SOGC 2020 Guideline 396

A Review by Richard Halpern

Fetal Surveillance in Labour, a Review Of SOCG 2020 Guideline 396: Oversights, Omissions And Opportunities Squandered

New guidelines for fetal surveillance in labour, Clinical Practice Guideline No. 396, were issued by the Society of Obstetricians and Gynecologists of Canada (SOGC) in March 2020. In Richard’s view, this new Guideline has little hope of improving the care of mothers and babies during labour and delivery, fails to adequately describe how and when newborn neurological injury relates to events occurring during labour and makes recommendations based on data of dubious clinical value. In Richard’s analysis, he argues that the best defence to birth trauma litigation is not defence oriented guidelines but improved neonatal outcomes. Further, improved neonatal outcomes depend on a firm understanding of how and when babies get injured in labour.

Families Are Being Put At Risk

In the paper, Richard discusses these issues thoroughly, with appropriate scientific references. The importance of neuroimaging of the newborn brain is vital to understanding causation. It provides definitive proof of how and when the injury occurred, and its importance cannot be diminished by any other clinical markers that seem discordant. Neuroimaging establishes a well-defined window of opportunity for injury, within days and even hours. Fetal heart rate patterns can be used to refine or narrow that window of opportunity for injury. Properly applying the differential diagnosis, the timing and cause of injury will be established in this context.

The new Guideline has not made any material contribution to improving intrapartum surveillance and offers little hope of improved neonatal outcomes. Indeed, it is in Richard’s opinion that, with this Guideline, unacceptable levels of completely avoidable newborn brain injury will continue unabated. This is at enormous cost to our health care system, our tort system, and, more distressingly, creates an intolerable burden for affected families.

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