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It is estimated that some 10 to 20% of cerebral palsy originates during labour, 70% before the onset of labour, and 10% after birth. At best, therefore, fetal heart rate monitoring (FHRM) could influence 20% of cerebral palsy. Work in California has shown the probable influence to be much less (Karin B Nelson and colleagues, New England Journal of Medicine1996;334: 613-8). The FHRM records of 395 children were reviewed. All were singletons born at term weighing 2500 g or more and 95 had moderate or severe cerebral palsy at the age of 3. Multiple late decelerations were associated with a fourfold, and decreased beat-to-beat variability with a threefold, increase in risk of cerebral palsy. Despite that, only two in 1000 children showing the FHRM abnormalities developed cerebral palsy if they survived to age three. (These data give no information about fetal death, early neonatal death, or death before age 3.) Other evidence suggests that FHRM has not reduced rates of cerebral palsy and these authors argue that performing caesarean section because of these abnormalities on monitoring could potentially be responsible for an increase in maternal morbidity with no commensurate benefit to the fetus.
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