title: [Can caesarean delivery prevent cerebral palsy? Medico-legal implications of a French ecological study].
abstract: OBJECTIVE
  For a long time, the benefit of a caesarean delivery in the prevention of cerebral palsy (CP) has been put forward, which was based on the assumption that CP is due to asphyxia in more than 50 % of the cases. However, from register-based data, this rate has been estimated less than 4 %. The aim of this study was to evaluate whether the rate of caesarean sections for fetal indication was correlated with the prevalence rate of CP in a French county.
  
  
  METHODS
  This was an ecological study of register-based prevalence estimates of children with CP (postnatal cases excluded) born between 1997 and 2003 in a French county compared with the rates of caesarean section for fetal distress obtained from the maternal and infant protection service of the county.
  
  
  RESULTS
  Whilst the rate of caesarean section for fetal indication increased by 44% during the period studied, the prevalence of CP remained nearly stable around 1.5 per 1000 live births. There was no correlation between caesarean section and CP prevalence (r'=-0.36, P=0.43).
  
  
  CONCLUSIONS
  The present study was in accordance with the results of a recent meta-analysis which concluded that emergency and prophylactic caesarean deliveries were not efficient in the prevention of CP. Indication of caesarean delivery for foetal heart rhythm anomaly, which is the most relevant cause for the growing rate of caesarean sections, should be justified by additional examinations in ambivalent cases, in order not to consider it as defensive medicine, which is ethically and therefore juridically blameworthy.
authors.affiliation: Registre des handicaps de l'enfant et observatoire périnatal (RHEOP), 23, avenue Albert-1(er)-de-Belgique, 38000 Grenoble, France; Commission d'expertise du CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France. Electronic address: claude.racinet@orange.fr.
authors.forename: C
authors.initials: C
authors.lastname: Racinet
authors.affiliation: Registre des handicaps de l'enfant et observatoire périnatal (RHEOP), 23, avenue Albert-1(er)-de-Belgique, 38000 Grenoble, France.
authors.forename: C
authors.initials: C
authors.lastname: Tronc
authors.affiliation: Grenoble 1/CNRS/TIMC-IMAG UMR 5525, 38041 Grenoble cedex, France; Pôle santé publique, CHU de Grenoble, 38043 Grenoble cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Sellier
authors.affiliation: Registre des handicaps de l'enfant et observatoire périnatal (RHEOP), 23, avenue Albert-1(er)-de-Belgique, 38000 Grenoble, France; Grenoble 1/CNRS/TIMC-IMAG UMR 5525, 38041 Grenoble cedex, France; Pôle santé publique, CHU de Grenoble, 38043 Grenoble cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Cans
authors.affiliation: Registre des handicaps de l'enfant et observatoire périnatal (RHEOP), 23, avenue Albert-1(er)-de-Belgique, 38000 Grenoble, France.
authors.forename: M E
authors.initials: ME
authors.lastname: van Bakel
mesh_terms: D002547:Cerebral Palsy / Q000453:epidemiology* / Q000517:prevention & control*; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007223:Infant; D011247:Pregnancy; D012042:Registries
keywords: Abnormal foetal heart rate; Anomalies du rythme cardiaque fœtal; Asphyxie fœtale aiguë perpartum; Caesarean section; Cerebral palsy; Césarienne; Defensive medicine; Intrapartum foetal asphyxia; Médecine défensive; Paralysie cérébrale; Prevention; Prévention