Perinatal antecedents of cerebral palsy.
The dramatic reduction in perinatal morbidity and mortality over the last decade has not been accompanied by any diminution in the incidence of cerebral palsy. We investigated retrospectively the relationship of certain perinatal events to the subsequent development of cerebral palsy in 75 infants. Cerebral palsy occurred in association with acute intrapartum asphyxia in 8% and traumatic delivery in 11%. Thirty-five percent of cases were associated with chronic fetal distress, defined by a unique fetal heart rate (FHR) pattern consisting of a normal baseline rate with persistently absent variability and mild variable decelerations with overshoot. This pattern was found frequently in association with postmaturity, meconium staining, intrauterine growth retardation, and neonatal seizures. Acid-base studies, when available, did not reveal acidosis. Twenty-seven percent of the cases involved a combination of chronic fetal distress, acute intrapartum fetal asphyxia, and/or traumatic delivery. We postulate that antenatal intermittent umbilical cord compression secondary to oligohydramnios results in repetitive transient central nervous system ischemia, insufficient to cause death, but resulting in a characteristic FHR pattern and impaired neurologic development. If these data are confirmed, this FHR pattern may be an important marker for the development of subsequent neurologic handicap or other adverse outcome.
Shields
J R
JR
Department of Maternal-Fetal Medicine, AMI--Tarzana Regional Medical Center, California.
Schifrin
B S
BS
D001238:Asphyxia Neonatorum / Q000150:complications*; D002547:Cerebral Palsy / Q000209:etiology*; D002908:Chronic Disease; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D005316:Fetal Distress / Q000150:complications* / Q000503:physiopathology; D005500:Follow-Up Studies; D006340:Heart Rate, Fetal; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000150:complications; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors