General Obstetrics and Gynecology: ObstetricsSevere fetal placental vascular lesions in term infants with neurologic impairment
Section snippets
Patients
A medicolegal case registry was used to identify 125 index cases with neonatal encephalopathy (NE), CP, or other well-documented related forms of long-term neurologic impairment after singleton birth at ≥36 weeks gestation. Cases from 32 states were entered into the registry without patient identifiers and represent, with 1 exception, births that occurred after 1990. Approximately 80% of cases were reviewed at the request of defense attorneys and 20% for plaintiffs. Infants with major
Results
Mean maternal age, mean infant birth weight for gestational age (Z-score), and the proportion of infants who were male were similar in the 125 index cases with neurologic impairment and the 250 children in the comparison group (Table I). Gestational age at delivery was slightly but significantly higher (39.5 ± 1.6 weeks vs 39.1 ± 1.4 weeks) in the index cases, in part because of a higher proportion of mothers delivering after 42 weeks (8% vs 4% in comparison group). Index cases were born more
Comment
The primary finding of this study is that more than one half of placentas from children referred for medicolegal consultation to evaluate possible causes of neurologic impairment had severe fetal vascular lesions. This represents a >5-fold increase compared with term placentas that were sent for pathologic evaluation in a university hospital setting. The similar prevalence in cases with or without NE and the lack of variation with respect to umbilical artery pH values and 5-minute Apgar scores
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