A Prospective Longitudinal Study of the Relationship Between Obstetrical Factors and CNS Damage

Abstract

Obstetricians do their best to prevent adverse effects of the complications of pregnancy and delivery on the fetus and newborn. Nevertheless the incidence of cerebral palsy is about two per thousand, and more than half the cases are of perinatal origin (Woods, 1976). If the concept of a “continuum of reproductive casualty” (Lilienfeld and Pasamanick, 1955) is true, then lowering perinatal mortality may well lead to a rise in the number of children with brain damage. Some doubts are now arising with respect to this concept, based on the observation that infants can develop normally after an extremely complicated perinatal period, such as preterm birth with severe asphyxia, provided adequate neonatal care was given. In fact one of the greatest feats of medicine in recent decennia has been the steadily rising prospects for low birthweight babies (Davies, 1976). However, it is not at all clear why some children acquire permanent and severe cerebral damage after relatively minor perinatal complications, whereas others emerge unharmed from a seemingly disastrous pre-, peri-, and postnatal period.