Adverse outcome of pregnancy and the quality of obstetric care.

The case-control method was used to study the relation between four possibly preventable adverse outcomes of pregnancy and suboptimal antepartum and intrapartum obstetric care defined by clinical consensus. Fetuses whose deaths were ascribed to asphyxia or trauma, and babies born at term who had seizures within 48 h of delivery, were significantly more likely than controls to have received suboptimal care during pregnancy. Babies with seizures, as well as those with terminal apnoea, were also substantially more likely than controls to have been born after a failure to react appropriately to signs of severe fetal distress during labour. Most of the babies who received suboptimal obstetric care, however, did not have any of these adverse outcomes. In addition, most babies with these adverse outcomes had apparently received satisfactory obstetric care. No relation was detected between cerebral palsy and suboptimal obstetric care.