Cerebral palsy and the birth process.

OBJECTIVE: To review the relationship between cerebral palsy and the birth process. DATA SOURCES: Medline and non-Medline literature search and personal experience. STUDY SELECTION: Articles that commented on the routinely used markers of foetal distress, such as abnormal foetal heart rate, meconium-stained liquor, and foetal acidosis. DATA EXTRACTION: Data were extracted and reviewed independently by both authors. DATA SYNTHESIS: The use of meconium alone as a predictor of cerebral palsy has a high false-positive rate of up to 99.6%. No specific foetal heart rate pattern that can accurately predict subsequent neurological impairment, and a low Apgar score is not by itself an indication of intrapartum asphyxia. The presence of encephalopathy in a neonate after birth and the association of multi-organ system dysfunction are important clues to the prior occurrence of foetal asphyxia. CONCLUSION: Cerebral palsy can be caused by asphyxia associated with the birth process. To be able to attribute cerebral palsy to peripartum asphyxia, there should be a sequence of signs during labour, delivery, and the perinatal period. Honest and sympathetic discussion between the obstetrician, paediatrician, and parents is critical throughout the counselling process.