Objective To identify intrapartum predictors of newborn encephalopathy in term infants. Design Population based, unmatched case-control study. Setting Metropolitan area of Western Australia, June 1993 to September 1995. Subjects All 164 term infants with moderate or severe newborn encephalopathy; 400 randomly selected controls. Main outcome measures Adjusted odds ratio estimates. Results The birth prevalence of moderate or severe newborn encephalopathy was 3.8/1000 term live births. The neonatal fatality was 9.1%. Maternal pyrexia (odds ratio 3.82), a persistent occipitoposterior position (4.29), and an acute intrapartum event (4.44) were all risk factors for newborn encephalopathy. More case infants than control infants were induced (41.5% and 30.5%, respectively) and fewer case infants were delivered by caesarean section without labour (3.7% and 14.5%, respectively). Operative vaginal delivery (2.34) and emergency caesarean section (2.17) were both associated with an increased risk. There was an inverse relation between elective caesarean section (0.17) and newborn encephalopathy. After application of a set of consensus criteria for elective caesarean section only three (7%) eligible case mothers compared with 33 (65%) eligible control mothers were sectioned electively. Of all the case infants, 113 (69%) had only antepartum risk factors for newborn encephalopathy identified; 39 (24%) had antepartum and intrapartum factors; eight (5%) had only intrapartum factors; and four (2%) had no recognised antepartum or intrapartum factors. Conclusions The causes of newborn encephalopathy are heterogeneous and many relate to the antepartum period. Elective caesarean section has an inverse association with newborn encephalopathy. Intrapartum hypoxia alone accounts for only a small proportion of newborn encephalopathy. These results question the view that most risk factors for newborn encephalopathy lie in the intrapartum period.

Objective To ascertain antepartum predictors of newborn encephalopathy in term infants.

AIM The aim of this study was to conduct a systematic review in order to identify the risk factors for cerebral palsy (CP) in children born at term. The secondary aim was to ascertain if the potential for prevention of these risk factors has been adequately explored.METHOD A MEDLINE search up to 31 July 2011 was completed, following the Meta-Analysis of Observational Studies in Epidemiology guidelines. Publications were reviewed to identify those with both a primary aim of identifying risk factors for all children or term-born children with CP and a cohort or case-control study design. Studies were examined for potential chance or systematic bias. The range of point estimates of relative risk is reported.RESULTS From 21 articles meeting inclusion ⁄ exclusion criteria and at low risk of bias, data from 6297 children with CP and 3 804 791 children without CP were extracted. Ten risk factors for termborn infants were statistically significant in each study: placental abnormalities, major and minor birth defects, low birthweight, meconium aspiration, instrumental ⁄ emergency Caesarean delivery, birth asphyxia, neonatal seizures, respiratory distress syndrome, hypoglycaemia, and neonatal infections. Strategies for possible prevention currently exist for three of these.INTERPRETATION Ten consistent risk factors have been identified, some with potential for prevention. Efforts to prevent these risk factors to interrupt the pathway to CP should be extended.Cerebral palsy (CP) is the most common physical disability of childhood. CP describes a group of disorders of movement and posture that are also often accompanied by associated impairments and secondary musculoskeletal problems. Term-born children account for 50 to 65% of children with CP, and they tend to be more severely impaired than children with CP born preterm.2 Moreover, the severity of disability in the term-born group seems to be increasing. 3 The incidence of CP among term-born infants ranges between 1 and 1.7 per 1000 live births, suggestive of a rare outcome.2-5 However, with 130 million infants born worldwide each year, 6 93% of whom are born at term, such incidence rates suggest that between 120 000 and 217 600 new cases of CP occur each year among term-born children, making this an important yet under-researched group with chronic lifelong disability.Over the past 50 years real progress has been made in the conceptual understanding of the aetiology of CP. We have confirmed that sentinel events around birth are responsible for a small proportion of CP. More typically, risk factors and multiple events interact in a cascade with additive effects. 7,8 However, despite the progress in conceptual understanding, there has been no discernible decrease in overall rates. Therefore, we asked what clinically meaningful messages could be drawn from the literature of the last 50 years to guide us towards prevention in the coming decades. The research questions for this study were (1) 'What risk factors for CP have been identified in the literature for infants born at...

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A decision-aid for women facing choices about birth after cesarean section is effective in improving knowledge and reducing decisional conflict. However, little evidence suggested that this process led to an informed choice. Strategies are required to better equip organizations and practitioners to empower women so that they can translate informed preferences into practice. Further work needs to examine ways to enhance women's power in decision-making within the doctor-patient relationship.

Objectives To describe trends in mode of delivery, to identify significant factors which affected mode of delivery, and to describe how these factors and their impact have changed over time.Design Total population birth cohort. Setting Western Australia 1984-2003.Participants The analysis was restricted to all singleton infants delivered at 37-42 weeks of gestation with a cephalic presentation (n = 432 327).Methods Logistic regression analyses were undertaken to estimate significant independent risk factors separately for elective and emergency caesarean sections compared with vaginal delivery (spontaneous and instrumental), adjusting for potential confounding variables. Conclusions Our data show significant changes in mode of delivery in Western Australia from [1984][1985][1986][1987][1988][1989][1990][1991][1992][1993][1994][1995][1996][1997][1998][1999][2000][2001][2002][2003], with an increasing trend in both elective and emergency caesarean section rates that do not appear to be explained by increased risk or indication.

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: II.