Cerebral Palsy is a devastating disease diagnosed in 1 per
326 children according to the Center for Disease Control & Prevention. Population-based studies from around the
world report prevalence estimates of CP ranging from 1.5 to more than 4 per
1,000 live births or children of a defined age range.
There are 17 million people worldwide whose lives have been affected by
cerebral palsy.
Cerebral palsy (CP) is the most common motor disability in
childhood and at present there is no cure for the disease.
Recent advances in regenerative and transplantation medicine
have experimented with transplantation of stem cells
in animals models , particularly umbilical cord blood cells
with mixed results. Two major clinical trials, placebos controlled, crossover
and observer blind are underway in US at Georgia
Regents University
and Duke University using umbilical cord blood
stem cells for transplantation. These
studies are currently recruiting participants.
Currently all studies are preliminary and It will take a
number of years for safe and effective therapies to make it to the clinic for
general public. Although some Unregulated European and Asian clinics are
offering the treatment but the possibilities for misinformation and
exploitation cannot be denied.
The birth of a baby with CP is often viewed as failing of
the obstetric and maternity services to manage labour causing an intrapartum
hypoxic insult. Over recent years it has been perceived that the cerebral palsy
has a multifactorial origin, and includes genetic, infective, nutritional, and
immune, as well as obstetric factors.
The obstetric causes are placental abruption, prolonged
PROM, chorioamnionitis, IUGR, pre-eclampsia, multiple births and placenta
praevia; however, only 10% of cases of CP in the developed world are caused by
cerebral hypoxia during birth. With this disclosure can the obstetric
profession breathe a collective sigh of relief?
A large population based cohort study by Strand et al
published in the forthcoming issue of BJOG:An International Journal of Obstetrics & Gynaecology has suggested that
placental dysfunction could be a major factor
involved in causal pathways leading to the more severe subtypes of CP.
Among a total of 533743 singleton liveborn children in Norway
during 1999–2008, 779 children were diagnosed with CP. Low placental weight was
found to be a risk factor for CP, as were low placental weight/birthweight
ratio and low placental weight/birth length ratio. The birth length ratio was
more important in causation, suggesting the occurrence of hypoxic insult early
in pregnancy.
In recent years, the placenta has not received much
importance when evaluating fetal wellbeing. A recent study in the journal
Placenta has associated abnormal placental morphometry with first-trimester
pregnancy-associated plasma protein–A (PAPP–A) levels in patients with
preeclampsia and IUGR, which themselves are associated with CP.
With the advancement in Ultrasound techniques, Doppler
measurement of the umbilical arteries and fetal microcirculatory changes over
the last three decades; it is possible to identify babies with decreased
placental function. The difficulty lies
in identifying the babies that require such intervention, a task that we still
undertake poorly maybe because of limited treatment capacity at present.
Placental volume can be measured accurately by MRI and can
be compared to fetal volume antenatally in suspected cases. Even basic
measurement of placenta like, weight and dimensions at delivery can be helpful
in this regard.
Even abnormal placental weight in patients with preeclampsia
predicts adverse neonatal outcome.
Placental investigation can contribute to neonatal risk assessment.
Infact, so little is known about placenta as a human organ
that in USA,
the National Institutes of Health (NIH) have launched a Human placenta project.
One of the main goals of the project is to develop new technologies for the
real-time assessment of placental development, allowing for the study of
placental function in normal versus abnormal pregnancies.
So, although obstetrician may have been excused of
suboptimal intrapartum management leading to CP, the obstetrician still has to
look into causation of abnormal placentation early in pregnancy possibly leading to CP.
References:
http://www.obgynnews.com/specialty-focus/obstetrics/single-article-page/what-does-the-human-placenta-project-mean-for-obstetrics-care/39692d362b41581b2734e4ecffacc2dd.html
No comments:
Post a Comment