DO CONCEPTS OF CAUSES AND PREVENTION OF CEREBRAL-PALSY REQUIRE REVISION

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.