Cerebral Palsy and Difficult Birth. A Scoping Review

Abstract

BACKGROUND: Despite evidence on the prenatal pathogenesis of Cerebral Palsy (CP), there are many instances where obstetricians face litigation for malpractice. OBJECTIVE: A scoping review of research on the association of CP with “difficult” delivery in term neonates. DESIGN: For the purposes of this review an internet search was performed using credible electronic databases. RESULTS: There are more than 32,500 citations under the keyword cerebral palsy, the majority of which, focus on diagnosis and treatment. Only 451 citations were included in the final review, associated with perinatal asphyxia, birth trauma, difficult delivery and obstetric litigations. Additionally, 139 medical books from various specialties were included in the research. DISCUSSION: The sequence of events is hereby presented, through which the original connection between CP and delivery, has gradually been cut off. Meanwhile, all contributing factors of difficult delivery are evaluated. Persistent abnormal fetal attitude seems to be strongly connected to the difficult birth in affected term neonates. Vaginal delivery is accomplished only after sufficient passive flexion of the fetal head, achieved by additional expulsive efforts by both the mother and the assisting personnel. This additional force is perceived by the parents to be as the principal etiology of CP in their infant. In the past decades, there has been increasing evidence pertaining fetal perceptual abilities and cognitive functions. CONCLUSIONS: Difficult birth may be the first, amongst the early manifestations of neonatal encephalopathy.