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Published criteria for judging whether cerebral palsy is caused during labor by lack of oxygen to the baby may need to be reexamined. In 1992, the American College of Obstetricians and Gynecologists (ACOG) published guidelines which list four criteria by which practitioners may link lack of oxygen to the baby at during labor to cerebral palsy. A researcher analyzed the medical literature and four cases of children with cerebral palsy whose births were complicated and compared the information to the four criteria. The first criteria, a low umbilical blood pH level indicating acidemia, gave confusing results when compared with observations and the literature. Apgar scores, the second criteria, may not correctly predict cerebral palsy unless they stay below four for over 20 minutes. However, the third criteria, seizures of the newborn, appeared predictive of cerebral palsy. The last ACOG criteria, multiorgan dysfunction, was not evident in the four cases. New research should be done to detect and prevent injuries before birth that can lead to cerebral palsy.

Preeclampsia is a condition that is characterized by high blood pressure, edema (the accumulation of fluid in tissues), and protein in the urine (proteinuria). It occurs most often in women who are pregnant for the first time and usually begins after week 20 of pregnancy. Another disorder that can occur during pregnancy is called the HELLP syndrome. It causes hemolysis (destruction of red blood cells), high levels of liver enzymes in the blood, and low levels of blood cells called platelets. In the past, it was common for these conditions to be misdiagnosed as hepatitis (inflammation of the liver), lupus erythematosus (connective tissue disease), cholangitis (inflammation of the bile duct), detached retina, or ulcers in the stomach or intestines. However, it now appears that many surgical and medical problems that occur during pregnancy are misdiagnosed as preeclampsia or the HELLP syndrome. This article describes the case reports of 11 patients with surgical or medical problems who were misdiagnosed because they produced symptoms similar to those of preeclampsia or the HELLP syndrome. Sixteen of the cases were caused by kidney disease and high blood pressure. There were four cases of ruptured gall bladder, three cases of cocaine abuse, three cases of lupus erythematosus, two cases of heart disease, and two cases of cancer. For many of these patients, the incorrect diagnosis meant that appropriate treatment was delayed and the number of infants delivered early was increased. (Consumer Summary produced by Reliance Medical Information, Inc.)