Case-control study of intrapartum care, cerebral palsy, and perinatal death.
OBJECTIVE
To investigate the relation between suboptimal intrapartum obstetric care and cerebral palsy or death.


METHODS
Case-control study.


METHODS
Oxford Regional Health Authority.


METHODS
141 babies who subsequently developed cerebral palsy and 62 who died intrapartum or neonatally, 1984-7. All subjects were born at term of singleton pregnancies and had no congenital anomaly. Two controls, matched for place and time of birth, were selected for each index case.


METHODS
Adverse antenatal factors and suboptimal intrapartum care (by using predefined criteria).


RESULTS
Failure to respond to signs of severe fetal distress was more common in cases of cerebral palsy (odds ratio 4.5; 95% confidence interval 2.4 to 8.4) and in cases of death (26.1; 6.2 to 109.7) than among controls. This association persisted even after adjustment for increased incidence of a complicated obstetric history in cases of cerebral palsy. Neonatal encephalopathy is regarded as the best clinical indicator of birth asphyxia; only two thirds (23/33) of the children with cerebral palsy in whom there had been a suboptimal response to fetal distress, however, had evidence of neonatal encephalopathy; these 23 formed 6.8% of all children with cerebral palsy born to residents of the region in the four years studied.


CONCLUSIONS
There is an association between quality of intrapartum care and death. The findings also suggest an association between suboptimal care and cerebral palsy, but this seems to have a role in only a small proportion of all cases of cerebral palsy. The contribution of adverse antenatal factors in the origin of cerebral palsy needs further study.
Gaffney
G
G
National Perinatal Epidemiology Unit, Radcliffe Infirmary, Oxford.
Sellers
S
S
Flavell
V
V
Squier
M
M
Johnson
A
A
D001034:Apgar Score; D015148:Cardiotocography; D016022:Case-Control Studies; D002547:Cerebral Palsy / Q000209:etiology* / Q000401:mortality; D004739:England / Q000453:epidemiology; D005260:Female; D005316:Fetal Distress / Q000401:mortality; D005323:Fetal Monitoring; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007744:Obstetric Labor Complications; D011247:Pregnancy; D011248:Pregnancy Complications; D011295:Prenatal Care / Q000592:standards*; D011787:Quality of Health Care; D012307:Risk Factors