This list of terms is not exhaustive, but are commonly used in expert witness reports, letters of claim, letters of response, and medical notes. Not included are conditions of labour which are unlikely to relate to negligence and birth injury. I have not included words relating to injury to the mother, as its outside the scope of this list.
Medical Terms – Labour
When you are reviewing your medical notes, or trying to make sense of the expert witness reports, there are a lot of medical words you may not be familiar with.
Therefore, I have put together a summary of some of the words you may see, and a brief explanation of their meaning.
This section deals with labour and the others with pregnancy, and post delivery.
This section deals only with terms/words likely to be used with regard to negligence and are not extensive regarding the entirety of pregnancy. To add these would make the list too long.
If you have further questions relating to the terms used in any reports you receive, the person to ask is the solicitor dealing with your case.
Fetal Heart Rythms. Normally detected by CTG, but can be detected by Doppler
Bradycardia
Persistent slow heart rate of the baby. Below 90 beats per minute is considered slow.
Tachycardia
Rapid heart rate of the baby, above the baseline.
Reassuring heart rate
A heart rate that looks normal and is reassuring
Non reassuring heart rate
A heart rhythm that is showing signs of fetal distress, but can return to a reassuring rhythm
Pathological heart rate
A rhythm which demonstrates a baby is in extreme distress and needs urgent delivery.
Amniotomy (Artificial Rupture of Membranes (AROM))
A small plastic instrument is used to break the membranes if necessary.
C Section/Caesarean Section
There are 4 grades of c section.
- Grade 1. Emergency when the mother and/or baby’s life is threatened. It should take place within 30 minutes of the decision being made.
- Grade 2. Urgent when there is mother/baby compromise that is not immediately life threatening. It should take place within 60 minutes.
- Grade 3. Scheduled. Early delivery required but no current compromise. It should take place within 24 hours
- Grade 4. Elective and can take place at a time to suit the mother and the labour ward.
These time frames are NICE guidelines and all hospital trusts are expected to adhere to them. Not following these guidelines may be negligent. Guidance and regulations change with evolving research based findings and as such guidance which may be relevant today, was not in force 10 years ago, and therefore cannot be applied to birth injury cases retrospectively. The changes can often be found via Google.
Cardiotocography (CTG) or electronic fetal monitoring (EFM)
Electronic monitoring during pregnancy and labour. Two pads are strapped to the abdomen and they record the baby’s heart rate, the mother’s heart rate and the contractions. Misinterpretation of CTG is one of the commonest reasons for birth injury. During some women’s labour, CTG monitoring should be continuous, such as when given an IV infusion of oxytocin to induce labour. At other times there are recommendations to use continuous CTG readings or to use intermittent monitoring of the baby’s heartrate. Midwives are expected to adhere to these guidelines, and it may be negligent not to do so. There are National Institute for Clinical Excellence (NICE) guidelines for fetal monitoring
Continuous Fetal Monitoring via CTG.
These are used if the pregnancy is high risk, or there have been issues throughout labour, or if concerns are developing. Failure to correctly interpret a CTG reading is one of the commonest reasons birth injury occurs.
Decelerations
Slowing of the fetal heart rate during contractions, apparent from the CTG trace. Early or type 1 decelerations are those which start at the onset of a contraction, and where the fetal heart rate reaches its lowest point at the peak of the contraction, returning to the baseline by the end of the contraction. Late or type 2 contractions are where the fetal heart rate reaches its lowest point more than 15 seconds after the contraction has peaked
Forceps Delivery
The use of curved metal instruments to deliver the baby. Should only be done by an experienced obstetrician. Poorly performed they can cause injury
Failure to Progress in Labour, Prolonged Labour
There are specified time periods that each stage of labour should last. If the time scale exceeds those guidelines, then the midwife/obstetrician are expected to take some action to expedite the birth. They may vary with hospitals.
Fetal Macrosomia (Large Baby)
Sometimes the baby is exceptionally large and will get stuck in the birth canal. Where possible this should be monitored beforehand and a c section advised instead. Women with gestational diabetes often have large babies, but ultrasound scans should also pick these up.
Fetal Blood Sample (FBS)
A test for acidosis (whether the baby’s blood is too acidic), which can indicate a shortage of oxygen. This is done by taking a tiny blood sample from a small scratch on the baby’s head (or bottom). This is quite an invasive procedure but is recommended by NICE in certain situations.
Hyperstimulation of the Uterus
Rapid, strong contractions, usually caused by overuse of the infusion of oxytocin and inadequate monitoring of the effect of the drug. This can be dangerous for the baby and not to remedy the hyperstimulation or recognise it, is negligent.
Individual Hospital Guidelines
Hospital Trusts often have individual guidelines which should follow NICE guidelines but they often have more detailed individualised systems. They can often be found on the hospitals maternity services websites.
Induction of Labour
Artificially inducing labour by various methods. A membrane sweep, pessaries, intravenous infusion to stimulate contractions, artificial rupture of membranes (AROM). When labour is induced with an IV infusion of oxytocin, continuous monitoring should always be done to avoid over stimulating the uterus.
Midwifery led Units/Birthing Centres
These units are as they say and do not have doctors routinely covering them. They are for straightforward births and the method of fetal monitoring is different from hospital births. The use of intermittent fetal monitoring is recommended. There are guidelines on when and for how long to listen to the heart rate at different stages of labour.
Intermittent fetal monitoring/Intermittent Auscultation (IA)
NICE recommend (deviation from these guidelines may be considered negligent)
- CTG is not used in women at low risk of complications
- that IA (intermittent monitoring) is offered to women at low risk of complications in in all birth settings;
- that IA is undertaken immediately after a contraction listening for at least one minute and repeating at least every 15 minutes.
For further information on NICE Guidelines during labour, follow the link away from this page
https://www.nice.org.uk/guidance/ng229/informationforpublic#
Placental abruption
A separation of the placenta from the uterine wall before the 3rd stage of labour. It can be mild with minimal effects, to catastrophic, with severe haemorrhage and infant mortality. Warning signs are constant abdominal pain with or without bleeding, and often abnormal fetal heart rate. Placental abruption can occur at times other than labour (which see).
During labour if the Placenta separates prematurely there will usually be severe pain and blood loss. The fetal heart rate will often become non reassuring. This event may be difficult to predict in labour if the abruption is very rapid, but if it is happening throughout part of the second stage, abnormalities of the fetal heart rate, changes in the feel of the abdomen, pain and bleeding will alert a competent midwife.
Shoulder Dystocia
This can occur particularly with larger babies, and if it has occurred in a previous birth and the baby is large, elective c section should be considered.
Umbilical Cord Prolapse
Normally the umbilical cord and placenta follow the baby through the birth canal. Rarely the cord goes in front of the baby’s head and is then compressed between the head and the pelvis, causing complete loss of oxygen to the baby. This must be recognised early and steps taken to expedite the birth.
Uterine rupture
Rarely the uterus will rupture during the second stage of labour. It causes a catastrophic blood loss and is a severe risk to the infant. Risk factors are hyperstimulation of the uterus with infusions of oxytocin, or vaginal birth after a c section.
Vaginal Birth after Caesarean (VBAC)
With a prior non emergency c section, some women are offered VBAC and an opportunity to labour naturally. The main risk, which is rare, is the uterus will rupture along the line of the old uterine scar.
