ABSTRACT
The method of this enquiry was that every case was considered by a multidisciplinary panel, with up to an hour’s discussion on each. After classifying the causes of death by maternal and fetal parameters, the assessors were asked to grade the standard of care given. The grading was divided as follows: Grade 0: no suboptimal care identified; Grade 1: some suboptimal care identified, which was unlikely to have
influenced the outcome of the case; Grade 2: an avoidable factor identified – alternative management might
have made a difference to the outcome; Grade 3: an avoidable factor identified – alternative management would
have been reasonably expected to alter the outcome. In all, 387 cases were assessed. The overall grades given were: Grade 0: 67 cases (17.3%); Grade 1: 47 cases (12.1%); Grade 2: 109 cases (28.1%); Grade 3: 164 cases (42.3%). Therefore, just over 70% of cases were graded as 2 or 3. Obviously, this grading system does not equate grades 2 and 3 with clinical negligence and proven causation, but there is a close approximation. It is no exaggeration to say, therefore, that two-thirds or more of fetal deaths in labour are probably related to substandard practice and could probably have been prevented if proper management had been carried out.
