{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T16:53:36Z","timestamp":1790528016744,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2004,12,17]],"date-time":"2004-12-17T00:00:00Z","timestamp":1103241600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2005,5]]},"abstract":"<jats:p><jats:bold>Objective\u2003<\/jats:bold> To review delivery details of intrapartum\u2010related fetal and neonatal deaths with singleton cephalic presentation and birthweight of 2500 g or more in which traumatic cranial or cervical spine injury or substantial difficulty at delivery of the head was a dominant feature.<\/jats:p><jats:p><jats:bold>Design\u2003<\/jats:bold> Review of freestyle summary reports and standard questionnaire responses submitted to the national secretariat for the Confidential Enquiry into Stillbirths and Death in Infancy (CESDI) during the 1994\/1995 intrapartum\u2010related mortality enquiry following regional multidisciplinary panel review.<\/jats:p><jats:p><jats:bold>Setting\u2003<\/jats:bold> United Kingdom.<\/jats:p><jats:p><jats:bold>Sample\u2003<\/jats:bold> Of the 873 cases of intrapartum\u2010related deaths reported in the 1994\u20131995 national enquiry, 709 weighed more than 2499 g. Reports from 181 (89 from 1994 and 92 from 1995) with a chance of meeting criteria for cranial or cervical trauma as significant contributors to death were examined in detail. Thirty\u2010seven were judged to meet the criteria stated in the objectives (23 from 1994 and 14 from 1995) and form the basis for this review.<\/jats:p><jats:p><jats:bold>Methods\u2003<\/jats:bold> Electronic and hand search of CESDI records relating to intrapartum\u2010related deaths.<\/jats:p><jats:p><jats:bold>Main outcome measures\u2003<\/jats:bold> Intrapartum events and features of care.<\/jats:p><jats:p><jats:bold>Results\u2003<\/jats:bold> There was evidence of fetal compromise present before birth in 33 of the 37 (89%) study group cases reviewed. One delivery was performed vaginally without instrumentation, and in one there was no attempt at vaginal delivery before caesarean section (CS) in the second stage of labour. Twenty\u2010four cases (65%) were delivered vaginally and 11 (30%) by CS after failure to deliver vaginally with instruments. A single instrument was used in six cases of vaginal delivery (four ventouse and two Kjelland's forceps). At least two separate attempts with different instruments were made in 24 cases. Overall, the ventouse was used in 27 cases and forceps in 29 cases. In six cases, three separate attempts were made with at least two different instruments, all of which included use of ventouse. The grade of operator was recorded in 27 cases. Of these, a consultant obstetrician was present at only one delivery and no consultant was recorded to have made the first attempt to deliver a baby. In six cases, shoulder dystocia was also reported.<\/jats:p><jats:p><jats:bold>Conclusions\u2003<\/jats:bold> This study suggests a lower incidence of death from difficult cephalic delivery and cranial trauma than previously reported. The CESDI studies were believed to have achieved high levels of ascertainment for all intrapartum\u2010related deaths from which the cases reported here were selected. Strictly applied entry criteria used in this study could have restricted the number of cases considered as could limited <jats:italic>in vivo<\/jats:italic> or postmortem investigations and lack of detailed autopsy. When cranial traumatic injury was observed, it was almost always associated with physical difficulty at delivery and the use of instruments. The use of ventouse as the primary or only instrument did not prevent this outcome. Some injuries occurred apparently without evidence of unreasonable force, but poorly judged persistence with attempts at vaginal delivery in the presence of failure to progress or signs of fetal compromise were the main contributory factor regardless of which instruments were used.<\/jats:p>","DOI":"10.1111\/j.1471-0528.2004.00508.x","type":"journal-article","created":{"date-parts":[[2005,4,14]],"date-time":"2005-04-14T11:54:05Z","timestamp":1113479645000},"page":"619-626","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Review of singleton fetal and neonatal deaths associated with cranial trauma and cephalic delivery during a national intrapartum\u2010related confidential enquiry"],"prefix":"10.1111","volume":"112","author":[{"given":"Fidelma","family":"O'Mahony","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph","family":"Settatree","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Platt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Johanson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2005,1,12]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/0020-7292(94)90349-2"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/0029-7844(96)00208-6"},{"key":"e_1_2_6_4_2","volume-title":"International Differences in the Use of Obstetrical Interventions","author":"Stevenson PA","year":"1992"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1996.tb09825.x"},{"key":"e_1_2_6_6_2","volume-title":"The Cochrane Library","author":"Johanson RB","year":"2004"},{"key":"e_1_2_6_7_2","volume-title":"Textbook of Fetal and Perinatal Pathology","author":"Wigglesworth JS","year":"1998"},{"key":"e_1_2_6_8_2","volume-title":"Public Health Advisory: Need for CAUTION When Using Vacuum Assisted Delivery Devices","author":"Food and Drug Administration","year":"1998"},{"key":"e_1_2_6_9_2","volume-title":"Confidential Enquiry into Stillbirths and Deaths in Infancy. 4th Annual Report","author":"Maternal and Child Health Research Consortium","year":"1997"},{"key":"e_1_2_6_10_2","volume-title":"Confidential Enquiry into Stillbirth and Deaths in Infancy. 5th Annual Report","author":"Maternal and Child Health Research Consortium","year":"1998"},{"key":"e_1_2_6_11_2","volume-title":"Confidential Enquiry into Stillbirths and Deaths in Infancy. 6th Annual Report","author":"Maternal and Child Health Research Consortium","year":"1999"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1998.tb10003.x"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.1986.tb03849.x"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/0029-7844(95)00213-B"},{"key":"e_1_2_6_15_2","first-page":"64","volume-title":"Perinatal Events and Brain Damage in Surviving Children Based on Papers Presented at an International Conference held in Heidelberg in 1986","author":"Wigglesworth JS","year":"1988"},{"key":"e_1_2_6_16_2","volume-title":"Report on Fetal and Perinatal Pathology","author":"The Joint Working Party of Royal College of Obstetricians and Gynaecologists and Royal College of Pathologists","year":"1988"},{"key":"e_1_2_6_17_2","volume-title":"National Sentinel Caesarean Section Audit Report","author":"Paranjothy S","year":"2001"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1576\/toag.1999.1.2.46"},{"key":"e_1_2_6_19_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199912023412301"},{"key":"e_1_2_6_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01957762"},{"key":"e_1_2_6_21_2","first-page":"308","volume-title":"Dewhurst's Textbook of Obstetrics and Gynaecology for Postgraduates","author":"Johanson RB","year":"1999"},{"key":"e_1_2_6_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)06341-3"},{"key":"e_1_2_6_23_2","first-page":"851","article-title":"Spontaneous intrauterine linear skull fracture: a rare complication of spontaneous vaginal delivery","volume":"87","author":"Heise RH","year":"1996","journal-title":"Obstet Gynaecol"},{"key":"e_1_2_6_24_2","first-page":"71","article-title":"Intracranial haemorrhage in the newborn. 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