Statement on Cerebral Palsy, Birth Overlooked.

SAN FRANCISCO -- An international consensus statement that attempts to bring some clarity to the relationship between intrapartum events and cerebral palsy has not received the attention it deserves in the United States, Dr. Julian T. Parer said.

The consensus statement was published in the prestigious British Medical Journal in 1999, but papers published outside of the United States are poorly read in this country. "Many of you will be hearing this for the first time," he said at a meeting on antepartum and intrapartum management sponsored by the University of California, San Francisco.

Fifteen medical associations from around the world--including the American College of Obstetricians and Gynecologists and the American Gynecological and Obstetrical Society--have endorsed the statement of the multidisciplinary consensus committee.

"The document is a remarkable reengineering of some of the aspects of intrapartum asphyxia as a cause of cerebral palsy (CP) that have not been looked at in such detail in the past," said Dr. Parer, professor and director of perinatal medicine and genetics at the university.

The consensus committee added some new elements to the criteria used to define an acute intrapartum hypoxic event that were not included in earlier criteria proposed by ACOG, for example. Criteria are divided into three "essential" criteria and eight "suggestive" ones.

The essential criteria start with what Dr. Parer called the standard for intrapartum hypoxia: evidence of metabolic acidosis in intrapartum fetal, umbilical arterial cord, or very early neonatal blood samples (a pH below 7 and a base deficit of 12 mmol/L or greater).

"These are very generous values," he commented. "The vast majority of babies with a pH of 7 and a base excess of negative 12 are not going to have any detectable abnormalities."