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Delay in expediting delivery once fetal compromise is identified or suspected

 

Situation

A mother attended with spontaneous rupture of membranes and raised blood pressure. Thick meconium was noted to be present. The CTG was nonreassuring and remained so despite fluid resuscitation. A decision was made to perform delivery by category 1 caesarean section. However, the delivery was delayed whilst awaiting the maternal blood results. The baby was delivered 3 hours and 45 minutes after the mother’s initial presentation to the unit.

The baby was in poor condition at birth. The baby was intubated and transferred for active therapeutic cooling.

Commentary

Although it could be argued this vignette reflects a baby with potentially antenatal chronic hypoxia, there was evidence of fetal distress on the CTG in the presence of thick meconium, but this was not acted upon promptly. Maternal safety is important, but the blood results should have been processed more quickly and the baby delivered sooner.

It is accepted that there can be many factors that influence the decision on how and when to deliver a baby. However, there were a number of instances where there was either inappropriate persistence with vaginal delivery, a delay in intervention in the second stage or a delay in delivery by caesarean section.

Things you can do

A robust system should be developed locally to ensure that the urgency of a delivery is communicated effectively between all teams involved in the mothers care. Any delay in delivery must be flagged up to the most senior obstetrician in charge and action should be taken immediately to reassess the necessity and potential impact of such a delay.