More About Cerebral Palsy

Factors or Complications in Pregnant Mother During Pregnancy

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• Exposure to toxins, radiation: can cause brain to develop abnormally - Brain malformations (cerebral dysgenesis).
• Crack and cocaine use: can cause damage to the central nervous system, the brain and other organs, blood vessel, as well as causing premature birth and low birth weight. Use during pregnancy can result in cerebral palsy, autism and other impairments
• Alcohol use: Can cause microcephaly (a smaller head circumference than normal which is associated with poor brain function), facial malformations, mental retardation and cerebral palsy. An estimated 8% of children with fetal alcohol syndrome will later develop cerebral palsy.
• Cigarette smoking: can result in a lower birth weight, one of the primary risks for cerebral palsy.
• Environmental toxins: these may be difficult to identify, yet can effect fetal development. For example, an epidemic of cerebral palsy occurred between 1953 and 1971 in Minamata Bay, Japan, due to pregnant women eating fish contaminated with methyl mercury. (Miller & Bachrach)
• Multiple child pregnancy: Can result in premature birth and/or low birth weight, which increases a child’s risk for CP. If the child is one of a twin, and especially if the other twin had died, the surviving twin has an increased chance of developing cerebral palsy.
• If child is a 1st born or 5th born:
• Vaginal bleeding during the third trimester: Placental abruption, a condition is where the placental lining separates from the mother’s uterus after 20 weeks of pregnancy and prior to birth, is the most common cause of bleeding during late pregnancy. In some cases where the abruption is high up in the uterus, or is slight, there is no bleeding, though extreme pain is felt and reported. If not treated, the blood loss can lead to shock. The consequences for the infant include: premature birth, difficulties with breathing and feeding, low blood pressure or low blood count, decreased oxygen and nutrients. Sometimes, decreased oxygen to the brain leads to later neurological or behavioral problems.
  (Question: Is it medical malpractice if the doctor does not properly diagnose placental abruption – perhaps ignores the woman’s complaints of extreme pain with little or no bleeding - and the baby develops cerebral palsy?)
• Rupture of Uterus during Pregnancy: Causes of uterine rupture include: a certain type of previous cesarean section, uterine surgery to remove uterine fibroids, abdominal trauma, or external cephalic version (physical manipulation to reposition fetus to a head down position). A previous cesarean section is the most common cause for uterine rupture and an external cephalic version is the least common cause.

Uterine rupture occurs in less than 1% of women with a low transverse cesarean section scar, 2 to 4% of women who have had a low vertical scar and 4 to 8% of women who have had a previous classical cesarean incision (an incision that is up and down across the whole uterus). (*Note: The scar that is seen on the mother's abdomen does not necessarily reflect the type of scar that was made on the uterus.)
Uterine rupture can deprive the fetus of oxygen from the sudden disruption in blood flow. This oxygen deprivation can cause serious damage to the brain and other vital organs within only minutes.
(Question: Is it medical malpractice if the doctor does not adequately explain risks involved with having vaginal birth after C-section (VBAC), the mother’s uterus ruptures and the baby develops cerebral palsy?)

• High blood pressure: Maternal hypertension can increase the risk of fetal stroke. Fetal stroke suffered by babies in the womb due to placental blood clots and bleeding inside the brain due to a blockade of blood vessels (intracranial hemorrhage).
  Failure to recognize or treat high blood pressure in the mother = medical mistake.
• Pre-eclampsia: Pre-eclampsia is a condition that occurs in up to 10% of pregnant women, and develops sometime after the 6th month of pregnancy. It is characterized by high blood pressure, excessive fluid retention (edema) and protein in the urine (proteinuria). Approximately 1% of pregnant women will have severe pre-eclampsia which can result in vasospasm of the blood vessels of both the mother and the placenta. This means the blood vessels, which are delivering oxygen and other needed nutrients to the mother and baby, alternately clamp down and relax, causing damage to the interior lining of the blood vessels. As the body tries to repair the damaged vessels, clots may form at the site, resulting in more constriction and narrowing of the blood vessels. Continued vasospasm, along with the formation of these miniature blood clots, can reduce blood flow and oxygen supply to both the mother's vital organs and the placenta. (Question: Can this lead to fetal strokes? I’m assuming yes, since maternal hypertension increases the risk of fetal stroke.)Depending on the severity of this condition, the heart, kidney, liver and brain in the mother may be affected. If the blood supply to the placenta is interrupted, the baby cannot grow well. The disturbance in blood flow to the placenta also can result in a condition called placenta abruption. Placenta abruption is a medical emergency that places both the lives of the mother and fetus at risk. Most women who develop Pre-eclampsia deliver healthy babies. Since there is no way to prevent this complication of pregnancy, the most important thing that a pregnant woman can do to detect this disorder is to receive regular prenatal examinations

Proteinuria: refers to protein in the urine and usually goes along with elevated blood pressure and excessive fluid retention (edema) – i.e., pre-eclampsia. (***Actually, Proteineuria during pre-eclampsia is a poor predictor of fetal outcomes: http://esciencenews.com/articles/2009/03/24/proteinuria.during.pre.eclampsia.a.poor.predictor.complications)
Question: Is the failure to recognize or treat pre-eclampsia in the mother a medical mistake?

• Hyperthyroidism: About 1 in 500 women have hyperthyroidism (high levels of thyroid hormone) during pregnancy. Some of these women will have the condition before they become pregnant, and others will develop it during their pregnancy. Hyperthyroidism can be difficult to diagnose because some of the symptoms hyperthyroidism are similar to symptoms of pregnancy.

Mild to moderate hyperthyroidism will not cause problems for the majority of pregnant women and their babies. When properly treated, the pregnancy will progress normally. However, women with severe or uncontrolled hyperthyroidism have increased risks for: 1) infection, 2) iron deficiency (anemia), and 3) high blood pressure or pre-eclampsia, and 4) miscarriage and/or stillbirth. The baby is at risk for being premature or low birth weight. Also, if the mother has severe hyperthyroidism, the baby is likely to have it as well.
If thyroid storm develops (very fast heart rate, tremors, nervousness, altered consciousness, nausea, vomiting, diarrhea, and an extremely high fever), the affects can be life threatening.

• Rh factor or Blood Type Incompatibility: If the mother and baby have opposite blood types, the mother’s body produces antibodies which attack the baby’s blood cells and destroys their ability to process bilirubin resulting in liver overload and brain damage. Known as Rh disease, this can be prevented with an injection of Rh immune globulin given to the mother in her 28th week; another injection is given after the baby is born.
  While first pregnancies usually don’t pose a serious problem, subsequent pregnancies can. If Rh incompatibility is not detected or treated, the baby can develop severe jaundice. Approximately 50% of newborn babies develop jaundice ( a yellow discoloration of the skin resulting from a build up of bilirubin (bile pigment). Babies with severe jaundice have more of a brownish discoloration. Severe jaundice is treated with a blue light which breaks down the bilirubin; this is called photo therapy. If this treatment does not work, a special blood transfusion may be done.
  Severe jaundice left untreated can cause brain damage, which can cause cerebral palsy, particularly athetoid CP.

Failure to treat jaundice = medical mistake. For more on failure to treat jaundice and kernicterus, click here.

• Seizures:
• Mental retardation:
• Age of parent(s): the mother is over 40 years old or under 20, the father is under 20
• African-American ethnicity - cerebral palsy has a higher rate of incidence within the African-American community;
• Poor nutrition of pregnant women:

To continue on with the Causes of Cerebral Palsy, follow these links:

• Complications in the Fetus During Pregnancy; and
• Problems during Delivery.

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