The Royal College of Obstetricians and Gynaecologists (RCOG) published its document Standards in Maternity Care in 2008 which is being used widely by commissioners, providers and policy makers. The document sets out the principles of quality-assured maternity services. This chapter identifies some key indicators as exemplars, although it is recommended to make use of the whole document. Prepregnancy care for women with social needs is essential. Prepregnancy care can improve outcomes in high-risk pregnancies regardless of whether the high-risk status is of medical or social aetiology. From a public health perspective, the identification of anomalies can improve perinatal morbidity and mortality, as conditions may be identified early in pregnancy and managed accordingly. Current approaches for the prevention of hypoxic ischaemic encephalopathy include antenatal identification and monitoring of fetal growth restriction and electronic fetal monitoring accompanied by intrapartum fetal blood sampling.

The birth of an infant who has a possible hypoxic ischaemic encephalopathy (HIE) is a source of great concern to the parents, obstetricians and paediatricians. Hypoxic cerebral brain injury that occurs in the perinatal period is recognised as a cause of severe long-term neurological deficit in children; it is often referred to as cerebral palsy. The absence of information and specific guidelines on HIE means that advice provided to women has to be collated from evidence-based effective antenatal and perinatal care that maximises the opportunity to deliver a healthy baby. Approaches to the prevention of HIE include the antenatal administration of corticosteroids to women in preterm labour, as this has been shown to reduce perinatal mortality, respiratory distress and intraventricular haemorrhage by over 50%. All units should have a regular continuing programme of in-service training including cardiotocography (CTG) interpretation, drills on emergency ('crash') caesarean section and neonatal resuscitation.