Intrapartum Complications Associated With Malformations of Cortical Development

Maria Augusta Montenegro, MD, PhD; Fernando Cendes, MD, PhD; Helena Saito, MD; Jéssica G. Serra, MD; Camila F. Lopes, MD; Ana Maria S. Piovesana, MD, PhD; Helaine Milanez, MD, PhD; Marilisa M. Guerreiro, MD, PhD

Disclosures

J Child Neurol. 2005;20(8):675-678. 

In This Article

Abstract and Introduction

Birth asphyxia can be an early sign of cerebral palsy, the effect of an antenatal anomaly rather than its cause. The objective of this study was to evaluate the occurrence of intrapartum complications in patients with malformation of cortical development. The data were retrospectively assessed and compared with a control group of children with idiopathic epilepsy. Intrapartum complications were reported in 22 (31.5%) patients, as opposed to only 2 in the control group (p < 0.001). Patients with cortical malformations frequently present intrapartum complications, which could lead to the misdiagnosis of hypoxic-ischemic encephalopathy.

It is not uncommon for a child with cerebral palsy thought to have been asphyxiated at birth to be found to have a brain malformation as the underlying cause of the developmental delay.[1] Although cerebral palsy is considered a potentially preventable neurologic morbidity, most cerebral palsy is not related to intrapartum asphyxia.[2,3,4,5,6,7] In fact, in 1897, Freud suggested that a difficult birth, in certain cases, is merely a symptom of deeper effects that influence the development of the fetus.[8]

Cortical development is a dynamic process and one or more stages can occur simultaneously.[9] Genetic predisposition and environmental factors play a role in the genesis of cortical malformations.[10] Although there is evidence that a small part of human cortical development can take place during the third trimester of pregnancy, as a general rule, most cortical organization is finished by approximately the twenty-fourth gestational week.[9,11] Therefore, malformations of cortical development can be easily differentiated from brain lesions caused by postnatal hypoxic-ischemic injury.

Three features are necessary to consider the intrapartum insult as the likely cause of brain injury: evidence of fetal distress, depression at birth, and a neonatal neurologic syndrome—depressed level of consciousness, ventilatory disturbance, hypotonia, and seizures—in the first hours and days of life.[12]

The objective of this study was to evaluate the occurrence of intrapartum complications in patients with malformations of cortical development.

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