Papers

Case-control study of intrapartum care, cerebral palsy, and perinatal death

National Perinatal Epidemiology Unit, Radcliffe Infirmary, Oxford OX2 6HE John Radcliffe Maternity Hospital, Oxford OX3 9DU Department of Neuropathology, Radcliffe Infirmary, Oxford OX2 6HE Correspondence to: Dr Johnson.

Abstract

Objective : To investigate the relation between suboptimal intrapartum obstetric care and cerebral palsy or death.
Design : Case-control study.
Setting : Oxford Regional Health Authority. Subjects - 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. Main outcome measures - 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.
Conclusion : 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.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Intrapartum care and cerebral palsy

E L G Beavis, A Johnson, and G Gaffney
BMJ 1994 309: 413. [Extract] [Full Text]

Cerebral palsy and neonatal encephalopathy

D Hall, G Gaffney, and A Johnson
BMJ 1994 308: 1507-1508. [Extract] [Full Text]

This article has been cited by other articles:

• Chan, S-Y, Franklyn, J A, Pemberton, H N, Bulmer, J N, Visser, T J, McCabe, C J, Kilby, M D (2006). Monocarboxylate transporter 8 expression in the human placenta: the effects of severe intrauterine growth restriction.. J Endocrinol 189: 465-471 [Abstract] [Full text]  
• Stelmach, T., Pisarev, H., Talvik, T. (2005). Ante- and Perinatal Factors for Cerebral Palsy: Case-Control Study in Estonia. J Child Neurol 20: 654-661 [Abstract]  
• Chan, S. Y, Andrews, M. H, Lingas, R., McCabe, C. J, Franklyn, J. A, Kilby, M. D, Matthews, S. G (2005). Maternal nutrient deprivation induces sex-specific changes in thyroid hormone receptor and deiodinase expression in the fetal guinea pig brain. J. Physiol. 566: 467-480 [Abstract] [Full text]  
• Greenwood, C, Yudkin, P, Sellers, S, Impey, L, Doyle, P (2005). Why is there a modifying effect of gestational age on risk factors for cerebral palsy?. Arch. Dis. Child. Fetal Neonatal Ed. 90: F141-F146 [Abstract] [Full text]  
• Wu, Y. W., Backstrand, K. H., Zhao, S., Fullerton, H. J., Johnston, S. C. (2004). Declining Diagnosis of Birth Asphyxia in California: 1991-2000. Pediatrics 114: 1584-1590 [Abstract] [Full text]  
• Cooley, W. C., and Committee on Children with Disabilities, (2004). Providing a Primary Care Medical Home for Children and Youth With Cerebral Palsy. Pediatrics 114: 1106-1113 [Abstract] [Full text]  
• Becher, J C, Bell, J E, Keeling, J W, McIntosh, N, Wyatt, B (2004). The Scottish perinatal neuropathology study: clinicopathological correlation in early neonatal deaths. Arch. Dis. Child. Fetal Neonatal Ed. 89: F399-F407 [Abstract] [Full text]  
• Stelmach, T., Kallas, E., Pisarev, H., Talvik, T. (2004). Antenatal Risk Factors Associated With Unfavorable Neurologic Status in Newborns and at 2 Years of Age. J Child Neurol 19: 116-122 [Abstract]  
• Chan, S., Kachilele, S., Hobbs, E., Bulmer, J. N., Boelaert, K., McCabe, C. J., Driver, P. M., Bradwell, A. R., Kester, M., Visser, T. J., Franklyn, J. A., Kilby, M. D. (2003). Placental Iodothyronine Deiodinase Expression in Normal and Growth-Restricted Human Pregnancies. J. Clin. Endocrinol. Metab. 88: 4488-4495 [Abstract] [Full text]  
• James, D. (2001). Caesarean section for fetal distress. BMJ 322: 1316-1317 [Full text]  
• Ellis, M., Manandhar, N., Manandhar, D. S, Costello, A. M d. L (2000). Risk factors for neonatal encephalopathy in Kathmandu, Nepal, a developing country: unmatched case-control study. BMJ 320: 1229-1236 [Abstract] [Full text]  
• Cleare, A. J., Sookdeo, S. S., Jones, J., O’Keane, V., Miell, J. P. (2000). Integrity of the Growth Hormone/Insulin-Like Growth Factor System Is Maintained in Patients with Chronic Fatigue Syndrome. J. Clin. Endocrinol. Metab. 85: 1433-1439 [Abstract] [Full text]  
• Gadian, D. G., Aicardi, J., Watkins, K. E., Porter, D. A., Mishkin, M., Vargha-Khadem, F. (2000). Developmental amnesia associated with early hypoxic-ischaemic injury. Brain 123: 499-507 [Abstract] [Full text]  
• Kavelaars, A., Kuis, W., Knook, L., Sinnema, G., Heijnen, C. J. (2000). Disturbed Neuroendocrine-Immune Interactions in Chronic Fatigue Syndrome. J. Clin. Endocrinol. Metab. 85: 692-696 [Abstract] [Full text]  
• Badawi, N., Kurinczuk, J. J, Keogh, J. M, Alessandri, L. M, O'Sullivan, F., Burton, P. R, Pemberton, P. J, Stanley, F. J (1998). Antepartum risk factors for newborn encephalopathy: the Western Australian case-control study. BMJ 317: 1549-1553 [Abstract] [Full text]  
• Kilby, M. D., Verhaeg, J., Gittoes, N., Somerset, D. A., Clark, P. M. S., Franklyn, J. A. (1998). Circulating Thyroid Hormone Concentrations and Placental Thyroid Hormone Receptor Expression in Normal Human Pregnancy and Pregnancy Complicated by Intrauterine Growth Restriction (IUGR). J. Clin. Endocrinol. Metab. 83: 2964-2971 [Abstract] [Full text]  
• Stewart, J. H, Andrews, J., Cartlidge, P. H T (1998). Numbers of deaths related to intrapartum asphyxia and timing of birth in all Wales perinatal survey, 1993-5. BMJ 316: 657-660 [Abstract] [Full text]  
• Hobbins, J. C., Tyson, W., Schifrin, B. S., Myers, S. A., Cohen, W. R., Gold, J. A., Nelson, K. B., Dambrosia, J., Grether, J. K., MacDonald, D. (1996). Electronic Fetal Monitoring in Predicting Cerebral Palsy. NEJM 335: 287-289 [Full text]  
• Petridou, E., Koussouri, M., Toupadaki, N., Papavassiliou, A., Youroukos, S., Katsarou, E., Trichopoulos, D. (1996). Risk Factors for Cerebral Palsy: A Case-Control Study in Greece. Scand J Public Health 24: 14-26 [Abstract]  
• Beavis, E L G, Johnson, A, Gaffney, G (1994). Intrapartum care and cerebral palsy. BMJ 309: 413-413 [Full text]  
• Hall, D, Gaffney, G, Johnson, A (1994). Cerebral palsy and neonatal encephalopathy. BMJ 308: 1507-1508 [Full text]