DEFINITION. A group of chronic disorders impairing control of movement that appear in the first few years of life and generally do not worsen over time.. Epidemiology . Incidence : 2 per 1000 live births.90% cases : No intrapartum cause found.Remaining 10% cases: Hypoxia may have had antena
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1. OBSTETRICIANS AND CEREBRAL PALSY BY
DR.MAMTA RATH DATTA
Tata Main Hospital,
2. DEFINITION A group of chronic disorders impairing control of
movement that appear in the first few years of life and
generally do not worsen over time.
3. Epidemiology Incidence : 2 per 1000 live births.
90% cases : No intrapartum cause found.
Remaining 10% cases: Hypoxia may have had antenatal/intrapartum origins.
4. ETIOLOGY Congenital : 85%
Acquired : 15%
Genetic : small % age
5. PRENATAL FACTORS Maternal pathology :
6. Contd. FETAL CONDITIONS
- arterial occlusion in utero
- blood dyscrasias
7. Contd. PLACENTAL & CORD ABNORMALITIEs
chronic placental insufficiency
true knots/tight cord around neck
8. Perinatal factors Prematurity/LBW
Neryous system malformations.
9. POSTNATAL FACTORS CNS infections
Late onset/mistreated hydrocephalous
10. TYPES OF LESIONS
11. CLASSIFICATION BY GEOGRAPHIC INVOLVEMENT
Quadriplegia: basal nuclei,brain stem,cortical lesions.
Diplegia: periventricular (commonest)
12. CLASSIFICATION(Contd.) By physiologic type:
ATHETIOD: Basal ganglion
13. Problems in defining the cause & timing of neuropathology of CP. CP not diagnosed until mths./yrs. after birth.
Signs of fetal compromise neither sensitive nor specific to a cause/timing of the cause.
Proven metabolic acidemia can be due to a chronic/acute hypoxic event.
14. CRITERIA TO DEFINE ACUTE INTRAPARTUM HYPOXIC EVENT Essential criteria :
Intrapartum umbilical arterial cord blood pH < 7 and base deficit = > 12 mmol/ l.
Early onset severe or mod. neonatal encephalopathy in infants >34 wks.
Spastic quadriplegic or dyskinetic CP
Non specific additional criteria:
Sentinel hypoxic event occuring just before or during labour.
Sudden deterioration of FHR following the above event
AS 0-6 > 5 mins.
Early evidence of multisystem involvement
Early imaging evidence of acute cerebral abnormality
16. Predicting CP in Neonatal Nursery Term babies: Clinical staging by Sarnat(76) .
Preterm babies:(Lacey et al,97)
Asymmetrical neck reflex.
Stereotypical repetive movements.
17. DIAGNOSIS Test motor skills
Check infants medical history
Rule out other disorders causing movement problems
18. INVESTIGATIONS CT Scan
MRI / Magnetic resonance spectroscopy
19. PATHOPHYSIOLOGY Dec. C.B.F. hypoxia / ischemia of brain
Opening of calcium channels
Inc. in lactate due to anaerobic glycolysis
Dec high energy phosphates
Redistibution of CO,inc. CBF at the cost of autoregulation leads to cerebral edema
Inc. glutamate conc. causes rapid and delayed cell death by osmotic lysis & free radical activation
21. Management Preventive mgt.
Excitatory amino acid inhibitors.
Conventional therapy for CP.
22. Malpractice Claims
Is cerebral palsy preventable?
23. MALPRACTICE CLAIMS Find out , if possible, the reasons behind the decision for claim
Offer to meet parents and to go thru clinical history
Evaluate the childs current condition
Study neonatal records
Review obst. care
Large majority of pathologies are multifactorial & mostly unpreventable reasons during fetal development and neonatal period.