Department of Neonatology, Charité University Medicine, Berlin Germany.
Pediatr Res. 2018 Feb;83(2):403-411. doi: 10.1038/pr.2017.238. Epub 2017 Nov 8.
Since the sixteenth century, competition between midwives and surgeons has created a culture of blame around the difficult delivery. In the late seventeenth century, 100 years before oxygen was discovered, researchers associated "apparent death of the newborn" with impaired respiratory function of the placenta. The diagnosis "birth asphyxia" replaced the term "apparent death of the newborn" during the mass phobia of being buried alive in the eighteenth century. This shifted the interpretation from unavoidable fate to a preventable condition. Although the semantic inaccuracy ("pulselessness") was debated, "asphyxia" was not scientifically defined until 1992. From 1792 the diagnosis was based on a lack of oxygen. "Blue" and "white" asphyxia were perceived as different disorders in the eighteenth, and as different grades of the same disorder in the nineteenth century. In 1862, William Little linked birth asphyxia with cerebral palsy, and although never confirmed, his hypothesis was accepted by scientists and the public. Fetal well-being was assessed by auscultating heart beats since 1822, and continuous electronic fetal monitoring was introduced in the 1960s without scientific assessment. It neither diminished the incidence of birth asphyxia nor of cerebral palsy, but rather raised the rate of cesarean sections and litigation against obstetricians and midwives.
自 16 世纪以来，助产士和外科医生之间的竞争围绕着分娩难题制造了一种归咎文化。在 17 世纪后期，也就是氧气被发现的 100 年前，研究人员将“新生儿明显死亡”与胎盘呼吸功能受损联系起来。在 18 世纪对活埋的普遍恐惧中，“出生窒息”一词取代了“新生儿明显死亡”一词。这将解释从不可避免的命运转变为可预防的状况。尽管语义不准确（“无脉搏”）存在争议，但直到 1992 年才对“窒息”进行科学定义。自 1792 年以来，该诊断基于缺氧。18 世纪，“蓝”窒息和“白”窒息被视为两种不同的疾病，而在 19 世纪则被视为同一种疾病的不同程度。1862 年，威廉·利特尔将出生窒息与脑瘫联系起来，尽管从未得到证实，但他的假设被科学家和公众接受。自 1822 年以来，人们通过听诊心跳来评估胎儿的健康状况，而连续电子胎儿监测则是在 20 世纪 60 年代引入的，没有经过科学评估。它既没有降低出生窒息的发生率，也没有降低脑瘫的发生率，而是提高了剖腹产率和针对产科医生和助产士的诉讼率。
