Conclusion
In this large series of neonates with HIE whose intrapartum care was
managed in three academic medical centers approximately two thirds of
the cases occurred in the initial setting of moderate variability and/or
accelerations on FHR tracing without a sentinel event. A significant
proportion of cases also had moderate variability, accelerations, or
both in the half hour prior to delivery. The study findings support the
concept that diverse clinical scenarios and labor characteristics may be
associated with the birth of an infant with HIE, and that moderate
variability and/or accelerations may not preclude the development of
that disorder. These findings support the notion that risk reduction for
HIE will likely involve improvement of management across a range of
clinical scenarios, and that some of these outcomes may prove to be
unpreventable.