Prognosis for twins with birth weight less than 1500 gm: the impact of cesarean section in relation to fetal presentation

Article Abstract:

The effect of cesarean section on incidence of infant death during childbirth, and incidence of cerebral palsy and mental retardation, was assessed in 862 individual twins weighing less than 1,500 grams (3.3 pounds) each at birth. In some twin pairs, one twin weighed more than this amount, and these heavier individuals were excluded from the study. The medical records of such twins born between 1973 and 1983 in Sweden were obtained. Information concerning twins with cerebral palsy or mental retardation born between 1973 and 1980 was obtained from questionnaires sent to rehabilitation centers and Boards of Education throughout Sweden. The rate of cesarean section increased from 7.7 percent between 1973 and 1976, to 40.5 percent between 1977 and 1980, and to 68.9 percent between 1981 and 1983. Infant deaths during and after childbirth decreased from 51.7 percent to 29.1 percent, and this decrease primarily affected the second-born twin. The risk of death during and after childbirth did not increase for first- and second-born twins delivered vaginally, either in the normal head-first position or the breech position. The incidence of cerebral palsy and/or mental retardation was 8.8 percent between 1973 and 1976 and 8.0 percent between 1977 and 1980. Even though neonatal mortality decreased while the rate of cesarean deliveries rose, it cannot be concluded that these two trends were linked, since there are many other influential factors. Thus, use of cesarean section did not have any significant effect on the mortality or risk of mental retardation or cerebral palsy in twins with birth weights less than 1,500 grams, even when the position of the fetus at birth was considered. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Patient outcomes, Mortality, Mental retardation, Cesarean section, Twins, Fetal presentation

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Intrauterine growth and spastic cerebral palsy: association with birth weight for gestational age

Article Abstract:

Although the causes of spastic cerebral palsy have never been clearly identified, conventional thought has attributed the disorder to perinatal brain damage. However, evidence is accumulating that most cases of spastic cerebral palsy result from events which occur prior to birth. To determine whether abnormal intrauterine growth may be related to cerebral palsy, the cases of 171 children with cerebral palsy were reviewed and compared to normal growth curves for a normal population. It was hypothesized that, although retarded growth per se does not cause cerebral palsy, retarded growth may be one sign of a suboptimal intrauterine environment. In 134 cases with gestation of more than 33 weeks, there was a strong association between poor intrauterine growth and cerebral palsy. Accelerated growth was apparently unrelated. Only recently has ultrasonography been applied to estimating prenatal weights of full term fetuses, and it is possible that normal weights have been systematically underestimated. The association between retarded intrauterine growth and cerebral palsy may actually be stronger than indicated. The absence of an association between cerebral palsy and growth retardation in infants born earlier than 34 weeks may be due to the fact that the combination of preterm delivery and growth retardation may influence neonatal mortality, and such infants were not adequately represented in the study population. (Consumer Summary produced by Reliance Medical Information, Inc.)

Fetus, Physiological aspects, Infants (Premature), Premature infants, Fetal growth retardation

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Appropriateness of intrapartum fetal heart rate management and risk of cerebral palsy

Article Abstract:

Cerebral palsy is characterized by paralysis on both sides of the body and is thought to be the result of abnormalities in brain development or a birth-related injury. However, studies in the US and Australia have shown that most cases of cerebral palsy are not associated with events during childbirth. The development of electronic fetal monitoring, an automated procedure for evaluating the condition of the fetus, has not reduced the incidence of cerebral palsy. Furthermore, inadequate obstetric care or delayed treatment of birth asphyxia, the insufficient intake of oxygen of the infant at birth, has not been correlated with an increased incidence of cerebral palsy either. Despite this evidence, it has been suggested that inadequate treatment of abnormal fetal heart rate patterns during the birth interval may contribute to the development of cerebral palsy. Therefore, the incidence of inadequate treatment of abnormal fetal heart rate patterns was assessed in 49 infants who developed cerebral palsy at one year of age, and in 49 infants without cerebral palsy. The results showed that the incidence of mismanagement of fetal heart rate patterns during childbirth was similar in both groups. These findings are consistent with previous studies that indicate that cerebral palsy is not associated with events during the birth. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Childbirth, Delivery (Childbirth), Fetal heart rate

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