Neonatal signs consistent with an acute peripartum or intrapartum event: |
- Apgar score of <5 at 5 minutes and 10 minutes
- Fetal umbilical artery acidemia – Fetal umbilical artery pH <7.0, or base deficit ≥12 mmol/L, or both
- Neuroimaging evidence of acute brain injury seen on brain MRI or MRS consistent with hypoxia-ischemia
- Presence of multisystem organ failure consistent with hypoxic-ischemic encephalopathy
|
Type and timing of contributing factors that are consistent with an acute peripartum or intrapartum event: |
- A sentinel hypoxic or ischemic event occurring immediately before or during labor and delivery:
- Ruptured uterus
- Severe abruptio placentae
- Umbilical cord prolapse
- Amniotic fluid embolus with coincident severe and prolonged maternal hypotension and hypoxemia
- Maternal cardiovascular collapse
- Fetal exsanguination from either vasa previa or massive fetomaternal hemorrhage
- Fetal heart rate monitor patterns consistent with an acute peripartum or intrapartum event, particularly a category I fetal heart rate pattern on presentation that converts to one of the following patterns:
- Category III pattern
- Tachycardia with recurrent decelerations
- Persistent minimal variability with recurrent decelerations
- Timing and type of brain injury patterns based on imaging studies consistent with an etiology of an acute peripartum or intrapartum event. Well-defined patterns on brain MRI typical of hypoxic-ischemic cerebral injury in the newborn are:
- Deep nuclear gray matter (ie, basal ganglia or thalamus) injury
- Watershed (borderzone) cortical injury
- No evidence of other proximal or distal factors that could be contributing
|
Developmental outcome is spastic quadriplegia or dyskinetic cerebral palsy: |
- Other subtypes of cerebral palsy are less likely to be associated with acute intrapartum hypoxic-ischemic events
- Other developmental abnormalities may occur, but they are not specific to acute intrapartum hypoxic-ischemic encephalopathy and may arise from a variety of other causes
|