Info about cerebral palsyThread
May 27, 2011 03:45 PM
I searched your site for research about cerebral palsy. Recent news reports of a $58 million judgment against a doctor who delivered a baby ultimately diagnosed with cerebral palsy. What does the research say about the timing of the insult to the brain? In other words, does the research make it clear how to determine who is "at fault". I am a midwife and I attended a birth many years ago that was totally uncomplicated except for a long pushing phase of 4 hours. Fetal heart tones were never a concern, the lowest one being 100 at the crowning of the head. I always wondered if I missed something. It seems to me that the anoxia could've happened in the antepartum, intrapartum or postpartum period, and we don't really have any good methods of diagnosing this. Thanks in advance. Joyce
May 31, 2011 11:08 PM
You are correct. The current wisdom is that most cases of cerebral palsy have origins other than intrapartum events, although it is certainly also possible that the normal stress of labor or the excessive stress of induced or augmented labor could overwhelm a compromised baby's ability to compensate. Research obstetricians have been trying to come up with a set of symptoms indicative of intrapartum hypoxia so as to identify those cases of neurologic injury that can be attributed to labor events. Leaving aside acute events such as uterine scar rupture, tetanic contractions, or umbilical cord prolapse, this isn't as easy as you would think. Neonatal seizure, for example, can be precipitated by overheating due to maternal fever, hyponatremia (low blood sodium) from too much IV fluid with insufficient salt, infection, congenital abnormality, etc. Other symptoms such as abnormal fetal heart rate or low blood pH at birth have very low predictive value for long-term outcome. In fact, those symptoms may represent a healthy compensation mechanism, and the absence of response may be more ominous. The fascinating thing to me is that in the U.S., at least, obstetricians are furiously back pedaling from the idea that continuous EFM allows intervention in time to prevent cerebral palsy but not back pedaling from using it.
All Times America/New_York
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