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Cerebral palsy is a condition characterized by an impairment of the body's ability to control
movement and posture. It results from faulty development of, or damage to the "motor" areas of
the brain, which are responsible for controlling movement. In some cases, cerebral palsy is
accompanied by other manifestations of brain injury,
such as seizures, intellectual impairment, behavioral problems, hearing deficits, or vision disorders.
The brain damage which causes cerebral palsyremains permanent from the time of injury. There
is no cure for cerebral palsy, and it is not contagious. |
Birth Trauma
Birth
trauma refers to injuries babies can have because of
doctor's mistakes. Babies can be seriously and permanently
injured when problems are not handled properly by doctors. There
are different types and causes of birth trauma. A discussion of
cerebral palsy and brachial plexus injuries is presented here.
The pregnancy, labor and
delivery, and newborn course mothers and babies can produce
problems which doctors and nurses must recognize and treat.
Problems with an unborn baby can result from lack of oxygen or
blood flow to their brain. This most frequently occurs during
labor and delivery when a fetus or unborn baby is undergoing
stress from the mother's contractions. Babies of mothers who are
diagnosed with high blood pressure, diabetes or other diseases
are especially at risk for problems to occur. It is essential
for doctors to thoroughly evaluate, monitor and diagnose
problems during the pregnancy. If not, babies may not receive
adequate oxygen over time in the womb.
Low Oxygen
Problems
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During the birthing process doctors and nurses have the
responsibility of making sure the baby does not suffer from lack
of oxygen.
Hypoxemia (which means decreased
oxygen in the blood) and ischemia (which means decreased flow of
blood) can combine to asphyxiate or suffocate the baby in the
womb. If a baby becomes asphyxiated, this can lead to the brain
becoming damaged. The injurious process is similar to a child
who has nearly drowned in water and suffers brain damage.
Doctors have developed electronic fetal monitors to provide
information about how a baby is tolerating labor.
The monitor information is
printed on a continuous strip of paper next to the laboring
mom's bed. It tells the labor and delivery team about the unborn
baby's heart rate as well as how the heart is responding to the
mother's contractions. When interpreted properly, the labor and
delivery team can determine when a baby is getting into trouble
from lack of oxygen. Doctors call this fetal distress.
The labor and delivery team must recognize changes on the fetal
monitor tracing which show the baby is suffering from lack of
oxygen and blood flow. They must promptly diagnose fetal
distress. Once they do, the delivery of the baby must be
promptly carried out by cesarean section. The cesarean section
removes the baby from a womb which is no longer healthy for the
baby; the baby is essentially suffocating in the womb. |
There are situations during pregnancy and the labor which can
suddenly effect a baby's oxygen level. Doctors and nurses must
promptly recognize and respond to the signs and symptoms of
obstetrical emergencies which can cause brain injuries to
babies. These include when the placenta
tears and separates from the uterine wall (placental abruption),
when the umbilical cord gets pinched if it slips out of the
birth canal (cord prolapse); when the uterus splits open
(uterine rupture), and sudden, prolonged decrease in the baby's
heart rate (fetal bradycardia). In each of these emergencies,
there is a dramatic decrease in oxygen and profusion of the
blood circulating to the baby's brain. The labor and delivery
team must rapidly deliver the baby in minutes by cesarean
section before irreversible brain damage sets in. Minutes and
seconds are critical in these types of obstetrical emergencies.
Delay is inexcusable when doctors and nurses discover any of
these complications.
If the baby has suffered from lack of oxygen in the womb, the
baby will be in a very stressed and depressed condition after
birth. The baby may require endotracheal intubation to help him
or her breath. They will probably be limp and floppy; they may
experience seizure activity, and require a stay in the neonatal
intensive care unit. The doctors will observe low Apgar scores
and the lab tests will show acidosis, which is a low pH. Often
the doctors will use ultrasound to look at the baby's brain,
this might be followed up with CT scans or MRIs. |
Days or weeks later the baby will be discharged home. The
pediatricians or neonatologists will advise the parents that
their child is at risk for developmental problems. The problems
may not be obvious until the child is one year of age or older.
Ultimately the pediatrician or pediatric neurologist will make
the diagnosis of cerebral palsy. Doctors might use the terms
hypoxic ischemic encephalopathy, quadriparesis or other medical
terms. Often the cerebral palsy could have been prevented had
the labor and delivery team properly observed, monitored and
acted promptly when the unborn baby demonstrated fetal distress.
Traumatic
Delivery and Vacuum
Extractors and Forceps
| Obstetricians use mechanical
instruments to assist in the delivery of babies.
There are two types of instruments used in America to assist
with deliveries - forceps and the vacuum extractors. Both of
them, when used properly, can help safely deliver babies.
Unfortunately, both of these powerful instruments can cause
trauma to a baby's head and brain. Doctors must be careful in
applying and pulling a baby's head with forceps and vacuum
extractors. If they are placed incorrectly, and if the doctor uses
too much pressure, pulls too hard or too often can all injure a
baby's brain. There are several different areas of the brain
that can be injured by forceps or vacuum extractors. |
The trauma
leads to bleeding within the brain. If the baby's brain has
bleeding inside of it, this can lead to the child developing
cerebral palsy. If one or both of these instruments are used,
the newborn may at first appear to be normal and healthy.
But
beginning shortly after delivery the newborn may begin to have
trouble breathing, turn blue, demonstrate seizure activity and
other abnormal neurological signs. These sick babies often will be
transferred to the neonatal or newborn intensive care unit where
imaging studies - ultrasound, CT scans, or MRIs - are used to
determine the area of the brain which is affected and to what
extent.
After discharge from the
hospital, the baby may not meet his milestones and demonstrate
physical and mental impairment. |
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