The science surrounding cerebral palsy (CP) indicates that it is a complex medical condition with multiple contributing variables and factors, and causal pathways are often extremely difficult to delineate. April 9, 2021

High-value claims against obstetricians in litigation in both the public and private sectors are mostly related to cerebral palsy (CP) cases on the basis of intrapartum hypoxia resulting in neonatal encephalopathy (NE) and, by extension, invoking ‘negligent intrapartum care’. This development has resulted in steep rises in insurance premiums, placing service delivery under serious threat.[1] It is widely assumed that CP is the direct result of an adverse event at birth and that it could have been prevented, yet only 10 – 14% of CP instances are caused by intrapartum hypoxia.[2] Clinical epidemiological studies have shown that most CP cases are not related to intrapartum hypoxia.[3,4] These studies appear, however, to be confined to high-income countries and are unlikely to be applicable to low- and middle-income countries (LMICs). South African (SA) data show that hypoxia-related deaths make up 28% of all early neonatal deaths.[5,6]

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