Problems During Delivery as an Etiology of Cerebral Palsy in Full-Term Infants

Abstract

Cerebral palsy (CP) is the most common neuromotor developmental disability in childhood. With advances in maternal and neonatal care, perinatal and neonatal mortality have decreased, but the overall prevalence of CP has remained stable. Sentinel events during the prepartum, intrapartum, and neonatal periods and their relationship to CP are complex and not completely understood. This chapter will present risk factors that occur specifically during the intrapartum period associated with but not necessarily causal of CP in full-term infants. Hypoxic events continue to be the most consistently implicated etiology but comprise only a small proportion – less than 10% – of cases of CP. Markers of fetal stress – abnormal fetal heart rate tracing and meconium-stained amniotic fluid – and subsequent low Apgar scores have been associated with CP. Direct damage to the fetal or neonatal brain through intracranial hemorrhage or stroke is also implicated as causes of CP. Complications surrounding labor associated with CP include uterine rupture, cord around the neck, prolonged labor, abnormal fetal presentation, multiple gestation, and chorioamnionitis. Placental compromise via abruption and infarction plays important and dynamic roles in the development of CP. Through identification of key risk factors that cause CP, emphasis can then shift toward their prevention and hopefully a decrease in the overall prevalence of CP.