Acute intrapartum event and the cooling decision — emergency + communication station

Emergency management and communication station for a baby with neonatal encephalopathy after an acute intrapartum event. Tests the obstetrician's contribution to the cooling decision, the documentation discipline, and the parent communication. Includes assessor key and marking domains.

Prompt

A 39+4 week primigravida's CTG converts from Category I to Category III with absent variability at 8 cm. You perform a Category 1 caesarean. At 10 minutes the infant is on positive pressure ventilation; cord arterial pH 6.91, base deficit minus 17 mmol/L. The neonatal registrar is 10 minutes away. The mother is in the recovery room; her partner is with her.

Station brief

Format. Emergency and communication station, approximately 12 minutes. You are the obstetric registrar on labour ward. The neonatal registrar is 10 minutes away and has been called. The midwife is with the baby. The assessor will run the clock and feed you new findings. ^[2]

Candidate instruction. Lead the obstetric contribution to the cooling decision, the documentation, and the parent communication. Verbalise your actions, your reasoning, your handover to the neonatal team, and your conversation with the parents. ^[2]

References5Show

[1]Sarnat HB, Sarnat MS Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study Arch Neurol, 1976.PMID 987769
[2]American College of Obstetricians and Gynecologists' Task Force on Neonatal Encephalopathy Executive summary: Neonatal encephalopathy and neurologic outcome, second edition. Report of the American College of Obstetricians and Gynecologists' Task Force on Neonatal Encephalopathy Obstet Gynecol, 2014.PMID 24785633
[3]Azzopardi DV, Strohm B, Edwards AD, et al. Moderate hypothermia to treat perinatal asphyxial encephalopathy N Engl J Med, 2009.PMID 19797281
[4]Azzopardi D, Strohm B, Marlow N, et al. Effects of hypothermia for perinatal asphyxia on childhood outcomes N Engl J Med, 2014.PMID 25006720
[5]Faix RG, Laptook AR, Shankaran S, et al. Whole-Body Hypothermia for Neonatal Encephalopathy in Preterm Infants 33 to 35 Weeks' Gestation: A Randomized Clinical Trial JAMA Pediatr, 2025.PMID 39992674

Acute intrapartum event and the cooling decision — emergency + communication station

Station brief

References5Show

[1]Sarnat HB, Sarnat MS Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study Arch Neurol, 1976.PMID 987769
[2]American College of Obstetricians and Gynecologists' Task Force on Neonatal Encephalopathy Executive summary: Neonatal encephalopathy and neurologic outcome, second edition. Report of the American College of Obstetricians and Gynecologists' Task Force on Neonatal Encephalopathy Obstet Gynecol, 2014.PMID 24785633
[3]Azzopardi DV, Strohm B, Edwards AD, et al. Moderate hypothermia to treat perinatal asphyxial encephalopathy N Engl J Med, 2009.PMID 19797281
[4]Azzopardi D, Strohm B, Marlow N, et al. Effects of hypothermia for perinatal asphyxia on childhood outcomes N Engl J Med, 2014.PMID 25006720
[5]Faix RG, Laptook AR, Shankaran S, et al. Whole-Body Hypothermia for Neonatal Encephalopathy in Preterm Infants 33 to 35 Weeks' Gestation: A Randomized Clinical Trial JAMA Pediatr, 2025.PMID 39992674