM with maternal, obstetrical, fetal risk factors, and excessive uterine activity for assessment of risk for cerebral palsy (CP). Methods: We performed a retrospective, case-control series of 50 term CP cases with apparent intrapartum neurological injury and 200 controls. All were deemed neurologically normal on admission. We compared the FRI against ACOG Category (I-III) system and long-term outcome parameters against ACOG monograph (NEACP) requirements for labor-induced fetal neurological injury. Results: Abnormal FRI's identified 100% of CP cases and did so hours before injury. ACOG Category III identified only 44% and much later. Retrospective ACOG monograph criteria were found in at most 30% of intrapartum-acquired CP patients; only 27% had umbilical or neonatal pH <7.0. Conclusions: In this initial, retrospective trial, an abnormal FRI identified all cases of labor-related neurological injury more reliably and earlier than Category III, which may allow fetal therapy by intrauterine resuscitation. The combination of traditional EFM with maternal, obstetrical, and fetal risk factors creating the FRI performed much better as a screening test than EFM alone. Our quantified screening system needs further evaluation in prospective trials.

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“…If mild asphyxiated babies are given immediate and accurate treatment, they may stand a chance to recover [6]. For those experiencing longer deprivations of oxygen may suffer from permanent damage to their brain, heart, lungs, kidneys, bowels or other organs and may also result in stillbirth or neonatal deaths [8], [9].They may also suffer neurological disabilities and malformations such as cerebral palsy, mental retardation, nerve deficits, hearing and vision impairment [10]. Birth asphyxia may result from several causes; some are unavoidable and some are due to faulty medical care and failure by the obstetrical team to react to asphyxiated babies in a correct and timely fashion [11].…”

Section: Types Of Obstetric Malpracticementioning

confidence: 99%

The causes and implications of obstetric malpractice

Kassim

Najid

2015

IJBAS

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Obstetrics and Gynaecology (O & G) are among the specialties at high risk of malpractice claims. In particular, obstetric malpractice attracts high incidence of claims as birth injuries are usually serious and devastating. The resulting disabilities and malformation from the injuries tend to be life-long and victims are deprived of years of enjoyment in life, independence and productivity. As these injuries occur on the victims early in life, the costs of medical care are usually enormous. As this imposes stressful and heavy burden on the family members, they tend to resort to litigation as means of procuring monetary compensation. The highest numbers of medical negligence cases in Malaysia involve obstetric injuries and six to seven-figure court awards are now becoming the trend for compensating obstetric malpractice victims. However, proving obstetric malpractice is not an easy task with years of litigation, which eventually may not provide victims with monetary compensation if unsuccessful. Further, the increase in obstetric litigation has triggered higher premium for medical indemnity insurance causing many doctors to leave the subspecialty. Even though the doctor at the end may not be found guilty but the trauma of being sued caused them to suffer difficulties in returning to their work.

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The incidence and implications of cerebral palsy following potentially avoidable obstetric complications: a preliminary burden of disease study

Cited by 12 publications

References 39 publications

Universal late pregnancy ultrasound screening to predict adverse outcomes in nulliparous women: a systematic review and cost-effectiveness analysis

Universal late pregnancy ultrasound screening to predict adverse outcomes in nulliparous women: a systematic review and cost-effectiveness analysis

The “Fetal Reserve Index”: Re-Engineering the Interpretation and Responses to Fetal Heart Rate Patterns

The causes and implications of obstetric malpractice

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