Association between Cerebral Palsy (CP) and Vaginal Birth vs. ERCS
A commonly stated reason to perform either an elective Cesarean Section or Elective Repeat Cesarean (ERCS) is to avoid potential fetal brain injury or birth trauma from a delivery through the birth canal.

One of the most severe forms of brain injury, called Celebral Palsy (CP), was at one time thought to be most commonly associated with a vaginal delivery; however, a review of the most recent medical data demonstrates that the causes of CP are multi-factorial with fewer than 10% specifically associated with birth trauma.

Definition of Celebral Palsy (CP):
Celebral Palsy is an broad term which includes a group of permanent, non-progressive, non-contagious motor conditions that cause physical disability in human brain function, most commonly seen by defects in body movement and control. Cerebral refers to the cerebrum, which is the affected area of the brain (although the disorder most likely involves problems with the connection between the cortex and other parts of the brain such as the cerebellum), and Palsy which refers to a disorder of movement.

CP occurs in approximately 1/500 live births. There is no known cure for this condition and medical management is limited to the prevention and treatment of complications arising from the effects of CP.

Causes of Celebral Palsy:
CP is caused by damage to the motor control centers of the developing brain and can occur during pregnancy, during childbirth or after birth up to about age three. These effects cause problems in movement and posture cause activity and are often accompanied by disturbances of cognitive reasoning, speech and communication, sensation, depth perception, and other sight-based perceptual problems.

Approximately one third of children also suffer from epilepsy.

Possible causes of CP during pregnancy:
  • Infections such as Toxoplasmosis, Rubella, Cytomegallovirus (CMV), Herpes Simplex and Group B Strep
  • Genetic Defects
  • Exposure to Radiation
  • Maternal Malnutrition
  • Maternal use of prescription drugs and illegal drug use
  • Multiple Births
  • Placental abnormalities to include placental insufficiency and associated Intrauterine Growth Restriction (IUGR) and placental abruption
  • Premature Birth (40-50% of all CP cases)
  • Sustained umbilical cord compression or blood flow occlusion leading to significant oxygen reduction to the brain of the baby, either hypoxia or asphyxia (Less than 10% of all cases)
  • Uncontrolled Maternal Chronic Hypertension, Pre-eclampsia and Eclampsia
  • Uncontrolled Diabetes, Thyroid disease to include Hypothyroidism and Hyperthyroidism
Possible causes of CP during labor:
  • Sustained umbilical cord compression or blood flow occlusion leading to significant oxygen reduction to the brain of the baby, either hypoxia or asphyxia (Less than 10% of all cases)
  • Placenta Abruption
  • Placenta Previa
  • Shoulder Dystocia with associated Brachial Plexus injury
Possible causes of CP following labor:
  • Infections, such as encephalitis and meningitis
  • Ingestion of toxins, such as lead poisoning
  • Near asphyxiation, such as choking on foreign objects (toys and pieces of food) or near drowning
  • Physical brain injury, such as shaken baby syndrome
  • Severe jaundice
  • Untreated seizures and epilepsy

Based on the current data, neither an elective Cesarean Section nor an ERCS is recommended to specifically reduce the risk of CP. Further, there is no consensus of data that the risk of CP is increased by attempting a VBAC or that ERCS is significantly safer than VBAC in reducing the risk of CP.

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