A Landmark Study from Finland
A groundbreaking 20-year study published in the American Journal of Obstetrics & Gynecology (November 2025) examined more than 317,000 term births across seven Helsinki University hospitals to answer one critical question: how many cases of hypoxic-ischemic encephalopathy (HIE) could have been prevented with better care during labor? The researchers found that nearly one in four HIE cases were potentially avoidable. In fact, half of all HIE cases that developed during labor, after a normal fetal heart tracing at admission, might have been prevented with timely recognition and intervention.
Understanding HIE and Intrapartum Asphyxia
HIE is a type of newborn brain injury caused by lack of oxygen and blood flow around the time of birth. It remains one of the leading causes of neonatal death and lifelong neurological disability in developed countries. While some cases result from sudden “sentinel events” like placental abruption or uterine rupture, many others arise from missed or misinterpreted warning signs on fetal monitoring during routine labor. The Finnish data revealed that 98% of babies who developed HIE despite a normal admission tracing suffered oxygen deprivation during labor, not before. That means these injuries evolved under hospital supervision and could have been prevented with vigilant monitoring and prompt action.
What the Researchers Found
Among 317,126 term births reviewed between 2005 and 2024, 314 newborns were diagnosed with HIE. Of these, 141 (45%) had normal fetal heart tracings (CTG) at admission, and 70 cases (about 50%) were considered potentially avoidable. In total, 22% of all HIE cases could have benefited from preventive measures. Babies with abnormal tracings at admission showed evidence of chronic hypoxia, evidenced by elevated erythropoietin and S100b protein levels indicating long-standing oxygen deprivation, but among those with normal tracings, the harm developed after labor began, often during hours of active monitoring.
Critically, the study pinpointed exactly where preventable failures occurred: “Within this group, 36 had optimal intrapartum care with timely interventions addressing fetal asphyxia, while 21 had delayed cesarean or vacuum-assisted vaginal deliveries and 49 had spontaneous vaginal deliveries following neglected pathological or uninterpretable fetal heart rate recordings.” In plain terms, nearly half of these infants were injured because staff either delayed delivery or ignored warning signs on fetal monitors. This is the first large-scale study to quantify that link between inadequate response to fetal distress and permanent brain injury.
These results align closely with a Swedish birth cohort study involving 71,189 births, including 80 cases of neonatal encephalopathy, which found that 54% of affected newborns experienced evolving hypoxia during labor. Together, these findings confirm that many cases of HIE occur after hospital admission, when prevention should be most achievable.
Why This Matters for Families
For families, this research reinforces a devastating truth: many catastrophic birth injuries occur not because of unavoidable conditions, but because hospital staff failed to act in time. When nurses or physicians misread fetal tracings, delay cesarean delivery, or allow pathological or uninterpretable fetal heart rate patterns to continue unaddressed, babies can suffer irreversible brain injury within minutes. The Finnish authors concluded that optimal intrapartum care such as rapid decision-making, clear team coordination, and consistent fetal surveillance could have prevented nearly a quarter of all HIE cases. Their findings make clear that HIE following a normal admission tracing is not a mystery of nature; it is, far too often, a product of delayed or negligent care.
Implications for Patient Safety and Accountability
These findings echo the Royal College of Obstetricians & Gynaecologists’ Each Baby Counts project, which found that nearly three-quarters of term brain injuries and early neonatal deaths might have been avoided with timely intrapartum intervention. For attorneys and patient advocates, this evidence strengthens the causal chain in many obstetric negligence cases: HIE following a normal admission tracing is intrapartum in origin; half of such injuries were preventable with proper monitoring and timely delivery; and neglected fetal distress and delayed cesarean response remain the leading, documented causes. These findings dismantle the defense that “the injury was unpreventable” or “occurred before arrival.” The data show that for many children, the injury unfolded during labor while caregivers had a chance to intervene.
Moving Forward
Families deserve answers when a preventable birth injury leaves a child with lifelong needs. Hospitals and obstetric teams must treat these findings as a mandate for reform, including maintaining continuous, interpretable fetal heart monitoring, acting immediately when patterns become non-reassuring, and following evidence-based timelines for decision-to-delivery intervals. Every missed opportunity for intervention can mean the difference between a healthy newborn and a lifetime of medical and developmental challenges. The evidence is now unequivocal: with attentive monitoring and timely care, most hypoxic-ischemic encephalopathy at term should never happen.
