Yes. In many cases, cerebral palsy is preventable. Cerebral palsy is a group of disorders that causes problems with balance and movement, and it can be caused by an injury to the developing brain during or near the time of birth. Often, the injury is caused by oxygen deprivation in the baby’s brain during labor and delivery, an improperly managed infection in the mother that spreads to the baby during or after birth, or untreated low blood sugar or high bilirubin levels (jaudice) after birth.
Conditions That Cause Cerebral Palsy
Listed below are conditions that, if mismanaged, can cause cerebral palsy. First, we will discuss conditions that cause a baby to be oxygen deprived. In the womb, the baby doesn’t receive oxygen from breathing (although babies do practice-breathe). Oxygen-rich blood travels from the mother’s uterus to the placenta, and then through the umbilical cord to the baby (for more information on this pathway, click here). Problems with the uterus, placenta, and umbilical cord, bleeding in the baby’s brain, and oxygenation and blood flow problems in the mother can all cause the baby’s brain to be deprived of oxygen, which can in turn cause cerebral palsy.
When the conditions listed below occur, injury often happens to the baby because the physicians and staff fail to recognize signs in the mother, or fail to properly monitor the baby’s heart rate. Oxygen deprivation in the baby is reflected in the fetal heart rate, which is why it is so important to have clinicians skilled in fetal heart tracing interpretation present during labor and delivery. The final factors contributing to brain damage in the baby are often 1.) the clinicians failing to monitor for or recognize signs of fetal distress, which are indications that a baby is being deprived of oxygen, and 2.) failure to quickly perform a C-section once a baby is in distress.
Hypoxic-ischemic encephalopathey (HIE). HIE is brain injury that occurs due to a lack of oxygen-rich blood in the brain, either caused by restricted blood flow in the brain or decreased oxygen supply going to the baby. Most of the conditions below can cause HIE and resultant cerebral palsy.
Uterine rupture. This occurs when the uterus tears open, potentially causing the unborn baby to leave the womb and enter the mother’s abdomen. When the uterus tears, the mother may lose so much blood that the baby is deprived of oxygen-rich blood. In addition, the rupture can cause the placenta and cord to be partially or fully cut off from the mother’s circulation, which also deprives the baby of oxygen.
There are several conditions that put a mother at risk of having uterine rupture; one especially important risk factor is when the mother has had a vaginal birth after C-section (VBAC).
Placental abruption. This occurs when the placenta separates from the uterus. This can cause bleeding in the mother and a decreased supply of oxygen-rich blood to the baby. It also can cause the placenta (and umbilical cord) to be cut off from the mother’s blood supply, either partially or completely. This can cause a little or a lot of oxygen deprivation in the baby.
Placenta previa. This is when the placenta grows close to the opening of the birth canal (cervical os) and either partially or completely covers it. If placenta previa is present near the time of delivery, delivery by C-section is generally required because uterine contractions and vaginal delivery in this situation can cause sudden and profuse bleeding (hemorrhaging) in the mother and even in the baby. It has long been recognized that placenta previa may cause life-threatening hemorrhage in less than fifteen minutes.
Intracranial hemorrhages (brain bleeds). Intracranial hemorrhages can occur due to HIE, or when there is trauma to the baby’s head. Traumatic injuries can happen as a result of compression (such as in cephalopelvic disproportion, when the baby’s head is to large to fit through the mother’s pelvis) and traction (when the baby gets stuck in the birth canal, requiring pulling) during delivery. Trauma also can occur during delivery when instruments such as forceps and vacuum extractors are used. These instruments put the baby at high risk of having a brain bleed. Mismanaging an abnormal birth position (such as face or breech presentation) also can cause brain trauma and bleeds. If improperly managed, intracranial hemorrhages may lead to hydrocephalus.
Hydrocephalus (fluid in the brain). This is swelling of the brain’s ventricles, which causes other areas of swelling in the brain. Once hydrocephalus occurs, many vessels in the brain are already functioning abnormally, which causes even more vessels to become dysfunctional. This can cause oxygen deprivation in the brain, which can then cause cerebral palsy.
Use of Pitocin/Oxytocin or Cytotec. These are drugs that physicians give mothers to speed up labor. Sometimes contractions can get too frequent and strong (hyperstimulation), and this causes continuous pressure on the placenta’s blood vessels, which can deprive the baby of oxygen-rich blood. Hyperstimulation also can cause excessive pressure on the baby’s head, which can cause brain trauma and bleeding.
Macrosomia (large baby) and Cephalopelvic disproportion. When a baby is large (macrosomia) or has a large head (cephalopelvic disproportion), there is a greater chance of traumatic delivery, which can include forceps and vacuum extractor use. In addition, prolonged labor may occur in cases of macrosomia and cephalopelvic disproportion, which also increases the chance of trauma and oxygen deprivation. If a mother has gestational diabetes, she has an increased chance of having a macrosomic baby.
