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Placental pathology in cases of neurologically impaired infants

Author
Raymond W Redline, MD
Section Editor
Susan M Ramin, MD
Deputy Editor
Vanessa A Barss, MD, FACOG

INTRODUCTION

Cerebral palsy (CP) and related causes of long-term neurologic impairment occur in approximately 2.0 to 2.5 per 1000 births [1-3]. Over 50 percent of affected children were born at term (37 weeks of gestation or more), 25 to 40 percent were delivered prior to 32 weeks of gestation, and the remainder were born between 32 and 37 weeks of gestation.

In population-based studies, risk factors for delivery of a neurologically impaired child include maternal infection, placental infection (acute chorioamnionitis), intrauterine growth restriction, and a family history of CP or related neurologic disorders. Immaturity and malformations of the central nervous system (CNS) are common causes of neurologic impairment among children delivered preterm. By comparison, few neurologically impaired children born at term have a clearly identifiable etiologic factor. Causes include perinatal stroke, an inborn error of metabolism (eg, mitochondrial disorders), CNS infection, congenital hypothyroidism, and exposure to an exogenous (eg, mercury) or endogenous (eg, bilirubin) toxin.

The contribution of intrapartum hypoxia to neural injury in term infants is controversial. In the United States and other developed countries the large number of medical liability claims against physicians who delivered neurologically impaired children has led to a crisis that threatens the availability of obstetrical care [4].

Epidemiologic studies suggest that intrapartum hypoxia is a direct cause of only about 9 percent of cases of CP [5,6]. Other evidence suggests that most CNS injury occurs in the intrapartum period [7]. The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics have proposed essential criteria needed to define that an acute intrapartum event was sufficient to cause cerebral palsy, as well as the collective criteria that suggest intrapartum timing [8].

Placental pathology can identify clinically silent, pathophysiologic processes that can directly cause CNS damage, decrease the threshold for neurological injury, or serve as markers for a deleterious in utero environment. Placental lesions associated with neurodisability have been found in the placentas of infants at all birth weights, but are most helpful for understanding unanticipated poor outcomes in term infants. This topic will review the association of findings on placental examination and adverse neurologic outcome in very low birth weight infants, followed by a more detailed consideration of the categories and specific placental findings found in the placentas of term infants with long-term neurologic impairment.

                              

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Literature review current through: Nov 2016. | This topic last updated: Wed May 13 00:00:00 GMT 2015.
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