Low Apgar scores and birth asphyxia. Misconceptions that promote undeserved negligence suits.

The temptation to specify cause-and-effect relationships in cases of neurologic handicap has created a number of misconceptions that have stimulated irresponsible malpractice litigation focusing on childbirth. Paradoxically, the number of such lawsuits is on the increase, even though obstetric and neonatal care has improved dramatically since Virginia Apgar introduced her scoring system in 1953. Nowadays, no evidence of intrapartum hypoxia is found in the majority of newborns who require resuscitation. Consequently, the value of using the Apgar score as an index for assessing asphyxia should be vigorously questioned. It should also be stressed that asphyxial damage may occur without respiratory depression. The recent proliferation of articles linking fetal scalp or cord blood evidence of metabolic acidosis to birth asphyxia threatens to create another legal booby trap. Although the development of fetal metabolic acidosis reflects oxygen deprivation, this fact should not be misconstrued to mean that any degree of oxygen deprivation can damage the brain. Available data make it quite clear that the fetus can sustain transient episodes of hypoxemia without ill effects. In those neonates born with low Apgar scores, cord blood gases should be measured to exclude hypoxemia. Securing such data can protect practitioners from subsequent legal inquiry. Routine determination of cord blood gases is not recommended, however, because a substantial number of newborns who are born acidotic have normal Apgar scores.(ABSTRACT TRUNCATED AT 250 WORDS)