Rc. Goodlin, DO CONCEPTS OF CAUSES AND PREVENTION OF CEREBRAL-PALSY REQUIRE REVISION, American journal of obstetrics and gynecology, 172(6), 1995, pp. 1830-1836
OBJECTIVE: My purpose was to explore the criteria of The American Coll
ege of Obstetricians and Gynecologists (Technical Bulletin No. 163) fo
r perinatal asphyxia to be linked to subsequent cerebral palsy. STUDY
DESIGN: Analysis of four cases of intrapartum fetal insults with subse
quent cerebral palsy and a literature review are presented. RESULTS: A
ll of the four cerebral palsy cases had sufficient intrapartum causes
of cerebral palsy, yet none fulfilled The American College of Obstetri
cians and Gynecologists' linkage criteria. Complications in the cerebr
al palsy cases were as follows: maternal intrapartum cardiac arrest, f
etal skull fracture with brain infarct, intrapartum fetal stroke, and
a newborn delivered after uterine rupture with only central nervous sy
stem defects. There are no well-done laboratory or clinical studies th
at unequivocally support the ''criteria'' that umbilical artery pH mus
t be <7.00 or the requirements of Apgar score <3, hypoxic-ischemic enc
ephalopathy, and multiple organ dysfunction. Apparent exceptions to th
ese criteria occur. CONCLUSIONS: The American College of Obstetricians
and Gynecologists Technical Bulletin's criteria for cerebral palsy li
nkage and the role of parturition in cerebral palsy should be reevalua
ted. A rebirth of obstetric enthusiasm for cerebral palsy research, te
aching, and treatment needs to occur.