The sound of a fetal heart rate in the 80’s will inflate any OBGYN’s heart rate to the 200’s. Everyone's biggest fear is a tragic outcome for the infant, most especially cerebral palsy, a condition that can lead to lifelong disability. The medical establishment has created and tested many interventions to prevent cerebral palsy, yet the number of cases has been stable since the 1960s. A new review article about cerebral palsy in the December 2015 American Journal of Obstetrics and Gynecology highlights some interesting new insights on the causes of cerebral palsy and the interventions that haven't led to any real change in its incidence.
New advances in genomic sequencing are revealing endless mutations that may be the root causes of cerebral palsy. In fact, 14% of cerebral palsy cases likely have a causative single gene mutation and another 31% have newly discovered copy number variations. These new findings have broad reaching implications for our approach to diagnosing and treating cerebral palsy, giving hope to new advances in the future.
Interestingly, it also has implications for the medical malpractice landscape, which has long connected the complicated idea of “birth asphyxia” with cerebral palsy. However, only 13% of term infants who exhibit neonatal encephalopathy at birth are later diagnosed with cerebral palsy.
The new genetic findings highlight that numerous causative elements could actually underlie cerebral palsy- infection, vessel thrombosis, or altered fetal inflammatory response, which all could be predicated by an altered genetic landscape. For instance, IUGR is associated with up to a 30 fold increased risk of cerebral palsy at term.
Electronic fetal heart rate monitoring was introduced into clinical practice in the 1960s without any prior randomized controlled trials to prove its usefulness. Cochrane systematic reviews have since shown that RCTs of electronic fetal heart rate monitoring show no reduction in cerebral palsy rates and have very high false positive rates. In fact, since the 1960’s, we have seen a six-fold increase in c-section rates and no change in cerebral palsy rates. In England, one-fifth of spending on maternity services is funneled to insurance coverage for lawsuits.
These new advances in research on the root causes of cerebral palsy may influence this long-held belief that cerebral palsy is caused by birth trauma, and consequently, lead to new advances in diagnosis and treatment.