Post-term pregnancy. When a baby is in the womb for too long, postmaturity syndrome may occur, which is when the uterus and placenta become insufficient due to the deterioration of the placenta. The placenta starts to gradually deteriorate after week 37, and then may not be able to supply adequate oxygen-rich blood to the baby.
Oligohydramnios. This is a condition of low amniotic fluid in the womb. The baby breathes and swallows amniotic fluid to aid in lung maturation and growth. When amniotic fluid is too low, the baby’s lungs may not sufficiently mature, which can cause respiratory distress as soon as the baby is born, which can lead to the baby being oxygen deprived. In addition, oligohydramnnios can cause cord compression and other dangerous pregnancy complications.
Umbilical cord problems. The umbilical cord is the baby’s lifeline; it carries oxygen-rich blood from the placenta to the baby. A prolapsed umbilical cord is when the cord exits the birth canal in front of the baby and gets impinged upon by the baby’s body and the birth canal. A nuchal cord is when the cord gets wrapped around baby’s neck, which hinders blood flow in multiple ways. These cord problems can cause the baby to be severely deprived of oxygen.
Prolonged and arrested labor. When labor is prolonged or stalled, a baby can become very distressed due to a lack of oxygen. Prolonged labor might lead the physician to use Pitocin or Cytotec to speed up the delivery, which can cause oxygen deprivation and trauma. Forceps and vacuum extractors also often are used during prolonged labor, and these instruments can cause brain bleeds. In addition, the forces of repeated contractions of labor can cause a lot of physical stress to the baby, which may result in further trauma and decreased oxygen.
Preeclampsia. When a mother has this condition, she has high blood pressure (hypertension). This can be the result of – or it can lead to – constriction of and damage to the vessels in the placenta that supply oxygen-rich blood to the baby through the umbilical cord. This decreased blood flow to the baby can cause the baby to be oxygen deprived.
Infections in the mother, such as chorioamnionitis and villitis, Group B Strep (GBS), a urinary tract infection (UTI), bacterial vaginosis (BV) and herpes simplex virus (HSV). These infections can all can cause premature birth or premature rupture of the membranes (PROM). When premature birth and PROM occur, the baby may have underdeveloped lungs, which can cause the baby to be oxygen deprived after birth due to respiratory distress. These babies also may have apnea of prematurity or anemia of prematurity, which also can lead to oxygen deprivation. Furthermore, many of these infections can travel to the baby’s brain during delivery – especially when PROM occurs – and cause meningitis and cerebral palsy.
PROM. This condition can be caused by chorioamnionitis or it can cause chorioamnionits, which is very dangerous for the baby. Chorioamnionitis can cause a blood infection (sepsis) that can lead to a brain infection (meningitis) and brain damage. In addition, PROM can cause premature birth, respiratory distress, oxygenation problems and HIE, as well as overventilation injuries caused by the baby being placed on a breathing machine. All of these complications can result in cerebral palsy.
Meconium aspiration. This is when the baby inhales meconium while in the womb. Meconium is amniotic fluid mixed with the baby’s first stool. When a baby is in distress in the womb, especially if the distress is prolonged, this can cause the baby to have a bowel movement. When the baby inhales meconium, this can cause major respiratory (breathing) problems in the baby as soon as they are born, which can cause oxygen deprivation and cerebral palsy. Sometimes the respiratory problems are so severe at birth that the baby can’t breathe independently and has to be resuscitated.
Jaundice (elevated bilirubin) and kernicterus. If high bilirubin (a byproduct of red blood cells) is not properly treated, it can build up in the baby’s blood, enter the brain tissue, and cause a form of brain damage called kernicterus, which can in turn cause cerebral palsy.
Neonatal hypoglycemia (low blood sugar). Hypoglycemia is one of the most common metabolic problems in newborns. This condition is very easy to discover and it also can be easily treated, in most cases. If undiagnosed and untreated, however, hypoglycemia can case severe brain damage and cerebral palsy. The reason it can cause brain injury is that glucose (blood sugar) is the major component of energy in the brain. If the brain receives inadequate glucose, brain cells and tissue start to die.
Seizures. Seizures are caused by uncontrolled electrical activity in the brain due to brain damage, such as brain nerve damage or problems with the brain’s chemistry. Seizures can damage the brain, and the longer a seizure lasts, or the more frequently the seizures occur, the worse the brain damage and resultant cerebral palsy.
Trusted Michigan Cerebral Palsy Lawyers
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- Nelson KB. The epidemiology of cerebral palsy in term infants. Ment Retard Dev Disabil Res Rev 2002; 8:146.