背景:尽管有证据表明脑瘫(CP)的产前发病机制,在许多情况下,产科医生因渎职而面临诉讼。
目的:对足月新生儿CP与“难产”关系的研究进行范围综述。
方法:出于本综述的目的,使用可靠的电子数据库进行了互联网搜索。
结果:在关键词脑瘫下有超过32,500次引用,其中大部分,专注于诊断和治疗。最终审查中仅包含451条引文,与围产期窒息有关,出生创伤,分娩困难和产科诉讼。此外,研究中包括来自各个专业的139本医学书籍。
结论:特此介绍事件的顺序,CP和交付之间的原始连接,逐渐被切断。同时,评估所有导致分娩困难的因素。持续的胎儿态度异常似乎与受影响的足月新生儿的分娩困难密切相关。阴道分娩只有在胎儿头部充分被动弯曲后才能完成,通过母亲和援助人员的额外驱逐努力来实现。父母认为这种额外的力量是婴儿CP的主要病因。在过去的几十年里,越来越多的证据表明胎儿的感知能力和认知功能。
结论:分娩困难可能是第一个,在新生儿脑病的早期表现中。
BACKGROUND: Despite evidence on the prenatal pathogenesis of Cerebral Palsy (CP), there are many instances where obstetricians face litigation for malpractice.
OBJECTIVE: A scoping
review of research on the association of CP with \"difficult\" delivery in term neonates.
METHODS: For the purposes of this
review an internet search was performed using credible electronic databases.
RESULTS: There are more than 32,500 citations under the keyword cerebral palsy, the majority of which, focus on diagnosis and treatment. Only 451 citations were included in the final
review, associated with perinatal asphyxia, birth trauma, difficult delivery and obstetric litigations. Additionally, 139 medical books from various specialties were included in the research.
CONCLUSIONS: The sequence of events is hereby presented, through which the original connection between CP and delivery, has gradually been cut off. Meanwhile, all contributing factors of difficult delivery are evaluated. Persistent abnormal fetal attitude seems to be strongly connected to the difficult birth in affected term neonates. Vaginal delivery is accomplished only after sufficient passive flexion of the fetal head, achieved by additional expulsive efforts by both the mother and the assisting personnel. This additional force is perceived by the parents to be as the principal etiology of CP in their infant. In the past decades, there has been increasing evidence pertaining fetal perceptual abilities and cognitive functions.
CONCLUSIONS: Difficult birth may be the first, amongst the early manifestations of neonatal encephalopathy.