CASE-CONTROL STUDY OF INTRAPARTUM CARE, CEREBRAL-PALSY, AND PERINATALDEATH

Objective-To investigate the relation between suboptimal intrapartum o bstetric care and cerebral palsy or death. Design-Case-control study. Setting-Oxford Regional Health Authority. Subjects-141 babies who subs equently developed cerebral palsy and 62 who died intrapartum or neona tally, 1984-7. All subjects were born at term of singleton pregnancies and had no congenital anomaly. Two controls, matched for place and ti me of birth, were selected for each index case. Main outcome measures- Adverse antenatal factors and suboptimal intrapartum care (by using pr edefined criteria). Results-Failure to respond to signs of severe feta l 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 a djustment for increased incidence of a complicated obstetric history i n 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 r esponse to fetal distress, however, had evidence of neonatal encephalo pathy; these 23 formed 6.8% of all children with cerebral palsy born t o residents of the region in the four years studied. Conclusion-There is an association between quality of intrapartum care and death. The f indings also suggest an association between suboptimal care and cerebr al palsy, but this seems to have a role in only a small proportion of all cases of cerebral palsy. The contribution of adverse antenatal fac tors in the origin of cerebral palsy needs further study.